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Closed manipulation under anesthesia for pediatric post-traumatic elbow arthrofibrosis.

麻醉下闭合手法治疗小儿创伤后肘关节纤维化。

  • 影响因子:0
  • DOI:10.1016/j.jse.2019.10.004
  • 作者列表:"Rane AA","Garcia BN","Wang AA
  • 发表时间:2020-02-01
Abstract

BACKGROUND:Post-traumatic elbow arthrofibrosis (PEA) and its associated limitations to elbow range of motion (ROM) are a recognized consequence of trauma to the pediatric elbow. Closed manipulation under anesthesia (CMUA) of the elbow can be performed in pediatric patients as a nonoperative attempt to improve dysfunctional ROM. Minimal outcome data to support CMUA exist. The study evaluates the efficacy of CMUA for PEA in pediatric patients. METHODS:Patients younger than 18 years who underwent CMUA (Current Procedural Terminology code 24300) for PEA between 2005 and 2015 at 3 institutions were included. A retrospective chart review was performed to collect demographic data and ROM premanipulation and at last follow-up. Paired 2-tailed t tests were used to compare pre- and postmanipulation elbow ROM. RESULTS:Thirteen patients with a mean age of 12.2 ± 2.6 years (range 6.7-15.6 years) met the inclusion criteria. Median time to CMUA from initial surgery was 4.2 months (interquartile range [IQR] 3.6-8.4, range 1.4-19.7 months). Median follow-up time was 6 months with an IQR of 3.3-10.0 months. At last follow-up, there was significant improvement in elbow flexion of 22° ± 17° (P < .001) and extension of 29° ± 21° (P < .001). The average premanipulation motion arc of 60° ± 24° significantly increased to 110° ± 22° at final assessment (P < .001). CONCLUSION:CMUA appears to be a valuable alternative and reliable procedure for improving PEA in pediatric patients who exhaust nonoperative interventions.

摘要

背景: 创伤后肘关节纤维化 (PEA) 及其对肘关节活动范围 (ROM) 的相关限制是公认的儿童肘关节创伤的后果。肘部麻醉下闭合手法 (CMUA) 可在儿科患者中进行,作为改善功能障碍ROM的非手术尝试。存在支持CMUA的最小结局数据。该研究评估CMUA对儿科患者PEA的疗效。 方法: 纳入 2005 年至 2015 年期间在 3 个机构接受CMUA (当前程序术语代码 24 3 00) 治疗PEA的年龄小于 18 岁的患者。进行回顾性图表回顾,收集人口统计学数据和ROM预处理,并在最后随访。使用配对 2-t标记的t t es t s进行t o比较前和pos t操纵t离子肘ROM。 结果: 13 例患者平均年龄 12.2 ± 2.6 岁 (范围 6.7-15.6 岁) 符合纳入标准。从初次手术到CMUA的中位时间为 4.2 个月 (四分位距 [IQR] 3.6-8.4,范围 1.4-19.7 个月)。中位随访时间为 6 个月,IQR为 3.3-10.0 个月。末次随访时,肘关节屈曲度 22 ° ± 17 ° (P < .001) 和伸展度 29 ° ± 21 ° (P < .001) 均有显著改善。在最终评估时,平均预操作运动弧 60 ° ± 24 ° 显著增加至 110 ° ± 22 ° (P <.001)。 结论: CMUA似乎是改善非手术干预儿童患者PEA的一种有价值的替代方法和可靠方法。

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