手术时间延长是骨骼未成熟患者孤立前交叉韧带重建术后手术并发症的独立危险因素
简介
该研究基于一项前瞻性多中心外科医生注册数据库，纳入719例骨骼未成熟患者（平均年龄13.3岁），均接受初次孤立性前交叉韧带（ACL）重建，平均随访17.6个月。结果显示，总并发症率为15.3%，平均手术时间为115.1分钟。多因素Logistic回归分析表明，在校正基线特征后，手术时间延长是并发症的独立风险因素（OR=1.19, p=0.002），尤其与手术…
英文摘要
PURPOSE: In the context of increasing intensive year-round training amongst youth athletes, the incidence of paediatric anterior cruciate ligament (ACL) reconstruction has risen markedly. There is a growing interest in minimising surgical complications for these patients. Although the literature has demonstrated an association between operative time and complications for ACL reconstruction in adults, this has not been explored in younger patients. The primary purpose of this study was to determine whether operative time is a risk factor for complications following ACL reconstruction in skeletally immature patients. Secondary aims included identifying the most common types of complications in this cohort and identifying which of these complications were associated with increased operative time. METHODS: A prospective, multicenter surgeon-driven registry was reviewed to identify skeletally immature patients who underwent primary isolated ACL reconstruction, with a minimum 8-month follow-up. Demographics, surgical characteristics, operative time and complications were recorded. Continuous variables were compared via an independent t-test or analysis of variance, and categorical variables were compared via Chi-squared or Fisher's exact tests. Comparisons were deemed to be statistically significant using a threshold of p < 0.05. Multiple logistic regression analysis was performed to control for baseline characteristics. RESULTS: A total of 719 patients were included with a mean follow-up of 17.6 ± 8.6 months (range 8-30 months), 483 (67.2%) were male. Mean age was 13.3 ± 1.9 years. Mean operative time was 115.1 ± 44.2 min. The complication rate for the cohort was 15.3%. After adjusting for baseline characteristics, increased operative time remained an independent risk factor for developing a complication (OR = 1.19, p = 0.002). Specifically, increased operative time was an independent risk factor for surgical site infection (OR = 1.30, p = 0.019) and arthrofibrosis (OR = 1.36, p = 0.009). CONCLUSIONS: Increased operative time was found to be an independent risk factor for complications following ACL reconstruction for skeletally immature patients. Specifically, operative time was associated with surgical site infection and arthrofibrosis. Future efforts to improve operative efficiency are warranted to improve patient outcomes. LEVEL OF EVIDENCE: Level III.