Rate of and Risk Factors for Reoperations After Open Reduction and Internal Fixation of Midshaft Clavicle Fractures: A Population-Based Study in Ontario, Canada.
Rate of and Risk Factors for Reoperations After Open Reduction and Internal Fixation of Midshaft Clavicle Fractures: A Population-Based Study in Ontario, Canada.
复制标题
锁骨中段骨折切开复位内固定术后的再次手术率和风险因素：加拿大安大略省的一项基于人群的研究。
DOI：
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
C. Veillette
中科院分区：
文献类型：
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作者：
T. Leroux;D. Wasserstein;P. Henry;A. Khoshbin;T. Dwyer;D. Ogilvie;N. Mahomed;C. Veillette
背景
已经描述了锁骨中段骨折切开复位内固定（ORIF）后的再手术率，但报告的骨不连、畸形愈合、感染和植入物取出率各不相同。我们试图在一个大的人群队列中建立锁骨切开复位内固定术后再手术的基线率和风险因素。
方法
管理数据库用于识别2002年4月至2010年4月期间接受闭合性锁骨中段骨折ORIF的16至60岁患者。主要结局为2年内再次手术（单独植入物取出、冲洗和清创[深部感染]、假关节重建[骨不连]或锁骨截骨[畸形愈合]）。次要结局是罕见的围手术期并发症，包括气胸、锁骨下血管损伤和臂丛神经损伤。进行多变量logistic回归分析，以确定患者和提供者因素对这些结果的影响。
结果
我们确定了1350例接受锁骨中段切开复位内固定术的患者（中位年龄32岁[四分位距21~44岁]; 81.3%为男性）。四分之一的患者（24.6%）接受了至少一次锁骨再次手术。最常见的手术是单独取出种植体（18.8%），女性风险最高（比值比[OR]，1.7; p = 0.002）。植入物取出的中位时间为12个月。分别有2.6%、2.6%和1.1%的患者在中位6个月、5个月和14个月后继发于骨不连、深部感染和畸形愈合的再次手术。锁骨不愈合的危险因素包括女性（OR，2.2; p = 0.04）和高合并症评分（OR，2.8; p = 0.009）。对于外科医生来说，较少的执业年限与患者发生感染的风险较小相关（OR，1.1; p <0.001）。确定了16例气胸（1.2%）;然而，臂丛神经和锁骨下血管损伤各发生在5例或更少的患者中。
结论
锁骨切开复位内固定后，四分之一的患者接受了再次手术。最常见的手术是取出植入物，尽管继发于骨不连、畸形愈合和感染的再次手术率较低，但仍高于先前报告的再次手术率。气胸和神经血管损伤不常见，应继续视为锁骨ORIF的罕见并发症。
证据等级
预测等级IV。有关证据等级的完整描述，请参见作者说明。
BACKGROUND
Reoperation rates following open reduction and internal fixation (ORIF) of midshaft clavicle fractures have been described, but reported rates of nonunion, malunion, infection, and implant removal have varied. We sought to establish baseline rates of, and risk factors for, reoperations following clavicle ORIF in a large population cohort.
METHODS
Administrative databases were used to identify patients sixteen to sixty years of age who had undergone an ORIF of a closed, midshaft clavicle fracture from April 2002 to April 2010. The primary outcome was a reoperation within two years (isolated implant removal, irrigation and debridement [deep infection], pseudarthrosis reconstruction [nonunion], or clavicle osteotomy [malunion]). The secondary outcome was rare perioperative complications, including pneumothorax, subclavian vasculature injury, and brachial plexus injury. A multivariable logistic regression analysis was performed to determine the influence of patient and provider factors on these outcomes.
RESULTS
We identified 1350 patients who underwent midshaft clavicle ORIF (median age, thirty-two years [interquartile range, twenty-one to forty-four years]; 81.3% male). One in four patients (24.6%) underwent at least one clavicle reoperation. The most common procedure was isolated implant removal (18.8%), and females were at highest risk (odds ratio [OR], 1.7; p = 0.002). The median time to implant removal was twelve months. A reoperation secondary to nonunion, deep infection, and malunion occurred in 2.6%, 2.6%, and 1.1% of the patients after a median of six, five, and fourteen months, respectively. Risk factors for clavicle nonunion included female sex (OR, 2.2; p = 0.04) and a high comorbidity score (OR, 2.8; p = 0.009). For surgeons, fewer years in practice was associated with a small risk of the patient developing an infection (OR, 1.1; p < 0.001). Sixteen pneumothoraces (1.2%) were identified; however, brachial plexus and subclavian vessel injuries were each found in five or fewer patients.
CONCLUSIONS
Following clavicle ORIF, one in four patients underwent a reoperation. The most common procedure was implant removal, and although the rates of reoperations secondary to nonunion, malunion, and infection were low they were higher than previously reported. Pneumothoraces and neurovascular injuries were infrequent and should continue to be considered rare complications of clavicle ORIF.
LEVEL OF EVIDENCE
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
约翰霍普金斯大学门诊护理小组 (ACG)。
DOI：
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发表时间：
1992
期刊：
HMO practice
影响因子：
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作者：
Weiner,JP;Starfield,BH;Lieberman,RN
通讯作者：
Lieberman,RN