儿童胫骨髁间嵴骨折的MRI应用与治疗趋势：一项全国数据库研究
简介
基于2016–2022年PearlDiver数据库3554例6–17岁儿童胫骨髁间棘骨折，分析MRI使用和手术趋势：MRI占19.1%，手术占22.7%，其中关节镜复位内固定（ARIF）占64.8%。MRI使用率由15.7%升至23.1%，手术及ARIF比例无显著变化；骨折移位是手术最强预测因素，术前MRI与手术和ARIF相关。地域差异提示非临床因素影响诊疗…
英文摘要
BACKGROUND: The management of pediatric tibial spine fractures is evolving as the evidence base has grown. Recent evidence suggests magnetic resonance imaging (MRI) evaluation may be warranted although optimal management is unknown. The present study sought to characterize national trends in surgical management and MRI utilization of pediatric tibial spine fractures. METHODS: Patients aged 6-17 years presenting with a first diagnosis of closed tibial spine fracture were identified from the 2016-2022 PearlDiver M170 database. MRI utilization, treatment strategy, and surgical technique (arthroscopic reduction and internal fixation [ARIF], open reduction and internal fixation [ORIF], or anterior cruciate ligament reconstruction) were determined for each injury. Factors independently associated with these variables were assessed by a multivariable analysis. The year 2020 was excluded from analyses of trends due to changes to health care utilization during the COVID-19 pandemic. RESULTS: Overall, 3,554 pediatric tibial spine fracture patients were identified. MRI was obtained for 681 patients (19.1%), with independent predictors of MRI use being increased age (odds ratio [OR] = 1.12 per year, P < .0001), fracture displacement (OR = 2.38, P < .0001), and geographic region (Midwest relative to West, OR = 1.57, P = .0013). A total of 806 patients (22.7%) underwent surgical management, with fracture displacement (OR = 14.13, P < .0001) and preoperative MRI (OR = 7.44, P < .0001) identified as independent predictors of this treatment strategy. Of patients treated surgically, ARIF was performed for 522 patients (64.8%), with an independent predictor being preoperative MRI (OR = 3.00, P < .0001). Notably, the rate of MRI utilization increased significantly through the study period (15.7% in 2016, 23.1% in 2022, R2 = 0.795, P = .0170), while the rates of operative treatment and ARIF did not change significantly. CONCLUSIONS: In this large database study of pediatric tibial spine fractures featuring over 3,000 patients treated over nearly a decade, we identified that MRI was obtained for 19.1% of the study population. The rate of MRI utilization increased over the course of the study period. Moreover, surgery was performed on 22.7% of the population. There were geographic variations in MRI and ARIF utilization, suggesting nonclinical factors impacting management. KEY CONCEPTS: (1)Only a minority of tibial spine fracture patients received magnetic resonance imaging, despite recognition of the frequency of associated injury, though this percentage did increase over the study period.(2)Geographic variations in imaging and surgical treatment were identified, suggesting nonclinical factors impacting management.(3)Fracture displacement was the strongest predictor of surgical treatment, which was most commonly performed arthroscopically. LEVEL OF EVIDENCE: III.