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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization
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Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization

机译：胫骨结节截骨术后的并发症：与螺钉大小和伴随的椎间盘切除术相关

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Background: Tibial tuberosity osteotomy (TTO) is a versatile procedure commonly used to treat patellar instability as well as to unload cartilage lesions. TTO with concomitant distalization (TTO-d) may be performed in patients with patella alta to stabilize the patella by helping it to engage in the trochlea earlier during flexion. Purpose: To identify and compare perioperative complications in patients who underwent TTO and those who underwent TTO-d and to analyze risk factors associated with these complications. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively identified perioperative complications and associated factors from medical records for 240 patients who underwent TTO with or without distalization performed by 2 surgeons at 2 institutions between 2009 and 2015. A musculoskeletal radiologist at each institution determined osteotomy union using a published grading system. Significance was set at P & .01. Results: Of the 240 patients, 153 (122 TTO, 31 TTO-d) had clinical and radiographic follow-up of at least 90 days or evidence of osseous union. Eighty-eight complications were identified in 71 of 153 (46%) patients: delayed union (n = 35); painful hardware (n = 32); deep vein thrombosis (n = 4); clinical nonunion, delayed range of motion, sensory deficit, and wound breakdown (n = 3 each); and broken screw, fascial hernia, hematoma, quadriceps dysfunction, and tibial fracture (n = 1 each). Thirteen of 35 delayed unions occurred in the TTO-d group ( P = .005). Painful hardware was more frequent in patients who received 4.5-mm screws (31/115) than in those who received 3.5-mm screws (1/38) ( P = .001). A reoperation was required in 38 of 153 patients (37 patients using 4.5-mm screws vs 1 patient using 3.5-mm screws; P & .001), primarily for screw removal (32/38). Conclusion: Minor complications, including delayed union and painful hardware, were common, but major complications such as tibial fracture, deep vein thrombosis, and clinical nonunion were rare. Delayed union was more frequent in the TTO-d group. The 3.5-mm screws were less painful and less likely to need removal than the 4.5-mm screws.
机译：背景：胫骨结节截骨术（TTO）是一种通用的手术方法，通常用于治疗pa骨不稳以及减轻软骨病变。伴distal骨远端化的TTO（TTO-d）可在al骨患者中进行，以通过在屈曲过程中帮助earlier骨更早地进入滑车来稳定stabilize骨。目的：确定并比较接受TTO和接受TTO-d的患者的围手术期并发症，并分析与这些并发症相关的危险因素。研究设计：队列研究;证据等级，3。方法：我们回顾性分析了2009年至2015年间由2位外科医师在2个机构进行的240例接受TTO手术或无远端手术的患者的医疗记录中的围手术期并发症和相关因素。每个机构的肌肉骨骼放射科医生确定了截骨联合使用已发布的评分系统。显着性设定为P ＜0。 .01。结果：在240例患者中，有153例（122例TTO，31例TTO-d）进行了至少90天的临床和影像学随访或骨结合的证据。在153名患者中的71名（46％）中发现了88例并发症：延迟愈合（n = 35）;痛苦的硬件（n = 32）;深静脉血栓形成（n = 4）;临床骨不连，活动延迟，感觉缺陷和伤口破裂（每组n = 3）;螺钉断裂，筋膜疝气，血肿，股四头肌功能不全和胫骨骨折（n = 1）。在TTO-d组中，发生了35个延迟工会中的13个（P = .005）。接受4.5毫米螺钉（31/115）的患者比接受3.5毫米螺钉（1/38）的患者更痛苦地使用硬件（P = .001）。 153例患者中有38例需要重新手术（37例使用4.5毫米螺钉，而1例使用3.5毫米螺钉; P <.001），主要是为了去除螺钉（32/38）。结论：较小的并发症（包括延迟愈合和硬性疼痛）是常见的，但主要并发症（如胫骨骨折，深静脉血栓形成和临床骨不连）很少见。 TTO-d组延迟工会更为常见。与4.5毫米螺钉相比，3.5毫米螺钉不那么痛苦，并且不太可能需要卸下。

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