Meijer Sjoerd Th, Janssen Stein J, Drijkoningen Tessa, Ring David
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts.
J Wrist Surg. 2015 May;4(2):88-92. doi: 10.1055/s-0035-1550161.
Background Perilunate injuries are complex and uncommon injuries that are typically the result of a high-energy injury and are nearly always treated operatively. Little is known about factors associated with unplanned reoperations after surgery for perilunate injuries. Purpose To assess the rate and types of unplanned reoperation after operative treatment of a perilunate dislocation. Patients and Methods We reviewed 115 patients of all ages with unplanned reoperations after operative treatment of perilunate injuries at five hospitals. Planned removal of implants were not considered as unplanned reoperations. Results Sixteen patients had an unplanned reoperation, including four for compartment syndrome (three hand, one forearm); three for deep infection; three for malalignment or an errant screw; two for early salvage procedures; and four for other reasons. We considered seven unplanned reoperations necessary (forearm compartment syndrome, infection, loss of alignment, errant screw) and nine debatable or unnecessary (hand compartment syndrome, early salvage procedures, suspected malunion, etc.). Patients who had an unplanned reoperation were younger (median age 24 versus 34 years; p = 0.0034); had earlier surgery (median days to surgery 0 versus 3; p = 0.0068); and were more likely injured in a motor vehicle collision (50% versus 17%; p = 0.0070). Accounting for interaction among the variables using multivariable analysis, the factors independently associated with unplanned reoperation were young age (odds ratio 0.92) and motor vehicle collision accidents (odds ratio 4.1). Conclusion We conclude that higher-energy injuries may be at greater risk for unplanned reoperation, but more than half of the unplanned reoperations were for debatable indications. Level III Retrospective Cohort Review.
月骨周围损伤是复杂且不常见的损伤，通常由高能损伤导致，几乎总是需要手术治疗。关于月骨周围损伤手术后计划外再次手术的相关因素知之甚少。目的：评估月骨周围脱位手术治疗后计划外再次手术的发生率及类型。患者与方法：我们回顾了五家医院115例接受月骨周围损伤手术治疗后计划外再次手术的各年龄段患者。计划内取出植入物不被视为计划外再次手术。结果：16例患者进行了计划外再次手术，其中4例因骨筋膜室综合征（3例手部，1例前臂）；3例因深部感染；3例因对线不良或螺钉失误；2例因早期挽救手术；4例因其他原因。我们认为7例计划外再次手术是必要的（前臂骨筋膜室综合征､感染､对线丢失､螺钉失误），9例有争议或不必要（手部骨筋膜室综合征､早期挽救手术､疑似骨不连等）。进行计划外再次手术的患者更年轻（中位年龄24岁对34岁；p = 0.0034）；手术时间更早（中位手术天数0天对3天；p = 0.0068）；且更可能在机动车碰撞中受伤（50%对17%；p = 0.0070）。使用多变量分析考虑变量间的相互作用，与计划外再次手术独立相关的因素是年轻（比值比0.92）和机动车碰撞事故（比值比4.1）。结论：我们得出结论，高能损伤可能有更高的计划外再次手术风险，但超过一半的计划外再次手术指征存在争议。三级回顾性队列研究。
