目的:探讨儿童足部骨折在X线片上的年龄和骨骼成熟的分布和特征,并确定手术的预测因素。
方法:这项回顾性研究包括足骨折患儿(≤18岁),谁接受了影像学检查(2020-2022年)。审查电子病历以获得人口统计学和临床数据。断裂特征,包括解剖位置,流离失所的存在,成角,关节受累,and,如果骨骼不成熟,收集了植骨受累和Salter-Harris骨折类型。使用Logistic回归模型来确定手术的预测因素。
结果:1,090(596名男孩,494-女孩;平均年龄,11.0±4.0岁)患者为1,325例(59.8%meta骨,33.8%指骨,包括6.4%的tal骨)骨折。第1跖骨骨折在年龄较小的儿童中更常见,而第2-4和5跖骨骨折在年龄较大的儿童中更常见(中位年龄:5.9岁与10.3年和12.4年,p<0.001)。在成熟和成熟的骨骼中,关节内骨折比未成熟的骨骼更常见(25.3%和20.4%vs.9.9%,p<0.001)。Physeal受累不常见(162/977,16.6%),最常见的模式是Salter-HarrisII型(133/162,82.1%)。少数患者(47/1090,4.3%)需要手术,手术的独立预测因素包括植物受累(OR=5.12,95%CI:2.48-10.39,p<0.001),多发性骨折(OR=3.85,95%CI:1.67-8.53,p=0.001),骨折位移(OR=9.16,95%CI:4.43-19.07,p<0.001),和关节受累(OR=2.72,95%CI:1.27-5.72,p=0.008)。使用这些预测因子,手术的可能性介于8.0%和1和86.7%之间,有3个预测因子.
结论:儿童足部骨折类型因年龄和区域骨骼成熟而异。Physeal参与,多处骨折,断裂位移,和关节受累是研究组手术的独立预测因素.
OBJECTIVE: To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery.
METHODS: This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020-2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery.
RESULTS: 1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3% and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%) of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95% CI: 2.48-10.39, p < 0.001), multiple fractures (OR = 3.85, 95% CI: 1.67-8.53, p = 0.001), fracture displacement (OR = 9.16, 95% CI:4.43-19.07, p < 0.001), and articular involvement (OR = 2.72, 95% CI:1.27-5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors.
CONCLUSIONS: Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.