前交叉韧带损伤治疗后的赔偿：2005 年至 2015 年挪威赔偿索赔的回顾。
Compensation after treatment for anterior cruciate ligament injuries: a review of compensation claims in Norway from 2005 to 2015.
机构信息
Department of Orthopaedic Surgery, Akershus University Hospital, 1478, Lørenskog, Norway.
The Norwegian System of Patient Injury Compensation, Postboks 3 St.Olavs plass, 0130, Oslo, Norway.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):628-633. doi: 10.1007/s00167-017-4809-y. Epub 2017 Nov 27.
PURPOSE
To assess the most common reasons for complaints following anterior cruciate ligament (ACL) injuries reported to the Norwegian System of Patient Injury Compensation (NPE), and to view these complaints in light of the ACL reconstructions (ACL-Rs) reported to the Norwegian Knee Ligament Registry (NKLR).
METHOD
Data from the NPE and the NKLR were collected for the study period (2005-2015). The age and gender and type of complaint and reason for granted compensation were collected from the NPE, while the graft choice and total number of ACL-R were collected from the NKLR. Risk for successful grant was estimated for graft type.
RESULTS
18,810 primary ACL-Rs were reported to the NKLR during the study period. A hamstring graft was used in 12,437 (66.1%) but the bone-patellar tendon-bone (BPTB) became the graft of choice at the end of the study period. 240 patients filed a complaint to the NPE, of which 101 were granted compensation. The odds ratio for a claim being granted following a hamstring graft was 2.9 compared to that of a BPTB graft (p = 0.002) The most common reason for compensation was a hospital-acquired infection in 39 patients (38.6%) followed by inadequate surgical technique (27, 26.7%) and delayed diagnosis (13, 12.9%). Of the 39 patients with infection, 27 had received a hamstring graft and six a BPTB graft (two patients were not reconstructed, data missing for three patients). Of the 27 patients who were granted compensation due to inadequate surgical technique, 24 had received a hamstring graft and three a BPTB graft.
CONCLUSION
Infection and inadequate surgical technique are the most common causes for granted compensation from the NPE following ACL injury. Hamstring grafts have a threefold risk of complication that yields compensation from the NPE compared to BPTB grafts. This information is relevant for patients and surgeons when choosing graft type. The trend of increased use of BPTB grafts is warranted based on the results from this study.
LEVEL OF EVIDENCE
Level III.
目的
评估向挪威患者伤害赔偿系统（NPE）报告的前交叉韧带（ACL）损伤后最常见的投诉原因，并根据向挪威膝关节韧带登记处（NKLR）报告的 ACL 重建（ACL-R）来看待这些投诉。
方法
研究期间（2005-2015 年）从 NPE 收集数据，从 NPE 收集年龄、性别和投诉类型以及获得赔偿的原因，从 NKLR 收集移植物选择和 ACL-R 的总数。估计了移植物类型成功获得赔偿的风险。
结果
在研究期间，NKLR 报告了 18810 例原发性 ACL-R。12437 例（66.1%）使用了腘绳肌移植物，但在研究结束时，骨-髌腱-骨（BPTB）成为首选移植物。240 名患者向 NPE 提出申诉，其中 101 名获得赔偿。与 BPTB 移植物相比，使用腘绳肌移植物的索赔获得批准的优势比为 2.9（p=0.002）。赔偿的最常见原因是 39 名患者（38.6%）的医院获得性感染，其次是手术技术不当（27 例，26.7%）和诊断延迟（13 例，12.9%）。在 39 名感染患者中，27 名接受了腘绳肌移植物，6 名接受了 BPTB 移植物（两名患者未重建，三名患者数据缺失）。在因手术技术不当而获得赔偿的 27 名患者中，24 名接受了腘绳肌移植物，3 名接受了 BPTB 移植物。
结论
感染和手术技术不当是 ACL 损伤后 NPE 获得赔偿的最常见原因。与 BPTB 移植物相比，腘绳肌移植物的并发症导致 NPE 赔偿的风险增加了三倍。当选择移植物类型时，这些信息对患者和外科医生都是相关的。根据本研究结果，增加使用 BPTB 移植物是合理的。
证据水平
三级。
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