膝关节脱位后血管损伤的发生率是多少？
What is the frequency of vascular injury after knee dislocation?
作者信息
Natsuhara Kyle M, Yeranosian Michael G, Cohen Jeremiah R, Wang Jeffrey C, McAllister David R, Petrigliano Frank A
出版信息
Clin Orthop Relat Res. 2014 Sep;472(9):2615-20. doi: 10.1007/s11999-014-3566-1.
BACKGROUND
Vascular injury secondary to an acute knee dislocation is a known complication. However, there exist wide discrepancies in the reported rate of vascular injury in this setting.
QUESTIONS/PURPOSES: Using a large private insurance database, we determined the frequency of vascular injury in knee dislocations across year of diagnosis, age, sex, and US geographic region and the proportion of these injuries requiring surgical repair.
METHODS
The PearlDiver database, which contains records from 11 million orthopaedic patients, was searched using ICD-9 diagnostic codes for all knee dislocation events from 2004 to 2009. Within this subset, we identified which knee dislocations had an associated vascular injury ICD-9 code. Patients were stratified by year of diagnosis, age, sex, and US geographic region, and Current Procedural Terminology codes were used to identify the subset of patients with vascular injury requiring surgical repair. Differences in frequency across demographic groups and over time were analyzed with Poisson regression analysis.
RESULTS
Among the 8050 limbs with knee dislocation identified over the study period, 267 had a concomitant vascular injury for an overall frequency of 3.3%. Males were found to have an increased risk of vascular injury compared to females (odds ratio = 2.59, p < 0.001). Additionally, patients aged 20 to 39 years had a higher risk of vascular injury when compared to those aged 0 to 19 years (odds ratio = 1.93, p = 0.001), 40 to 59 years (odds ratio = 1.57, p = 0.014), and 60 years or older (odds ratio = 2.81, p = 0.036). There were no differences in vascular injury frequency across US geographic regions or diagnosis year. Thirty-four of the 267 cases of vascular injury (13%) underwent surgical treatment.
CONCLUSIONS
This is the largest study, to our knowledge, that analyzes the proportion of knee dislocations that result in vascular injury. Our data suggest that there is a lower frequency of vascular injury associated with knee dislocation and a lower proportion of vascular injuries undergoing surgical treatment than previously reported. These findings may support a more selective angiography protocol to screen for vascular injury, rather than performing this invasive diagnostic test on all knee dislocations, as has been done historically. Future large-scale and prospective studies should analyze factors that may predispose to vascular injuries after knee dislocation and determine which patients should be screened for vascular injury after knee dislocation.
LEVEL OF EVIDENCE
Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
背景
急性膝关节脱位继发血管损伤是一种已知的并发症。然而，在这种情况下，报道的血管损伤发生率存在很大差异。
问题/目的：利用一个大型私人保险数据库，我们确定了不同诊断年份、年龄、性别和美国地理区域的膝关节脱位患者中血管损伤的发生率，以及这些损伤中需要手术修复的比例。
方法
使用ICD-9诊断编码在PearlDiver数据库（包含1100万骨科患者的记录）中搜索2004年至2009年所有膝关节脱位事件。在这个子集中，我们确定哪些膝关节脱位有相关的血管损伤ICD-9编码。患者按诊断年份、年龄、性别和美国地理区域分层，并使用当前手术操作术语编码来识别需要手术修复的血管损伤患者子集。通过泊松回归分析来分析不同人口统计学组和不同时间的发生率差异。
结果
在研究期间确定的8050例膝关节脱位肢体中，267例伴有血管损伤，总体发生率为3.3%。发现男性血管损伤的风险高于女性（优势比=2.59，p<0.001）。此外，与0至19岁的患者相比，20至39岁的患者血管损伤风险更高（优势比=1.93，p=0.001），40至59岁的患者（优势比=1.57，p=0.014），以及60岁及以上的患者（优势比=2.81，p=0.036）。美国不同地理区域或诊断年份的血管损伤发生率没有差异。267例血管损伤病例中有34例（13%）接受了手术治疗。
结论
据我们所知，这是分析导致血管损伤的膝关节脱位比例的最大规模研究。我们的数据表明，与膝关节脱位相关的血管损伤发生率较低，接受手术治疗的血管损伤比例也低于先前报道。这些发现可能支持采用更具选择性的血管造影方案来筛查血管损伤，而不是像过去那样对所有膝关节脱位患者都进行这种侵入性诊断检查。未来的大规模前瞻性研究应分析膝关节脱位后可能易发生血管损伤的因素，并确定哪些患者在膝关节脱位后应接受血管损伤筛查。
证据水平
IV级，预后研究。有关证据水平的完整描述，请参阅作者指南。
Zotero 插件