Harada Garrett K, Arshi Armin, Fretes Nickolas, Formanek Blake, Gamradt Seth, McAllister David R, Petrigliano Frank A
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA (Mr. Harada, Dr. Arshi, Dr. Fretes, Dr. McAllister, and Dr. Petrigliano) and the Department of Orthopaedic Surgery, Keck School of Medicine of USC (Mr. Formanek, Dr. Gamradt), Los Angeles, CA.
J Am Acad Orthop Surg Glob Res Rev. 2019 Jul 3;3(7):e075. doi: 10.5435/JAAOSGlobal-D-19-00075. eCollection 2019 Jul.
Rotator cuff tears are one of the most common injuries worldwide, yet it is difficult to predict which patients will have poor outcomes after arthroscopic rotator cuff repair (RCR). The purpose of this study was to identify an association between preoperative vitamin D (25D) levels and postoperative complications in arthroscopic RCR.
From a national claims database, patients undergoing arthroscopic RCR with preoperative 25D levels were reviewed. Patients were stratified into 25D-sufficient (≥20 ng/dL) or 25D-deficient (<20 ng/dL) categories and examined for development of postoperative complications. Multivariate logistic regression was performed using age, sex, and Charlson Comorbidity Index (CCI) as covariates. From this, risk-adjusted odds ratios (ORs) were calculated comparing complications between the two groups.
One thousand eight hundred eighty-one patients with measured preoperative 25D levels were identified; 229 patients were 25D deficient (12.2%). After adjusting for age, sex, and Charlson Comorbidity Index, 25D-deficient patients had increased odds of revision RCR (OR 1.54, 95% confidence interval 1.21 to 1.97, < 0.001) and stiffness requiring manipulation under anesthesia (OR 1.16, 95% confidence interval 1.03 to 2.03, = 0.035).
Vitamin D deficiency is associated with a greater risk of postoperative surgical complications after arthroscopic RCR and may be a modifiable risk factor. Further investigation on preoperative vitamin D repletion is warranted.
肩袖撕裂是全球最常见的损伤之一，然而，很难预测哪些患者在关节镜下肩袖修复术（RCR）后会有不良预后。本研究的目的是确定术前维生素D（25D）水平与关节镜下RCR术后并发症之间的关联。
从一个全国性的索赔数据库中，对术前有25D水平的接受关节镜下RCR的患者进行了回顾。患者被分为25D充足（≥20 ng/dL）或25D缺乏（<20 ng/dL）两类，并检查术后并发症的发生情况。使用年龄、性别和Charlson合并症指数（CCI）作为协变量进行多因素逻辑回归。由此，计算出风险调整后的优势比（OR），比较两组之间的并发症情况。
确定了1881例术前测量了25D水平的患者；229例患者25D缺乏（12.2%）。在对年龄、性别和Charlson合并症指数进行调整后，25D缺乏的患者进行翻修RCR的几率增加（OR 1.54，95%置信区间1.21至1.97，<0.001），以及需要在麻醉下进行手法治疗的僵硬几率增加（OR 1.16，95%置信区间1.03至2.03，=0.035）。
维生素D缺乏与关节镜下RCR术后手术并发症的风险增加有关，可能是一个可改变的风险因素。有必要对术前维生素D补充进行进一步研究。
