半月板切除术 vs 半月板修复术：再入院率、再手术率及骨关节炎发生率的比较
简介
该研究基于Premier Health数据库，纳入36,386例经倾向评分匹配的半月板修复与切除术患者（各18,193例），比较两组90天再入院率、再手术率及症状性骨关节炎（OA）的医疗利用率。关键发现：两组90天再入院率均较低（修复组1.1% vs 切除组1.9%）；修复组再手术率显著低于切除组（2.3% vs 4.3%，P<0.0001）；切除组术后2年…
英文摘要
BACKGROUND: The meniscus has a proven role in load transmission, stability, and prevention of osteoarthritis (OA). Research suggests that meniscal repair may improve long-term joint health as compared with meniscectomy, but higher reoperation and readmission rates may be incurred. PURPOSE: To examine 90-day readmissions, reoperations, and health care utilization for symptomatic OA for patients who underwent meniscal repair vs meniscectomy. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing 1 of 2 index procedures, meniscal repair or meniscectomy, were identified in the Premier Health Database. Three endpoints were investigated: 90-day readmission, reoperations, and health care utilization for symptomatic OA. The demographics for each index procedure group were matched by propensity score matching. Chi-square tests of independence were used to compare endpoints between the index procedure groups, and subanalyses were performed for patients aged <40 vs ≥40 years. RESULTS: After matching, 36,386 patients (36,386 knees; 18,193 with meniscectomy and meniscal repair each) were included in this study (mean ± SD age, 38 ± 17 years [meniscectomy group, 38.45 ± 17.29; repair group, 38.10 ± 17.37]; mean Charleston Comorbidity Index, 0.12 ± 0.38 [meniscectomy group, 0.12 ± 0.38; repair group, 0.12 ± 0.37]). The index procedures had similarly low rates of 90-day readmission (1.1% for repair and 1.9% for meniscectomy). Patients undergoing repair were significantly less likely to necessitate reoperation, whether the index procedure or another type (2.3% vs 4.3% for meniscectomy; P < .0001). Patients undergoing meniscectomy were significantly more likely to receive OA treatment within 2 years of meniscectomy as opposed to meniscal repair (9.2% vs 6.7%; P < .0001), and this trend was maintained for both age groups. CONCLUSION: This study demonstrated that the index procedures had similarly low rates of 90-day readmission. Patients undergoing repair were significantly less likely to necessitate any reoperation. OA treatment was significantly more likely in patients who had meniscectomy as opposed to meniscal repair, and this trend was maintained for both age groups. These data may support consideration for meniscal preservation in all patients, regardless of age; however, future studies are needed to further stratify age-appropriate recommendations and tear patterns.