胫距跟（TTC）关节融合术的危险因素及并发症：创伤性踝关节骨折与骨关节炎的全国性数据库比较
Risk Factors and Complications in Tibiotalocalcaneal (TTC) Arthrodesis: A Nationwide Database Comparison Between Traumatic Ankle Fracture and Osteoarthritis.
作者信息
Dawar Abhiram, Chundi Gnaneswar, Ahn David B, Chopra Avani A, Lopez Jonathan, Montani Matthew, Lin Sheldon S, Jones Tuckerman
机构信息
Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA.
Penn State College of Medicine, Hershey, PA, USA.
出版信息
Foot Ankle Orthop. 2025 Mar 18;10(1):24730114251325851. doi: 10.1177/24730114251325851. eCollection 2025 Jan.
BACKGROUND
Tibiotalocalcaneal (TTC) arthrodesis is an established treatment for osteoarthritis (OA), offering stabilization and earlier weightbearing. However, its role in managing traumatic fractures (TFs) remains controversial because of higher risks of complications. This study aimed to compare complication rates, readmissions, and predictors of adverse outcomes in TTC arthrodesis performed for OA vs TF using a national database.
METHODS
A retrospective cohort study was conducted using the Nationwide Readmissions Database (2016-2021). Patients undergoing TTC arthrodesis were identified via () codes and stratified by indication (OA or TF). Primary outcomes included complication rates, 30- and 90-day readmissions, and revision surgeries. Multivariable logistic regression identified independent predictors of complications. Propensity score matching (PSM) was performed to account for baseline differences.
RESULTS
TF cases exhibited significantly higher complication rates (54.5% vs 16.0%, < .001), including malunion (11% vs 2%, < .001) and cellulitis (5% vs 1%, < .001). Readmission rates were also elevated in TF patients at 30 days (17% vs 3%, < .001) and 31-90 days (14% vs 4.8%, < .001). Logistic regression identified chronic kidney disease, diabetes, and obesity as independent predictors of complications. PSM confirmed these findings, demonstrating significantly higher rates of complications and readmissions in TF patients.
DISCUSSION
Findings indicate that TTC arthrodesis for TF is associated with higher risks of complications and readmissions compared with OA, attributable to acute injury characteristics and surgical complexity. Chronic comorbidities further exacerbate these risks. Optimizing perioperative management and timing of surgery in TF patients may mitigate complications. This study highlights the need for individualized care strategies to improve outcomes in TTC arthrodesis for trauma.
LEVEL OF EVIDENCE
Level III, therapeutic: case-control study.
背景
胫距跟关节融合术是治疗骨关节炎（OA）的一种既定方法，可提供稳定性并能较早负重。然而，由于并发症风险较高，其在治疗创伤性骨折（TF）中的作用仍存在争议。本研究旨在使用国家数据库比较因OA与TF行胫距跟关节融合术的并发症发生率、再入院率及不良结局的预测因素。
方法
使用全国再入院数据库（2016 - 2021年）进行一项回顾性队列研究。通过（）编码识别接受胫距跟关节融合术的患者，并按适应证（OA或TF）进行分层。主要结局包括并发症发生率、30天和90天再入院率以及翻修手术。多变量逻辑回归确定并发症的独立预测因素。进行倾向评分匹配（PSM）以考虑基线差异。
结果
TF病例的并发症发生率显著更高（54.5%对16.0%，<0.001），包括畸形愈合（11%对2%，<0.001）和蜂窝织炎（5%对1%，<0.001）。TF患者在30天（17%对3%，<0.001）和31 - 90天（14%对4.8%，<0.001）的再入院率也升高。逻辑回归确定慢性肾病、糖尿病和肥胖是并发症的独立预测因素。PSM证实了这些发现，表明TF患者的并发症和再入院率显著更高。
讨论
研究结果表明，与OA相比，因TF行胫距跟关节融合术的并发症和再入院风险更高，这归因于急性损伤特征和手术复杂性。慢性合并症进一步加剧了这些风险。优化TF患者的围手术期管理和手术时机可能会减轻并发症。本研究强调需要个性化护理策略以改善创伤性胫距跟关节融合术的结局。
证据水平
III级，治疗性：病例对照研究。
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