Karthikeyan Chinnakkannu, Nacime Salomao Barbachan Mansur, Natalie Glass, Phinit Phisitkul, Annunziato Amendola, John E Femino
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引用次数: 0
Abstract
Background: The use of posterior ankle and hindfoot arthroscopy (PAHA) has been expanding over time. Many new indications have been reported in the literature. The primary objective of this study was to report the rate of PAHA complication in a large cohort of patients and describe their potential associations with demographical and surgical variables.
Methods: In this IRB-approved retrospective comparative study, patients who underwent posterior ankle and/or hindfoot arthroscopy in a single institution from December 2009 to July 2016 were studied. Three fellowship-trained orthopaedic foot and ankle surgeon performed all surgeries. Demographic data, diagnosis, tourniquet use, associated procedures, and complications were recorded. To investigate a priori factors predictive of neurologic complication after PAHA, univariate and multivariable logistic regression was utilized. Where appropriate, sparse events sensitivity analysis was tested by fitting models with Firth log-likelihood approach.
Results: A total of 232 subjects with 251 surgeries were selected. Indications were posterior ankle impingement (37%), flexor hallux longus disorders (14%), subtalar arthritis (8%), and osteochondral lesions (6%). Complications were observed in 6.8% (17/251) of procedures. Neural sensory lesions were noted in 10 patients (3.98%), and wound complications in 4 ankles (1.59%). Seven neurologic lesions resolved spontaneously and 3 required further intervention. In a multivariable regression model controlled for confounders, the use of accessory posterolateral portal was the significant driver for neurologic complications (odds ratio [OR] 32.19, 95% CI 3.53-293.50).
Conclusion: The complication rate in this cohort that was treated with posterior ankle and/or hindfoot arthroscopy was 6.8%. Most complications were due to neural sensorial injuries (sural 5, medial plantar nerve 4, medial calcaneal nerve 1 ) and 3 required additional operative treatment. The use of an accessory posterolateral portal was significantly associated with neurologic complications. The provided information may assist surgeons in establishing diagnoses, making therapeutic decisions, and instituting surgical strategies for patients that might benefit from a posterior arthroscopic approach.
Level of evidence: Level III, retrospective comparative study.
背景:随着时间的推移，后踝和后足关节镜(PAHA)的应用越来越广泛。文献中报道了许多新的适应症。本研究的主要目的是报告大量患者中PAHA并发症的发生率，并描述其与人口统计学和手术变量的潜在关联。方法:在这项经irb批准的回顾性比较研究中，研究了2009年12月至2016年7月在单一机构接受后踝关节和/或后足关节镜检查的患者。三名研究金训练的足部和踝关节整形外科医生进行了所有手术。记录人口统计资料、诊断、止血带使用、相关手术和并发症。采用单因素和多因素logistic回归分析，探讨PAHA术后神经系统并发症的先验预测因素。在适当的情况下，用Firth对数似然方法拟合模型来测试稀疏事件敏感性分析。结果:共入选受试者232例，手术251例。适应症为后踝关节撞击(37%)，拇长屈肌疾病(14%)，距下关节炎(8%)和骨软骨病变(6%)。6.8%(17/251)的手术出现并发症。神经感觉病变10例(3.98%)，踝关节创面并发症4例(1.59%)。7例神经病变自发消退，3例需要进一步干预。在控制混杂因素的多变量回归模型中，使用副后外侧门静脉是神经系统并发症的重要驱动因素(优势比[OR] 32.19, 95% CI 3.53-293.50)。结论:该队列中采用后踝和/或后足关节镜治疗的并发症发生率为6.8%。大多数并发症是由于神经感觉损伤(腓肠5、足底内侧神经4、跟内侧神经1)，其中3例需要额外的手术治疗。副后外侧门静脉的使用与神经系统并发症显著相关。所提供的信息可以帮助外科医生建立诊断，做出治疗决定，并为可能受益于后关节镜入路的患者制定手术策略。证据等级:III级，回顾性比较研究。
期刊介绍：
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine
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