目的:与软骨修复同时进行的重新对准截骨术通常需要早期限制负重,并可能增加显著的发病率,可能导致早期围手术期并发症的风险增加。本研究的目的是使用美国外科医生学会国家外科质量改善计划(ACS-NSQIP)数据库,比较孤立软骨修复(ICR)与伴随软骨修复和截骨术(CRO)后30天的并发症发生率。
方法:使用当前程序术语代码查询了2006年至2019年之间的NSQIP注册,以识别接受ICR的患者(自体软骨细胞植入,自体骨软骨移植,或同种异体骨软骨移植)和CRO(伴有胫骨高位截骨术,股骨远端截骨术,和/或胫骨结节截骨术)。比较治疗组之间的并发症率,使用多变量逻辑回归分析调整性别,年龄,使用类固醇,和呼吸状态。
结果:共确定了773例ICR和97例CRO手术。ICR组患者平均年龄为35.9岁,CRO组为31.2岁。与ICR组(97.8分钟)相比,CRO组(170.8分钟)的手术时间明显更长。多变量分析显示PE率无显著差异,VTE,以及ICR和CRO组之间的全因再接纳。没有伤口破裂的事件,在CRO组中发现了SSI和再次手术,虽然ICR组的特点是伤口破裂率低,再操作,和SSI(<1.1%)。
结论:这些发现进一步支持在适当的情况下同时进行截骨术和软骨修复,并帮助外科医生对接受软骨修复治疗的患者进行术前咨询。
OBJECTIVE: Realignment osteotomy performed concomitantly with cartilage restoration typically requires early restricted weightbearing and can add significant morbidity, potentially leading to an increased risk of early perioperative complications. The purpose of this study was to compare the 30-day complication rates after isolated cartilage restoration (ICR) versus concomitant cartilage restoration and osteotomy (CRO) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
METHODS: NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing ICR (autologous chondrocyte implantation, osteochondral autograft transfer, or osteochondral allograft transplantation) and CRO (with concomitant high tibial osteotomy, distal femoral osteotomy, and/or tibial tubercle osteotomy). Complications rates between treatment groups were compared using multivariate logistic regression analyses adjusted for sex, age, steroid use, and respiratory status.
RESULTS: A total of 773 ICR and 97 CRO surgical procedures were identified. Mean patient ages were 35.9 years for the ICR group and 31.2 years for the CRO group. Operative time was significantly longer in the CRO group (170.8 min) compared with the ICR group (97.8 min). Multivariate analysis demonstrated no significant differences in rates of PE, VTE, and all-cause readmission between the ICR and CRO groups. No events of wound disruption, SSI and reoperation were found in the CRO group, while the ICR group was characterized by low rates of wound disruption, reoperation, and SSI (<1.1%).
CONCLUSIONS: These findings further support concomitant osteotomy with cartilage restoration when appropriate and aid surgeons in the preoperative counseling of patients undergoing cartilage restoration treatment.