在门诊环境下进行的胫骨结节截骨术早期并发症发生率较低

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-08-01 DOI:10.1016/j.asmr.2024.100948

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引用次数: 0

摘要

目的探讨门诊胫骨结节截骨术（TTO）术后早期并发症的特点，以确定其在这种情况下的安全性。方法对2017年7月至2022年8月期间因髌骨不稳或髌骨软骨软化症而接受由单个外科医生实施的TTO手术，并进行至少3个月的临床和影像学随访的患者进行评估纳入。虽然纳入标准是至少随访 3 个月，但如果截骨愈合的证据在更早的时间内被观察到，则最终随访时间为 2 个月。对患者的人口统计学特征、围手术期风险因素和并发症发生率进行了回顾性收集。分类数据采用χ2和费舍尔精确检验进行分析。结果共有167名患者的195个膝关节符合纳入标准，平均年龄为（24.7±9.2）岁，平均随访时间为10.9个月（2-69个月）。42名（25.1%）患者的47个（24.1%）膝关节发生了51例早期术后并发症。其中10例为主要并发症，41例为轻微并发症。主要并发症与年龄较大（P = .015）、吸烟（P = .038）和术前髌腱与侧髁间距较小（P = .012）有关。42例（21.5%）膝关节再手术发生在37例（22.2%）患者身上。最常见的再手术原因包括切除有症状的硬件（31 个膝关节；15.9%）和需要在麻醉下溶解粘连并进行操作的关节纤维化（8 个膝关节；4.1%）。再次手术的平均时间为13.0个月（1-42个月）。较小的体重指数与再次手术的风险增加有关（P = .002）。结论门诊 TTO 采用所述技术是安全的，但术后出现轻微并发症的情况并不少见。应告知患者硬件刺激、关节纤维化和最终再次手术的发生率相对较高。

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Tibial Tubercle Osteotomies Performed in an Outpatient Setting Have a Low Rate of Early Complications

Purpose

To characterize the early postoperative complications following outpatient tibial tubercle osteotomy (TTO) to determine its safety in this setting.

Methods

Patients undergoing TTO by a single surgeon between July 2017 and August 2022 for patellar instability or patellofemoral chondromalacia and achieving a minimum of 3 months of clinical and radiographic follow-up were evaluated for inclusion. Although an inclusion criterion was a minimum follow-up of 3 months, if evidence of a healed osteotomy was observed sooner, final follow-up was accepted at 2 months. Patient demographics, perioperative risk factors, and incidence of complications were collected retrospectively. Categorical data were analyzed using χ² and Fisher exact tests. Continuous data were analyzed using 2-tailed t tests and Mann-Whitney U data for parametric and nonparametric data, respectively.

Results

A total of 195 knees in 167 patients met inclusion criteria, with a mean age of 24.7 ± 9.2 years and mean follow-up time of 10.9 months (range, 2-69 months). Fifty-one early postoperative complications occurred in 47 (24.1%) knees in 42 (25.1%) patients. Ten major and 41 minor complications occurred. Major complications were associated with older age (P = .015), smoking (P = .038), and smaller preoperative patellar tendon–lateral trochlear ridge distance (P = .012). Forty-four reoperations occurred in 42 (21.5%) knees in 37 (22.2%) patients. The most common reasons for reoperation included removal of symptomatic hardware (31 knees; 15.9%) and arthrofibrosis requiring lysis of adhesions and manipulation under anesthesia (8 knees; 4.1%). The mean time to reoperation was 13.0 months (range, 1-42 months). Smaller body mass index was associated with increased risk of reoperation (P = .002).

Conclusions

Outpatient TTO is safe when performed with the described technique, but the later development of minor complications is not infrequent following surgery. Patients should be counseled regarding a relatively high incidence of hardware irritation, arthrofibrosis, and eventual reoperation.