鹅足肌腱切断术是否会影响胫骨平台骨折手术部位感染率？
Does pes anserinus tenotomy affect surgical site infection rate in operative tibial plateau fractures?
机构信息
Heersink School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA.
Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA.
出版信息
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):615-620. doi: 10.1007/s00590-023-03711-x. Epub 2023 Sep 4.
PURPOSE
To assess if pes anserinus tenotomy (PAT) during definitive open reduction and internal fixation (ORIF) of tibial plateau fractures is associated with a decreased risk of surgical site infection (SSI) and other postoperative complications.
METHODS
A retrospective review of all adults who underwent ORIF for tibial plateau fractures from April 2005 to February 2022 at single level 1 trauma center was performed. Patients who had a medial approach to the plateau with minimum three-month follow-up were required for inclusion. All patients with fasciotomy for compartment syndrome or with traumatically avulsed or damaged pes anserinus prior to ORIF were excluded. Two groups were created: those who received a pes anserinus tenotomy with repair (PAT group) and those whose pes anserinus were spared and left intact (control group). Patient demographics, injury and operative characteristics, and surgical outcomes were compared. The primary outcomes were rates of deep and superficial SSI.
RESULTS
The PAT group had significantly lower rates of deep SSI (9.2% vs. 19.7%, P = 0.009), superficial SSI (14.2% vs. 26.5%), P = 0.007), and any SSI (15.8% vs. 28.9%, P = 0.005). Multiple logistic regression showed that heart failure (aOR = 7.215, 95% CI 2.291-22.719, P < 0.001), and presence of open fracture (aOR = 4.046, 95% CI 2.074-7.895, P < 0.001) were independently associated with increased odds of deep SSI, while PAT was associated with a decreased odds of deep SSI (aOR = 0.481, 95% CI 0.231-0.992, P = 0.048). PAT had significantly lower rates of unplanned return to the operating room (20.8% vs. 33.7%, P = 0.010) and implant removal (10.0% vs. 18.0%, P = 0.042).
CONCLUSION
While these data do not allow for discussion of functional recovery or strength, pes anserinus tenotomy was independently associated with significantly lower rates of infection, unplanned operation, and implant removal.
LEVEL OF EVIDENCE
Level III.
目的
评估在胫骨平台骨折的确定性切开复位内固定（ORIF）过程中进行鹅足肌腱切断术（PAT）是否与降低手术部位感染（SSI）和其他术后并发症的风险有关。
方法
对 2005 年 4 月至 2022 年 2 月在单一级 1 创伤中心接受 ORIF 治疗的所有成年人进行了回顾性分析。需要纳入接受平台内侧入路且至少随访 3 个月的患者。所有接受筋膜切开减压治疗筋膜间室综合征或在 ORIF 前因创伤而撕脱或损伤鹅足肌腱的患者均被排除在外。创建了两组：一组接受鹅足肌腱切断术+修复（PAT 组），另一组鹅足肌腱未被切断且保持完整（对照组）。比较了患者的人口统计学、损伤和手术特征以及手术结果。主要结局是深部和浅部 SSI 的发生率。
结果
PAT 组深部 SSI（9.2% vs. 19.7%，P = 0.009）、浅部 SSI（14.2% vs. 26.5%，P = 0.007）和任何 SSI（15.8% vs. 28.9%，P = 0.005）的发生率明显较低。多因素逻辑回归显示心力衰竭（aOR = 7.215，95%CI 2.291-22.719，P < 0.001）和开放性骨折（aOR = 4.046，95%CI 2.074-7.895，P < 0.001）与深部 SSI 的发生几率增加独立相关，而 PAT 与深部 SSI 的发生几率降低相关（aOR = 0.481，95%CI 0.231-0.992，P = 0.048）。PAT 组患者的计划再次手术（20.8% vs. 33.7%，P = 0.010）和植入物取出（10.0% vs. 18.0%，P = 0.042）的发生率明显较低。
结论
尽管这些数据不允许讨论功能恢复或力量，但鹅足肌腱切断术与感染、计划外手术和植入物取出的发生率显著降低独立相关。
证据水平
III 级。
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