开放楔形胫骨高位截骨术后并发症的危险因素分析与防治

Risk factors and prevention of complications after open wedge tibial high osteotomy

目的研究开放楔形胫骨高位截骨术(opening wedge high tibial osteotomy,OWHTO)后并发症的发生情况,分析发生并发症的危险因素,总结防治措施。方法回顾性分析2017年2月—2019年12月青岛大学附属医院行OWHTO的105例膝骨性关节病患者的病历及影像学资料,所有患者随访时间至少6个月。按照是否出现并发症分为无并发症组(A组,92例)和并发症组(B组,13例)。对2组患者一般资料(年龄、性别、侧别、病程、体质量指数、是否吸烟饮酒、合并症等)、手术时间、影像学测量指标、血常规指标等影响因素进行统计学分析,并应用多因素logistic回归分析研究影响OWHTO围手术期并发症发生的危险因素。结果所有患者平均年龄为(59.92±4.81)岁,其中男性27例,女性78例,术后并发症总发生率为12.38%。多因素logistic回归分析显示,病程(OR=1.636,P=0.015)、手术时间(OR=1.064,P=0.023)、体质量指数(OR=1.432,P=0.042)、截骨间隙(OR=4.203,P=0.003)是OWHTO术后并发症发生的独立危险因素。结论病程、手术时间、体质量指数、截骨间隙是OWHTO术后并发症发生的独立危险因素。控制体重、缩短手术时间,特别是针对病程较长、截骨间隙较大的患者及时采取预防措施对减少术后并发症的发生具有重要意义。

Objective To study the occurrence of complications after opening wedge high tibial osteotomy(OWHTO),analyze the risk factors and summarize the prevention and treatment measures.Methods The medical records and imaging data of 105 patients with knee osteoarthrosis who underwent OWHTO in our hospital were retrospectively analyzed.There were 88 cases in the uncomplicated group(group A)and 17 cases in the complication group(group B).The general information(age,gender,side,course of diseases,body mass index(BMI),smoking,drinking,complications,etc.),operation time,imaging measurement,blood routine indexes of two groups were statistical analyzed.Multivariate logistic regression analysis was used to study the risk factors of perioperative complications.Results The average age of all patients was(59.92±4.81)years old,including 27 males and 78 females.The total incidence of postoperative complications was 12.38%.The results of multivariate Logistic regression analysis showed that course of disease(OR=1.636,P=0.015),operation time(OR=1.064,P=0.023),BMI(OR=1.432,P=0.042)and osteotomy space(OR=4.203,P=0.003)were independent risk factors for postoperative complications of OWHTO.Conclusion Course of disease,operation time,BMI and osteotomy space are independent risk factors for postoperative complications of OWHTO.It is of great significance to control the body weight and shorten the operation time,especially to take timely preventive measures for patients with long course of disease and large osteotomy gap to reduce the occurrence of postoperative complications.