Sherman O H, Fox J M, Snyder S J, Del Pizzo W, Friedman M J, Ferkel R D, Lawley M J
J Bone Joint Surg Am. 1986 Feb;68(2):256-65.
In a retrospective review of 3,261 arthroscopic procedures on the knee, 2,640 met the criteria for inclusion in this analysis. The patients' ages ranged from eight to eighty-three years. There were 1,541 male and 1,099 female patients. Eight hundred and ninety-five of the injuries were work-related. A tourniquet was used in 1,175 procedures and the average tourniquet time was thirty minutes. There were 216 complications over-all (8.2 per cent), 126 being designated as major and ninety-seven, as minor. The major complications that were evaluated were infections, hemarthrosis, adhesions, effusions, cardiovascular, neurological, reflex sympathetic dystrophy, and instrument breakage, and the minor complications were difficulties with wound-healing and ecchymosis. Chi-square analysis showed the following factors to be significant (p less than 0.05). Patients with an industrial injury had a higher rate of neurological complications and reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest over-all complication rate. Partial medical meniscectomy was associated with a higher over-all complication rate and the highest hemarthrosis rate, and partial lateral meniscectomy was associated with the highest rate of instrument breakage. Abrasion arthroplasty had the highest rate of complications of wound-healing, and subcutaneous lateral release was associated with the most adhesions. The sex of the patient and whether or not a tourniquet had been used had no effect on complications. The experience of the surgeon with arthroscopic procedures also had no correlation with the complication rate. Multiple regression analysis showed that two factors (age and, if a tourniquet was used, the tourniquet time) were dominant predictors of complications. From these data, a model was devised for predicting which patients were at risk for complications and their relative levels of risk. Certain complications may be preventable, and for others the risk factors can be reduced. The high-risk patients in our series were fifty years old or older and had a tourniquet time of sixty minutes or longer.
在对3261例膝关节镜手术的回顾性研究中，2640例符合本分析的纳入标准。患者年龄从8岁到83岁不等。其中男性患者1541例，女性患者1099例。895例损伤与工作相关。1175例手术使用了止血带，平均止血带使用时间为30分钟。总体并发症216例（8.2%），其中126例为严重并发症，97例为轻微并发症。评估的严重并发症包括感染、关节积血、粘连、积液、心血管、神经、反射性交感神经营养不良和器械断裂，轻微并发症为伤口愈合困难和瘀斑。卡方分析显示以下因素具有显著性（p<0.05）。工伤患者神经并发症和反射性交感神经营养不良的发生率较高。诊断性关节镜检查总体并发症发生率最低。部分半月板切除术总体并发症发生率较高，关节积血发生率最高，外侧半月板部分切除术器械断裂发生率最高。磨损性关节成形术伤口愈合并发症发生率最高，皮下外侧松解术粘连发生率最高。患者性别及是否使用止血带对并发症无影响。外科医生的关节镜手术经验与并发症发生率也无相关性。多元回归分析显示，两个因素（年龄以及若使用止血带时的止血带使用时间）是并发症的主要预测因素。根据这些数据，设计了一个模型来预测哪些患者有并发症风险及其相对风险水平。某些并发症可能是可预防的，对于其他并发症，风险因素可以降低。我们研究系列中的高危患者为50岁及以上且止血带使用时间为60分钟或更长时间的患者。
