Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
J Shoulder Elbow Surg. 2020 Jun;29(6):1121-1126. doi: 10.1016/j.jse.2019.11.007. Epub 2020 Feb 10.
This study aimed to determine whether there are significant differences in 30-day perioperative complications between arthroscopic and open débridement (irrigation and débridement [I&D]) for septic arthritis (SA) of the shoulder using the American College of Surgeons National Surgical Quality Improvement Program database.
Patients undergoing arthroscopic or open I&D of the native shoulder from 2006-2016 were identified in the National Surgical Quality Improvement Program database. Those with a diagnosis of SA were included in the study. Patients with a concurrent diagnosis of osteomyelitis around shoulder (n = 25) or polyarthritis (n = 2) were excluded from the study. Patient demographics, comorbidities, and complications were compared between the groups. Poisson regression, which controlled for age and American Society of Anesthesiologists (ASA) score, was used to calculate the relative risks with 95% confidence intervals for minor adverse events, serious adverse events, total adverse events, and unplanned reoperations between the 2 treatment groups, with significance set at P < .0125 after Bonferroni correction.
Overall, 147 and 57 patients underwent arthroscopic and open I&D, respectively, for SA of the shoulder. Patients in the open I&D group were more likely to be smokers (P = .0213), whereas patients in the arthroscopy group had higher ASA scores (P = .0008). After controlling for age and ASA score, we found no significant differences in the risk of minor adverse events (P = .0995), serious adverse events (P = .2241), total adverse events (P = .1871), or unplanned reoperations (P = .3855).
Arthroscopic débridement appears to be a safe alternative to open débridement for SA of the native shoulder. The incidence and risk of 30-day perioperative complications are similar after arthroscopic and open I&D for SA of the shoulder.
本研究旨在使用美国外科医师学院国家手术质量改进计划数据库确定在全关节镜下清创术（关节镜下清创术）与开放性清创术（冲洗和清创术 [I&D]）治疗肩关节化脓性关节炎（SA）的围手术期 30 天并发症是否存在显著差异。
从美国外科医师学院国家手术质量改进计划数据库中确定了 2006 年至 2016 年间接受全关节镜或开放性 I&D 治疗的原发性肩关节患者。将患有 SA 的患者纳入研究。患有肩部骨髓炎（n = 25）或多关节炎（n = 2）的患者被排除在研究之外。比较两组患者的人口统计学资料、合并症和并发症。使用泊松回归，在年龄和美国麻醉医师协会（ASA）评分的基础上进行校正，计算两组间 minor adverse events（轻微不良事件）、serious adverse events（严重不良事件）、total adverse events（总不良事件）和计划外再次手术的相对风险，95%置信区间和 Bonferroni 校正后 P 值 <.0125 具有统计学意义。
总体而言，有 147 名患者接受全关节镜 I&D，57 名患者接受开放性 I&D，用于治疗肩关节 SA。开放性 I&D 组患者更有可能吸烟（P =.0213），而关节镜组患者的 ASA 评分更高（P =.0008）。在控制年龄和 ASA 评分后，我们发现 minor adverse events（轻微不良事件）、serious adverse events（严重不良事件）、total adverse events（总不良事件）和计划外再次手术的风险无显著差异（P =.0995、P =.2241、P =.1871、P =.3855）。
关节镜清创术似乎是治疗原发性肩关节 SA 的一种安全替代开放性清创术的方法。肩关节 SA 关节镜下和开放性 I&D 后 30 天围手术期并发症的发生率和风险相似。
