近节指间关节融合术后不愈合和再次手术及相关患者因素。
Nonunion and Reoperation Following Proximal Interphalangeal Joint Arthrodesis and Associated Patient Factors.
机构信息
University of Cincinnati Medical Center, OH, USA.
Cleveland Clinic, OH, USA.
出版信息
Hand (N Y). 2022 May;17(3):566-571. doi: 10.1177/1558944720939196. Epub 2020 Aug 8.
BACKGROUND
Proximal interphalangeal joint (PIPJ) arthrodesis can provide reliable pain relief and restore hand function in patients with PIPJ arthritis. However, there is a paucity of literature on patient-specific preoperative risk factors that are associated with adverse outcomes after PIPJ arthrodeses. Therefore, the primary purpose of this study was to assess preoperative predictors of nonunion and reoperation after PIPJ arthrodesis.
METHODS
This study identified all patients who underwent PIPJ arthrodesis at a single community practice between 1987 and 2013. The final analysis included 415 PIPJs treated with arthrodesis. The mean follow-up was 1.3 years. Data on preoperative diagnosis, demographics, comorbidities, and operative techniques were recorded, as well as the occurrence of nonunions and reoperations. Logistic regression models were used to identify independent risk factors of nonunion and reoperation.
RESULTS
There were 40 nonunions (10%) and 62 reoperations (15%). Of the reoperations, there were 39 incidences of isolated hardware removal, 9 irrigation and debridement, 8 amputations, 5 revision arthrodeses, and 1 corrective osteotomy. The highest number of nonunions occurred in the traumatic diagnosis group (37%), followed by the rheumatoid group (23%) and the scleroderma group (15%). The highest number of reoperations occurred within the traumatic joint disorder group (40%), followed by the rheumatoid group (24%) and the scleroderma group (11%). Multivariate analysis revealed that male sex ( < .01) and hepatic disease ( = .03) were significant risk factors of nonunion. Male sex was also significantly associated with increased reoperation risk ( < .01).
CONCLUSION
Risks of nonunions and reoperations after PIPJ arthrodeses are low; however, these findings may guide clinicians and patients in the preoperative decision-making process and help with targeted postoperative surveillance to mitigate these risks.
背景
近节指间关节（PIPJ）关节融合术可为 PIPJ 关节炎患者提供可靠的疼痛缓解和恢复手部功能。然而，目前关于与 PIPJ 关节融合术后不良结果相关的患者特异性术前危险因素的文献很少。因此，本研究的主要目的是评估 PIPJ 关节融合术后非融合和再手术的术前预测因素。
方法
本研究确定了 1987 年至 2013 年间在一家社区诊所接受 PIPJ 关节融合术的所有患者。最终分析包括 415 例接受关节融合术治疗的 PIPJ。平均随访 1.3 年。记录了术前诊断、人口统计学、合并症和手术技术的数据，以及非融合和再手术的发生情况。使用逻辑回归模型确定非融合和再手术的独立危险因素。
结果
有 40 例（10%）非融合和 62 例（15%）再手术。再手术中，单独取出内固定物 39 例，冲洗清创 9 例，截肢 8 例，翻修融合术 5 例，矫正性截骨术 1 例。创伤性诊断组非融合发生率最高（37%），其次是类风湿组（23%）和硬皮病组（15%）。创伤性关节疾病组再手术发生率最高（40%），其次是类风湿组（24%）和硬皮病组（11%）。多变量分析显示，男性（<.01）和肝脏疾病（=.03）是非融合的显著危险因素。男性也是再手术风险增加的显著相关因素（<.01）。
结论
PIPJ 关节融合术后非融合和再手术的风险较低；然而，这些发现可能指导临床医生和患者进行术前决策，并有助于有针对性的术后监测，以降低这些风险。
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