Ji Chenni, Cheng Jiaxiang, Su Hang, Zhu Yanbin, Zou Min
Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
Department of Orthopedic Surgery, Cangzhou Central Hospital, No. 16 Xinhuaxi Road, Cangzhou, Hebei, 061000, People's Republic of China.
BMC Surg. 2025 May 27;25(1):230. doi: 10.1186/s12893-025-02968-9.
Inflammatory and markers have a vital role in the development and prediction of adverse events following surgical procedures. This study aims to examine the relationship between high-sensitivity C-reactive protein to lymphocyte ratio (hs-CLR) and incision complications (ie, poor healing of superficial incisions, wound infection) following medial opening-wedge high tibial osteotomy (MOWHTO) for unicompartmental knee osteoarthritis (KOA).
This retrospective study analyzed patients who underwent MOWHTO for varus KOA between January 2021 and June 2024 in two tertiary referral hospitals. Baseline characteristics and laboratory test results were obtained through a review of inpatient medical records. The primary outcome measure was the incidence of incision complications occurring within 30 days postoperatively, determined by examining both inpatient records and outpatient follow-up documentation after discharge. To explore the relationship between hs-CLR and incision complications, we employed restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) curves, as well as univariate and multivariate logistic regression models.
There were 528 participants, including 190 males and 338 females, with a mean age of 56.2 ± 6.5 years. Within the 30 days following surgery, 48 patients (9.1%; 95% CI, 6.6% to 11.5%) experienced incision complications. Both the unadjusted and adjusted RCS analyses revealed the consistently significant nonlinear relationship (P < 0.05). ROC curve analysis identified an optimal hs-CLR cut-off value of 1.83, accordingly categorizing patients into low hs-CLR (n = 298) and high hs-CLR (n = 230) groups. Multivariate analyses employing two adjustment techniques demonstrated a significant relationship between a hs-CLR ≥ 1.83 and an increased risk of incision complications, with an odds ratio of 8.08 (95% CI, 3.16 to 20.63; P < 0.001) for "fully adjusted model" and of 8.99 (95%CI, 3.92 to 20.63; P < 0.001) for "backward elimination model".
This study demonstrated a robust association between preoperative hs-CLR and the risk of postoperative incision complications following MOWHTO for varus KOA. Although the observed odds ratios were substantial, the wide confidence intervals highlight the need for validation through larger, multicenter studies.
炎症及标志物在外科手术后不良事件的发生和预测中起着至关重要的作用。本研究旨在探讨高敏C反应蛋白与淋巴细胞比值（hs-CLR）与内侧开口楔形高位胫骨截骨术（MOWHTO）治疗单髁膝关节骨关节炎（KOA）后切口并发症（即浅表切口愈合不良、伤口感染）之间的关系。
这项回顾性研究分析了2021年1月至2024年6月在两家三级转诊医院接受MOWHTO治疗内翻型KOA的患者。通过查阅住院病历获取基线特征和实验室检查结果。主要结局指标是术后30天内发生的切口并发症发生率，通过检查住院记录和出院后的门诊随访文件来确定。为了探讨hs-CLR与切口并发症之间的关系，我们采用了限制性立方样条（RCS）分析、受试者工作特征（ROC）曲线以及单因素和多因素逻辑回归模型。
共有528名参与者，包括190名男性和338名女性，平均年龄为56.2±6.5岁。在术后30天内，48名患者（9.1%；95%CI，6.6%至11.5%）出现切口并发症。未调整和调整后的RCS分析均显示出一致的显著非线性关系（P<0.05）。ROC曲线分析确定hs-CLR的最佳截断值为1.83，据此将患者分为低hs-CLR组（n=298）和高hs-CLR组（n=230）。采用两种调整技术的多因素分析表明，hs-CLR≥1.83与切口并发症风险增加之间存在显著关系，“完全调整模型”的比值比为8.08（95%CI，3.16至20.63；P<0.001），“向后排除模型”的比值比为8.99（95%CI，3.92至20.63；P<0.001）。
本研究表明，术前hs-CLR与内翻型KOA行MOWHTO术后切口并发症风险之间存在密切关联。尽管观察到的比值比很大，但较宽的置信区间凸显了通过更大规模的多中心研究进行验证的必要性。
