| Objective:The aim of this paper is to analyse whether there is a significant difference between early surgery with a preoperative waiting time of≤12 hours and delayed surgery at different timing of surgery in terms of closed reduction rate,operative time and complications,with a view to discovering a relatively safe time for delayed surgery and thus saving healthcare resources to some extent.Methods:1.A total of 120 cases of pediatric supracondylar humeral fractures were collected from the Department of Pediatric Surgery of Shandong University Qilu Hospital from January 2018 to December 2020,and a total of 120 cases that met the criteria were screened.Observation indicators:closed reduction rate,closed reduction surgery time,hospitalization time,fracture healing time,Flynn elbow function score,needle tract infection,iatrogenic neurovascular injury,and complications of cubitus varus.2.According to the surgical timing,the study subjects were divided into four groups:the preoperative waiting time was≤12 hours,totaling 15 cases;the preoperative waiting time was 12-24 hours,totaling 35 cases;the preoperative waiting time was 24-72 hours,a total of 58 cases;preoperative waiting time≥72 hours,a total of 12 cases.3.The surgical method was closed reduction and percutaneous pinning or open reduction and percutaneous pinning.All children were given elbow joint flexion 90°and forearm neutral plaster external fixation.4.The SPSS25.0 statistical software was used to statistically analyze the observation indexes of the four groups of cases.The normality test adopted the Shapiro-Wilk test method.The indicators that meet the normal distribution and have uniform variance use one-way ANOVA analysis of variance to compare whether there were significant differences between the groups.The non-normal distribution indicators used the Kruskal-Wallis H test,the unordered categorical variables used the chi-square test,and the ordered classification Variables used rank sum test.The Bonferroni method adjusted the significance level and performs multiple comparisons afterwards(Fisher’s exact test was used when the expected count of≥2 cells is less than 5).Numerical variables that meet the normal distribution are represented by the mean±standard deviation,and the numerical variables that do not meet the normal distribution are represented by the median(lower quartile to upper quartile).When P<0.05,the difference was statistically significant.Results:1.Comparison of general clinical data:there were no statistically significant differences between the four groups in terms of gender,side of injury,age and weight of cases(P>0.05).2.There were no statistically significant differences between cases in the group with a preoperative waiting time of≤12 hours and those in the group with a preoperative waiting time of 12-24 hours in terms of closed reduction rate,operative time,hospitalization time,fracture healing time,Flynn’s elbow function score,pin tract infection,iatrogenic neurovascular injury,and cubitus varus complications(P>0.05).3.The differences in closed reduction rate,closed reduction surgery time,and hospitalization time in the four groups of cases were statistically significant(P<0.05).Closed reduction rate:The preoperative waiting time≤12 hours group was significantly higher than the preoperative waiting time group of 24-72 hours group(80.0%VS 34.5%,P<0.05),the preoperative waiting time≤12 hours group was significantly higher than that of the preoperative waiting time≥72 hours group(80.0%VS 25.0%,P<0.05),the preoperative waiting time of 12-24 hours group was significantly higher than the preoperative waiting time group of 24-72 hours group(62.9%VS 34.5%,P<0.05),the preoperative waiting time of 12-24 hours group was significantly higher than that of the preoperative waiting time≥72 hours group(62.9%VS 25.0%,P<0.05).Closed reduction surgery time(minutes):The preoperative waiting time≤12 hours group was significantly shorter than the preoperative waiting time group of 24-72 hours(35.00(22.5～42.50)VS45.00(30.0～50.00),P<0.05),the preoperative waiting time≤12 hours group was significantly shorter than the preoperative waiting time≥72 hours group(35.00(22.5～42.50)VS115.00(112.5～117.50),P<0.05),the preoperative waiting time was 12-24 hours group significantly shorter than the preoperative waiting time group of 24-72 hours group(45.00(30.0～50.00)VS55.00(50.00～60.00),P<0.05),and the preoperative waiting time was 12-24 hours group was significantly shorter than the preoperative waiting time≥72 hours group(45.00(30.0～50.00)VS115.00(112.5～117.50),P<0.05).Hospitalization time(days):The preoperative waiting time≤12 hours group was significantly shorter than the preoperative waiting time group of 24-72 hours(5.0(4.0～6.0)VS8.0(7.0～9.0),P<0.01),the preoperative waiting time≤12 hours group was significantly shorter than the preoperative waiting time≥72 hours group(5.0(4.0～6.0)VS9.5(8.0～12.0),P<0.01),the preoperative waiting time was 12-24 hours group was significantly shorter than the preoperative waiting time was 24-72 hours in the group(7.0(6.0～8.0)VS8.0(7.0～9.0),P<0.01),and the preoperative waiting time was 12-24 hours group was significantly shorter than the preoperative waiting time≥72 hours group(7.0(6.0～8.0)VS9.5(8.0～12.0),P<0.01).4.There was no statistically significant difference between the four groups of cases in open reduction surgery time,fracture healing time,Flynn elbow function score,needle tract infection,iatrogenic neurovascular injury,and cubitus varus complications(P>0.05).Conclusions:1.In closed supracondylar humeral fractures in children without vascular damage,it was still safe to delay the timing of surgery from 12 to 24 hours,with no significant differences in any of the observations between the two.2.After 24 hours of delayed surgery,the closed reduction rate decreased significantly,the closed reduction surgery time was significantly extended,and the hospital stay was significantly extended.3.The different timing of surgery had no significant effect on the open reduction surgery time,fracture healing time,Flynn’s elbow function score,needle tract infection,iatrogenic neurovascular injury,and cubitus varus complications. |
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