Learning curve of total hip arthroplasty through direct anterior approach
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NETL
NSTL
万方数据
[目的]分析直接前入路(direct anterior approach,DAA)全髋关节置换术(total hip arthroplasty,THA)治疗股骨颈骨折的临床疗效,并探讨其学习曲线.[方法]回顾性分析2020年1月-2021年12月在本院骨科采用用DAA入路行THA58例股骨颈骨折患者,采用累积和分析法分析学习曲线,比较不同学习阶段患者临床资料.[结果]依据CUSUM学习曲线,初始期为编序1～22病例,成长期为编序23～32病例,成熟期为编序33～58病例.随手术例数的积累,手术时间[(165.1±16.5)min,(139.8±7.2)min,(120.4±8.2)min,P＜0.001]、术中失血量[(187.6±16.4)ml,(147.3±19.0)ml,(118.9±11.4)ml,P＜0.001]和住院天数[(8.6±1.7)d,(6.5± 0.9)d,(5.0±0.7)d,P＜0.001]均有显著降低,并发症显著下降,影像显著假体位显著改善.术后1个月和3个月时成熟期的Harris评分明显优于初始期和成长期(P＜0.05),但是术后6个月时三组间Harris评分差异无统计学意义(P＞0.05).[结论]股骨颈骨折DAA-THA具有术中损伤小,恢复快等优势,但其有较长学习曲线,需经过23～32例才能达到技术成熟期.
[Objective]To analyze the clinical outcome of total hip arthroplasty(THA)through direct anterior approach(DAA)for femo-ral neck fractures,and to explore its learning curve.[Methods]A retrospective analysis was performed on 58 patients who received DAA-THA for femoral neck fracture in our hospital from January 2020 to December 2021.The learning curve was analyzed by cumulative sum(CUSUM)analysis,and the clinical data of patients at different learning stages were compared.[Results]According to CUSUM learning curve,the initial stage was sequence of 1～22 cases,the growth stage was sequence 23～32 cases,and the maturity stage was sequence 33～58 cases.With the accumulation of operation cases,operation time[(165.1±16.5)min,(139.8±7.2)min,(120.4±8.2)min,P＜0.001],intraopera-tive blood loss[(187.6±16.4)ml,(147.3±19.0)ml,(118.9±11.4)ml,P＜0.001]and hospital stay[(8.6±1.7)days,(6.5±0.9)days,(5.0±0.7)days,P＜0.001]were significantly reduced,the complications were significantly decreased(P＜0.05),and the imaging significant prosthetic position was significantly improved(P＜0.05).Harris scores in the mature stage were significantly better than those in the initial stage and growth stage 1 and 3 months after surgery(P＜0.05),but there was no significant difference in Harris scores among the three groups 6 months after surgery(P＞0.05).[Conclusion]DAA-THA has the advantages of less intraoperative injury and faster recovery,but it has a long learn-ing curve,requiring 23～32 cases to reach technical maturity.
femoral neck fracturetotal hip arthroplastydirect anterior approachlearning curvecumulative sum analysis
NETL
NSTL
万方数据
