Patel Neeraj M, Mundluru Surya N, Beck Nicholas A, Ganley Theodore J
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
University of Texas Health Science Center at Houston, Houston, Texas, USA.
Orthop J Sports Med. 2019 May 2;7(5):2325967119842885. doi: 10.1177/2325967119842885. eCollection 2019 May.
Meniscal injuries in children can pose treatment challenges, as the meniscus must maintain its biomechanical function over a long lifetime while withstanding a high activity level. While the adult literature contains a plethora of studies regarding risk factors for failure of meniscal surgery, such reports are scarcer in children.
To determine the rate at which children undergoing meniscal surgery require subsequent reoperation as well as to define risk factors for reoperation in this population.
Case-control study; Level of evidence, 3.
A retrospective institutional database of 907 first-time meniscal surgical procedures performed between 2000 and 2015 was reviewed. All patients were <18 years old. Demographic and intraoperative information was recorded, as were concurrent injuries or operations and subsequent procedures. Univariate analysis consisted of chi-square and independent-samples tests. Multivariate logistic regression with purposeful selection was then performed to adjust for confounding factors.
The mean ± SD patient age was 13.2 ± 2.1 years, and 567 (63%) were male. The mean postoperative follow-up duration was 20.1 ± 10.1 months. Overall, 83 patients (9%) required repeat surgery at a mean of 23.2 months after the index operation. After adjustment for confounders in a multivariate model, meniscal repair resulted in 3.1-times higher odds of reoperation when compared with meniscectomy (95% CI, 1.2-8.3; = .02), while white-white zone tears had 2.8-times lower odds of reoperation (95% CI, 1.01-7.7; = .04) versus red-red and red-white zone tears.
Approximately 9% of children undergoing meniscal surgery will require reoperation at a mean 23.2 months after the index operation. Repair carried approximately 3-times higher odds of reoperation than meniscectomy, while white-white zone tears had nearly 3-times lower odds of requiring repeat surgery when compared with tears in other zones.
儿童半月板损伤可能带来治疗挑战，因为半月板必须在漫长的一生中维持其生物力学功能，同时承受较高的活动水平。虽然成人文献中有大量关于半月板手术失败风险因素的研究，但此类报告在儿童中较少见。
确定接受半月板手术的儿童需要后续再次手术的发生率，并确定该人群再次手术的风险因素。
病例对照研究；证据等级，3级。
回顾了2000年至2015年间进行的907例首次半月板手术的机构回顾性数据库。所有患者年龄均小于18岁。记录了人口统计学和术中信息，以及并发损伤或手术及后续手术情况。单因素分析包括卡方检验和独立样本检验。然后进行有目的选择的多因素逻辑回归以调整混杂因素。
患者的平均年龄±标准差为13.2±2.1岁，其中567例（63%）为男性。术后平均随访时间为20.1±10.1个月。总体而言，83例患者（9%）在初次手术后平均23.2个月需要再次手术。在多因素模型中调整混杂因素后，与半月板切除术相比，半月板修复导致再次手术的几率高出3.1倍（95%可信区间，1.2 - 8.3；P = 0.02），而白-白区撕裂与红-红区和红-白区撕裂相比，再次手术的几率低2.8倍（95%可信区间，1.01 - 7.7；P = 0.04）。
接受半月板手术的儿童中，约9%在初次手术后平均23.2个月需要再次手术。修复手术导致再次手术的几率比半月板切除术高出约3倍，而白-白区撕裂与其他区域的撕裂相比，需要再次手术的几率低近3倍。
