开放性与关节镜下肘关节松解术治疗原发性骨关节炎：两年时人口统计学和并发症的比较
Open versus arthroscopic elbow arthrolysis for primary osteoarthritis: A comparison of demographics and complications at two years.
作者信息
Remily Ethan A, Bains Sandeep S, Dubin Jeremy A, Hameed Daniel, Chen Zhongming, Livesey Michael G, Ingari John V, Gilotra Mohit N, Hasan S Ashfaq
机构信息
LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, USA.
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
出版信息
J Orthop. 2023 Jul 4;42:30-33. doi: 10.1016/j.jor.2023.06.011. eCollection 2023 Aug.
INTRODUCTION
Open techniques have traditionally been utilized in the surgical management of elbow osteoarthritis (OA). However, advances in elbow arthroscopy, in conjunction with the movement towards minimally invasive surgery, have led to an increase in the utilization of an arthroscopic approach. The primary aim of this investigation was to compare demographics and complication rates between patients undergoing open or arthroscopic arthrolysis for elbow OA with a secondary objective of identifying risk factors for infection with each treatment.
METHODS
A retrospective review of a private, all-payer database was performed to identify patients undergoing either open (n = 1482) or arthroscopic (n = 2341) arthrolysis for elbow osteoarthritis. The primary outcome was 2-year complications, which included infection, wound complications, and nerve injuries. Categorical variables were compared utilizing chi-square analyses, while continuous variables were compared using independent sample t-tests. Odd ratios (OR) were ascertained to quantify the risk attributed to open arthrolysis compared to arthroscopic. Multivariable logistic regression was performed to assess risk factors for infection following open or arthroscopic arthrolysis of an elbow with OA.
RESULTS
Age was significantly higher in the open cohort (55 ± 13.4 years) compared to the arthroscopic cohort (52 ± 13.1 years) (p < 0.001). The open cohort was more likely to be female (32.0 vs. 22.9%, p < 0.001) and have a Charlson Comorbidity Index (CCI) greater than three (9.2 vs. 7.1%, p < 0.001). Open procedures were associated with an increased risk of nerve injury (OR: 1.50) and wound complications (OR: 7.70) compared to arthroscopic arthrolysis. Multivariable logistic regression identified open procedures as a risk factor for infection (OR: 11.15). Moreover, diabetes (OR: 1.48), chronic kidney disease (OR: 1.89) and tobacco use (OR: 2.29) were found as risk factors for infection among the open cohort.
CONCLUSIONS
This study found patients undergoing open arthrolysis of OA to be older and have a greater number of medical comorbidities compared to those undergoing arthroscopic arthrolysis. Open arthrolysis was associated with an increased rate of infection, nerve injury and wound complications compared to arthroscopic arthrolysis. After controlling for age and comorbidities with multivariable logistic regression, open arthrolysis remained a risk factor for infection. Arthroscopic elbow arthrolysis is associated with a lower risk of complications, including infection and may be favored for the management of OA of the elbow.
LEVEL OF EVIDENCE
III (retrospective cohort study).
引言
传统上，开放技术一直用于肘关节骨关节炎（OA）的外科治疗。然而，随着肘关节镜技术的进步，以及向微创手术的发展，关节镜手术的应用有所增加。本研究的主要目的是比较接受开放性或关节镜下肘关节松解术治疗OA患者的人口统计学特征和并发症发生率，次要目的是确定每种治疗方法感染的危险因素。
方法
对一个私立的全付费数据库进行回顾性分析，以确定接受开放性（n = 1482）或关节镜下（n = 2341）肘关节骨关节炎松解术的患者。主要结局是2年并发症，包括感染、伤口并发症和神经损伤。分类变量采用卡方分析进行比较，连续变量采用独立样本t检验进行比较。计算比值比（OR）以量化开放性松解术与关节镜手术相比的风险。进行多变量逻辑回归分析，以评估OA肘关节开放性或关节镜下松解术后感染的危险因素。
结果
与关节镜组（52±13.1岁）相比，开放组患者年龄显著更高（55±13.4岁）（p < 0.001）。开放组女性比例更高（32.0%对22.9%，p < 0.001），Charlson合并症指数（CCI）大于3的比例更高（9.2%对7.1%，p < 0.001）。与关节镜下松解术相比，开放手术导致神经损伤（OR：1.50）和伤口并发症（OR：7.70）的风险增加。多变量逻辑回归分析确定开放手术是感染的危险因素（OR：11.15）。此外，糖尿病（OR：1.48）、慢性肾病（OR：1.89）和吸烟（OR：2.29）被发现是开放组感染的危险因素。
结论
本研究发现，与接受关节镜下松解术的患者相比，接受开放性OA松解术的患者年龄更大，合并症更多。与关节镜下松解术相比，开放性松解术的感染、神经损伤和伤口并发症发生率更高。在通过多变量逻辑回归控制年龄和合并症后，开放性松解术仍然是感染的危险因素。关节镜下肘关节松解术并发症风险较低，包括感染，可能更适合于肘关节OA的治疗。
证据水平
III级（回顾性队列研究）。
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