四角融合术后计划外再次手术的相关因素：478例腕关节研究
Factors Associated With Unplanned Reoperation After 4-Corner Arthrodesis: A Study of 478 Wrists.
作者信息
Garcia Brittany N, Lu Chao-Chin, Chen Wei, Stephens Andrew R, Kazmers Nikolas H, Sauer Brian C, Tyser Andrew
机构信息
Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, UT.
George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City Veterans Affairs IDEAS Center, Salt Lake City, UT.
出版信息
J Hand Surg Glob Online. 2022 Nov 26;5(1):1-5. doi: 10.1016/j.jhsg.2022.10.015. eCollection 2023 Jan.
PURPOSE
The 4-corner arthrodesis (FCA) is a reliable, motion-sparing technique used to treat scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis, particularly in stage III wrists in which the capitolunate articulation is compromised. Surgical technique and patient-level variables may influence complications following FCA. We sought to evaluate the rate of complications in a large, combined database and manual chart review study.
METHODS
Current Procedural Terminology codes were used to search the United States Veteran's Health Administration corporate database to identify wrists treated with FCA over a 24-year period. A retrospective chart review was completed to collect data regarding scapholunate advanced collapse/scaphoid nonunion advanced collapse stage, implant used, the use of a bone graft, smoking status, and comorbidities for all patients undergoing an FCA. A multivariable cox proportional hazards regression was used to assess hazard ratios for reoperation. Incidence rates and the standard error of the mean for reoperation and conversion to total wrist fusion were calculated after grouping patients by 10-year age categories.
RESULTS
A total of 478 wrists underwent FCA during the study period, with a mean follow-up of 63 months. Seventy-three (16%) wrists required reoperation. The most frequent secondary procedures included unplanned implant removal (8.2%), total wrist arthrodesis (4.6%), and revision FCA (1.7%). Positive smoking history increased the risk of reoperation, whereas posterior interosseous nerve neurectomy, arthritis stage, and fixation type did not have a statistically significant association with reoperation. Younger age demonstrated an increased incidence of overall reoperation and wrist fusion.
CONCLUSIONS
The most common reason for reoperation after FCA was implant removal. Smoking history is associated with increased rates of reoperation and wrist arthrodesis. Knowledge of these factors may assist with accurately counseling and indicating patients for FCA.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
目的
四角融合术（FCA）是一种可靠的、保留运动功能的技术，用于治疗舟月关节晚期塌陷和舟骨不愈合晚期塌陷性关节炎，尤其是在头月关节受累的III期腕关节。手术技术和患者层面的变量可能会影响FCA术后的并发症。我们试图在一个大型综合数据库和手工图表回顾研究中评估并发症的发生率。
方法
使用当前手术操作术语代码搜索美国退伍军人健康管理局的企业数据库，以识别在24年期间接受FCA治疗的腕关节。完成了一项回顾性图表审查，以收集所有接受FCA治疗患者的舟月关节晚期塌陷/舟骨不愈合晚期塌陷阶段、使用的植入物、骨移植的使用、吸烟状况和合并症的数据。使用多变量cox比例风险回归来评估再次手术的风险比。在按10岁年龄组对患者进行分组后，计算再次手术和转换为全腕关节融合的发生率和平均标准误差。
结果
在研究期间，共有478个腕关节接受了FCA治疗，平均随访63个月。73个（16%）腕关节需要再次手术。最常见的二次手术包括计划外植入物取出（8.2%）、全腕关节融合术（4.6%）和翻修FCA（1.7%）。阳性吸烟史增加了再次手术的风险，而后骨间神经切除术、关节炎阶段和固定类型与再次手术没有统计学上的显著关联。年龄较小显示总体再次手术和腕关节融合的发生率增加。
结论
FCA术后再次手术的最常见原因是植入物取出。吸烟史与再次手术和腕关节融合率的增加有关。了解这些因素可能有助于准确地为患者提供咨询并指导其接受FCA治疗。
研究类型/证据水平：治疗性III级。
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