Dubin Jeremy A, Bains Sandeep S, Remily Ethan, Salem Hytham, Sax Oliver, Hameed Daniel, Nace James, McClure Philip K, Delanois Ronald E
LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA.
J Orthop. 2024 Jul 25;59:8-12. doi: 10.1016/j.jor.2024.07.006. eCollection 2025 Jan.
Despite the recognized importance of managing vascular injury associated with knee dislocation, studies have been limited by small patient sizes, data older than five years, and lack of inclusion of newer procedural and diagnoses codes. This has been reflected in the reported frequency of knee dislocation associated with vascular injury ranging from 1.6 % to 64 %. As such, we sought to determine: (1) the frequency of knee dislocations associated with vascular injuries; (2) the frequency of knee dislocations associated with vascular injuries that required repair; as well as (3) independent risk factors for knee dislocation with vascular injury that require repair, across different age groups, sexes, and United States geographic regions.
A national, all-payer database was queried from January 1, 2010 to June 31, 2022. The frequency of a vascular injury was calculated by dividing the number of vascular injuries within 30 days of all knee dislocations by the total number of knee dislocations in each category. The frequency of a vascular injury that required repair was calculated by dividing the number of vascular injuries that required repair associated with knee dislocation by the total number of vascular injuries associated with knee dislocations. Patients were categorized by year of diagnosis, age, sex, and US geographic region. Multivariable logistic regressions were calculated to determine independent risk factors for knee dislocation with vascular injury.
From 2010 to 2022, there were 99,688 knee dislocations. Of the total knee dislocations, there were 1066 (1.1 %) vascular injuries associated with knee dislocations, 96,530 (96.8 %) were closed dislocations, and 3158 (2.2 %) were open dislocations. Of the 1066 vascular injuries associated with knee dislocations, 262 (24.6 %) vascular injuries required repair. Male sex (P < 0.001), Elixhauser Comorbidity Index (ECI) > 3 (P < 0.001), alcohol abuse (P = 0.006), congestive heart failure (P = 0.01), hypothyroidism (P = 0.003), and obesity (P < 0.001), were independent risk factors for knee dislocation with vascular injuries.
Our study provides a refined understanding of the historically low incidence of knee dislocation with vascular injury as well as an increase in vascular injuries requiring repair from 2010 to 2022. Given the large expense of irreversible injury in these patients, vulnerable patient populations identified in our study, such as obese patients with additional comorbidities, should be a focus of future intervention. These findings can guide physicians in a clinical setting to appropriately manage the expectations of patients as well as minimize the morbidity and mortality associated with this presentation.
尽管人们已经认识到处理与膝关节脱位相关的血管损伤的重要性，但以往的研究受到患者数量少、数据超过五年以及未纳入更新的手术和诊断编码的限制。这反映在报告的与血管损伤相关的膝关节脱位发生率从1.6%到64%不等。因此，我们试图确定：（1）与血管损伤相关的膝关节脱位的发生率；（2）需要修复的与血管损伤相关的膝关节脱位的发生率；以及（3）不同年龄组、性别和美国地理区域中需要修复的伴有血管损伤的膝关节脱位的独立危险因素。
查询了一个全国性的全支付者数据库，时间跨度为2010年1月1日至2022年6月31日。血管损伤的发生率通过将所有膝关节脱位后30天内的血管损伤数量除以各分类中膝关节脱位的总数来计算。需要修复的血管损伤的发生率通过将与膝关节脱位相关的需要修复的血管损伤数量除以与膝关节脱位相关的血管损伤总数来计算。患者按诊断年份、年龄、性别和美国地理区域进行分类。计算多变量逻辑回归以确定伴有血管损伤的膝关节脱位的独立危险因素。
2010年至2022年期间，共有99,688例膝关节脱位。在所有膝关节脱位中，有1066例（1.1%）与血管损伤相关，96,530例（96.8%）为闭合性脱位，3158例（2.2%）为开放性脱位。在与膝关节脱位相关的1066例血管损伤中，262例（24.6%）血管损伤需要修复。男性（P < 0.001）、埃利克斯豪泽合并症指数（ECI）> 3（P < 0.001）、酒精滥用（P = 0.006）、充血性心力衰竭（P = 0.01）、甲状腺功能减退（P = 0.003）和肥胖（P < 0.001）是伴有血管损伤的膝关节脱位的独立危险因素。
我们的研究对伴有血管损伤的膝关节脱位的历史低发生率以及2010年至2022年期间需要修复的血管损伤的增加有了更精确的认识。鉴于这些患者不可逆损伤的巨大费用，我们研究中确定的脆弱患者群体，如伴有其他合并症的肥胖患者，应成为未来干预的重点。这些发现可以指导临床医生合理管理患者的期望，并尽量减少与此表现相关的发病率和死亡率。
