别管它:肱骨远端骨折固定术中的尺神经处理--一项大型数据库研究

Bijan Dehghani, Thompson Zhuang, R. DeAngelis, Mitchell Hallman, Kelsey Young, Derek J Donegan, Samir Mehta
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摘要

摘要 目的确定肱骨远端切开复位内固定术(ORIF)术中尺神经操作对术后尺神经炎的影响。方法: 采用回顾性队列研究:本研究使用 PearlDiver Mariner 数据库进行回顾性队列分析。使用当前手术术语(CPT)代码对接受肱骨远端骨折切开复位内固定术的患者进行识别。并发尺神经转位术、神经成形术或神经溶解术使用 CPT-64718 进行定义,与指数手术在同一天进行。排除了指数手术前一年内已有尺神经病变的患者。在术后 3、6、9 和 12 个月比较了术后至少 2 周发生的延迟尺神经病变的发生率。采用多变量逻辑回归模型评估尺神经转位术、神经成形术或神经溶解术与迟发性尺神经病之间的关系,并对年龄、性别、保险类型和 Elixhauser 合并症指数的影响进行调整。研究结果共有 16881 名患者接受了肱骨远端手术切除术,其中有 2016 人(11.9%)同时接受了尺神经转位术、神经成形术或神经溶解术。两组患者的年龄和保险类型不同(P<0.001)。191/2,016(9.5%)名接受尺神经转位术、神经成形术或神经溶解术的患者和742/14,865(5.0%)名未接受尺神经转位术、神经成形术或神经溶解术的患者在2周至1年内发生了尺神经病变(p<0.001)。在所有时间点,尺神经转位、神经成形术或神经溶解术与延迟尺神经病变几率增加有关(p<0.001)。结论在肱骨远端ORIF手术时进行尺神经转位、神经成形术或神经溶解术与术后延迟性尺神经炎发生率增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Leave it Alone: Ulnar Nerve Management in Distal Humerus Fracture Fixation – A Large Database Study
ABSTRACT Objectives: To determine the impact of intra-operative ulnar nerve manipulation during distal humerus open reduction internal fixation (ORIF) on post-operative ulnar neuritis. Methods: This study was a retrospective cohort analysis using the PearlDiver Mariner Database. Patients undergoing ORIF of distal humerus fractures were identified using Current Procedure Terminology (CPT) codes. Concurrent ulnar nerve transposition, neuroplasty, or neurolysis was defined using CPT-64718, occurring on the same day as the index procedure. Patients with pre-existing ulnar neuropathy within one year prior to the index procedure were excluded. The incidence of delayed ulnar neuropathy, occurring at least 2 weeks post-operatively, was compared at 3, 6, 9, and 12 months. Multivariable logistic regression models were employed to evaluate the association between ulnar nerve transposition, neuroplasty, or neurolysis and the development of delayed ulnar neuropathy, adjusting for the effects of age, sex, insurance type, and Elixhauser comorbidity index. Results: 16,881 patients who underwent distal humerus ORIF were identified, of which 2,016 (11.9%) received concurrent ulnar nerve transposition, neuroplasty, or neurolysis. The cohorts differed by age and insurance type (p<0.001). Ulnar neuropathy between 2 weeks and 1 year occurred in 191/2,016 (9.5%) patients who received ulnar nerve transposition, neuroplasty, or neurolysis and 742/14,865 (5.0%) patients who did not (p < 0.001). Ulnar nerve transposition, neuroplasty, or neurolysis was associated with increased odds of delayed ulnar neuropathy at all time points (p<0.001). Conclusion: Ulnar nerve transposition, neuroplasty, or neurolysis at the time of distal humerus ORIF was associated with an increased incidence of delayed post-operative ulnar neuritis.
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