Yalcin Sercan, Seals Karrington, McLaughlin William, Fulkerson John P, Farrow Lutul D
Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Orthop J Sports Med. 2023 Jun 28;11(6):23259671231178345. doi: 10.1177/23259671231178345. eCollection 2023 Jun.
Tibial tubercle osteotomy (TTO) is a commonly utilized surgical procedure for the treatment of patellofemoral instability. Although midterm and long-term outcomes are known, perioperative complications have not been consistently reported.
To identify the incidence and predictors of adverse events in the first 90-day perioperative period after TTO.
Case series; Level of evidence, 4.
Patients undergoing primary TTO between January 1, 2010, and December 31, 2019, were included. Readmissions in the first 90 days after surgery were collected, and data were collected for the following variables: age, sex, smoking status, body mass index, laterality, preoperative diagnosis, presence of trochlear dysplasia, tourniquet use, TTO procedure, tibial tubercle distalization, trochleoplasty, chondral procedure, number of screws, and use of an epidural catheter. Predictors of readmission for any reason were identified using multivariable logistic regression analysis.
A total of 345 TTO procedures were included in the final analysis. The incidence of readmissions for any reason was 20.6% (71/345). The most common reason for readmission was postoperative pain (26/345 [7.5%]), followed by wound complications (19/345 [5.5%]) and epidural catheter-related complications (overall: 16/345 [4.6%]; specific: 16/167 [9.6%]. The incidence of major complications was 2.0% (7/345). The number of patients with each major complication was as follows: 1 for deep vein thrombosis, 2 for pulmonary embolism, 1 for septic arthritis, 1 for tibial tubercle fracture, and 2 for loss of fixation. Female sex and smoking were associated with readmission for pain.
The incidence of major complications after TTO was very low (2.0%), but 20.6% of cases required readmission, primarily for an indwelling epidural catheter (3.5%) and postoperative pain (7.5%). Concomitant soft tissue procedures and the number of screws were associated with readmission after TTO. Utilizing individualized postoperative pain management and preoperative discussions about expected pain may help to avoid readmission for pain after TTO.
胫骨结节截骨术（TTO）是治疗髌股关节不稳常用的外科手术。虽然中期和长期疗效已有报道，但围手术期并发症的报道并不一致。
确定TTO术后90天围手术期不良事件的发生率及预测因素。
病例系列研究；证据等级，4级。
纳入2010年1月1日至2019年12月31日期间接受初次TTO手术的患者。收集术后90天内的再入院情况，并收集以下变量的数据：年龄、性别、吸烟状况、体重指数、患侧、术前诊断、是否存在滑车发育不良、是否使用止血带、TTO手术方式、胫骨结节远端化、滑车成形术、软骨手术、螺钉数量以及是否使用硬膜外导管。采用多变量逻辑回归分析确定任何原因导致再入院的预测因素。
最终分析共纳入345例TTO手术。任何原因导致的再入院发生率为20.6%（71/345）。再入院最常见的原因是术后疼痛（26/345 [7.5%]），其次是伤口并发症（19/345 [5.5%]）和硬膜外导管相关并发症（总体：16/345 [4.6%]；具体：16/167 [9.6%]）。主要并发症的发生率为2.0%（7/345）。每种主要并发症的患者数量如下：深静脉血栓形成1例，肺栓塞2例，化脓性关节炎1例，胫骨结节骨折1例，内固定失败2例。女性和吸烟与因疼痛再入院相关。
TTO术后主要并发症的发生率很低（2.0%），但20.6%的病例需要再次入院，主要原因是留置硬膜外导管（3.5%）和术后疼痛（7.5%）。伴随的软组织手术和螺钉数量与TTO术后再入院相关。采用个体化的术后疼痛管理以及术前关于预期疼痛的讨论可能有助于避免TTO术后因疼痛再次入院。
