Johnson Alex A, Wolfe Elizabeth L, Mintz Douglas N, Demehri Shadpour, Shubin Stein Beth E, Cosgarea Andrew J
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2018 Oct 19;6(10):2325967118803614. doi: 10.1177/2325967118803614. eCollection 2018 Oct.
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.
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.
Cohort study; Level of evidence, 3.
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 < .01.
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 ( = .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) ( = .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; < .001), primarily for screw removal (32/38).
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.
胫骨结节截骨术（TTO）是一种常用的多功能手术，用于治疗髌骨不稳定以及减轻软骨损伤。对于高位髌骨患者，可进行伴有远移的胫骨结节截骨术（TTO-d），通过帮助髌骨在屈曲过程中更早地进入滑车来稳定髌骨。
识别和比较接受TTO和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。
队列研究；证据等级，3级。
我们回顾性地从2009年至2015年期间在2家机构由2名外科医生进行的有或无远移的TTO手术的240例患者的病历中识别围手术期并发症及相关因素。每家机构的一名肌肉骨骼放射科医生使用已发表的分级系统确定截骨愈合情况。显著性设定为<.01。
240例患者中，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有骨愈合证据。153例患者中的71例（46%）出现了88种并发症：愈合延迟（n = 35）；内固定疼痛（n = 32）；深静脉血栓形成（n = 4）；临床骨不连、活动范围延迟、感觉障碍和伤口裂开（各n = 3）；以及螺钉断裂、筋膜疝、血肿quadriceps功能障碍和胫骨骨折（各n = 1）。35例愈合延迟中有13例发生在TTO-d组（ =.005）。接受4.5毫米螺钉的患者（31/115）内固定疼痛比接受3.5毫米螺钉的患者（1/38）更频繁（ =.001）。153例患者中有38例需要再次手术（37例使用4.5毫米螺钉，1例使用3.5毫米螺钉；<.001），主要是为了取出螺钉（32/38）。
包括愈合延迟和内固定疼痛在内的轻微并发症很常见，但胫骨骨折、深静脉血栓形成和临床骨不连等严重并发症很少见。TTO-d组愈合延迟更频繁。3.5毫米螺钉比4.5毫米螺钉疼痛较轻且不太可能需要取出。
