关节镜下与开放性肩袖修复术的感染率
Infection Rates in Arthroscopic Versus Open Rotator Cuff Repair.
作者信息
Hughes Jonathan D, Hughes Jessica L, Bartley Justin H, Hamilton William P, Brennan Kindyle L
机构信息
Department of Orthopedic Surgery, Scott & White Medical Center, Temple, Texas, USA.
出版信息
Orthop J Sports Med. 2017 Jul 20;5(7):2325967117715416. doi: 10.1177/2325967117715416. eCollection 2017 Jul.
BACKGROUND
The prevalence of rotator cuff repair continues to rise, with a noted transition from open to arthroscopic techniques in recent years. One reported advantage of arthroscopic repair is a lower infection rate. However, to date, the infection rates of these 2 techniques have not been directly compared with large samples at a single institution with fully integrated medical records.
PURPOSE
To retrospectively compare postoperative infection rates between arthroscopic and open rotator cuff repair.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
From January 2003 until May 2011, a total of 1556 patients underwent rotator cuff repair at a single institution. These patients were divided into an arthroscopic repair group and an open group. A Pearson chi-square test and Fisher exact test were used, with a subgroup analysis to segment the open repair group into mini-open and open procedures. The odds ratio and 95% CI of developing a postoperative infection was calculated for the 2 groups. A multiple-regressions model was then utilized to identify predictors of the presence of infection. Infection was defined as only those treated with surgical intervention, thus excluding superficial infections treated with antibiotics alone.
RESULTS
A total of 903 patients had an arthroscopic repair, while 653 had open repairs (600 mini-open, 53 open). There were 4 confirmed infections in the arthroscopic group and 16 in the open group (15 mini-open, 1 open), resulting in postoperative infection rates of 0.44% and 2.45%, respectively. Subgroup analysis of the mini-open and open groups demonstrated a postoperative infection rate of 2.50% and 1.89%, respectively. The open group had an odds ratio of 5.645 (95% CI, 1.9-17.0) to develop a postoperative infection compared with the arthroscopic group.
CONCLUSION
Patients undergoing open rotator cuff repair had a significantly higher rate of postoperative infection compared with those undergoing arthroscopic rotator cuff repair.
背景
肩袖修复的患病率持续上升，近年来从开放手术技术向关节镜技术有显著转变。关节镜修复的一个报道优势是感染率较低。然而，迄今为止，这两种技术的感染率尚未在单一机构中通过具有完整综合医疗记录的大样本进行直接比较。
目的
回顾性比较关节镜下和开放肩袖修复术后的感染率。
研究设计
队列研究；证据等级，3级。
方法
从2003年1月至2011年5月，共有1556例患者在单一机构接受肩袖修复。这些患者被分为关节镜修复组和开放组。采用Pearson卡方检验和Fisher精确检验，并进行亚组分析，将开放修复组分为小切口开放手术组和开放手术组。计算两组术后发生感染的比值比和95%可信区间。然后利用多元回归模型确定感染存在的预测因素。感染仅定义为接受手术干预的病例，因此排除仅用抗生素治疗的浅表感染。
结果
共有903例患者接受关节镜修复，653例接受开放修复（600例小切口开放手术，53例开放手术）。关节镜组有4例确诊感染，开放组有16例（15例小切口开放手术，1例开放手术），术后感染率分别为0.44%和2.45%。小切口开放手术组和开放手术组的亚组分析显示术后感染率分别为2.50%和1.89%。与关节镜组相比，开放组术后发生感染的比值比为5.645（95%可信区间，1.9 - 17.0）。
结论
与接受关节镜肩袖修复的患者相比，接受开放肩袖修复的患者术后感染率显著更高。
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