摘要
目的:探讨"SuperPATH"微创全髋关节置换术的学习曲线并分析其临床应用价值。方法:回顾性分析2014年8月至2018年12月本院采用"SuperPATH"微创全髋关节置换术连续治疗的85例老年股骨颈骨折伴重度骨质疏松患者资料，其中男性24例，女性61例；年龄57~70岁，平均（62，3.3）岁。手术均同一医疗组完成。按接受手术的先后顺序分为4组（N=85，n=21，21，21，22）。比较各组手术时间、手术切口长度、术中出血量、围手术期并发症、髋臼假体前倾角以及术后6周Harris髋关节评分，采用对数曲线回归分析方法反映手术时间随手术例数变化的趋势[y=aln(x)+b，x为手术例数，y为手术时间]。结果:85例患者均获得完整随访，随访率100%，随访时间5~12个月，中位随访时间8个月。四组患者年龄、性别、分型、受伤至手术时间等一般情况差异无统计学意义（P>0.05），具有可比性。四组均未发生坐骨神经损伤（n=0），组A有1例围手术期髋关节假体脱位，组A、B各有1例术后切口感染，各组围手术期并发症发生率差异无统计学意义（P>0.05），术后6周Harris髋关节评分组间差异无统计学意义（P>0.05）。四组手术时间：（122.05±6.13）min，（115.43±9.22）min，（106.71±7.23）min，（98.64±4.46）min，四组间差异有统计学意义（P<0.01），组A、B分别与组C、D比较差异有统计学意义（P<0.01），C组，D组间比较差异无统计学意义（P>0.05），In对数曲线回归分析结果显示，随着手术例数的增加，总手术时间（y=8.778ln(x)+141.11，r2=0.5158，P<0.01）减少，在C组、D组相对稳定。四组间术中出血量、手术切口长度、术后髋臼假体前倾角比较有统计学意义（P<0.01）。结论:"SuperPATH"微创全髋关节置换术疗效稳定确切但存在学习曲线。总手术时间、手术切口长度、术中出血量随手术例数增加而减小，髋臼假体前倾角随手术例数增加而接近理想前倾角20°，学习曲线可较快达到平稳，适合临床推广。
Abstract
Objective:To explore the learning curve of SuperPATH minimally invasive total hip arthroplasty and evaluate its clinical application value.Methods:A retrospective study was conducted of consecutive 85 osteoporotic femoral neck fracture patients who had been treated with SuperPATH minimally invasive total hip arthroplasty from August 2014 to December 2018 at Department of Orthopedic, Affiliated Hospital/Clinical Medical Collage of Chengdu University. There were 24 males and 61 females, with an average age of (62±3.3) years (57-70 years). All operations were completed by the same medical group.The patients were divided into 4 groups (n=85) according to the date of operations: group A (n=21), group B (n=21), group C (n=21) and group D (n=22). The operative time, incision length, intraoperative hemorrhage, perioperative complications, anteversion of acetabular prosthesis and Harris hip score at 6 weeks were statistically analyzed and compared between 4 groups. The Log curve regression analysis was used to reflect the change trend of operation time with the number of operation cases. [y=aln(x)+b, x indicating the number of surgical cases, y operation time].Results:85 patients were fully followed up, with a follow-up rate of 100%. The follow-up time was 5 to 12 months, with a median follow-up time of 8 months. The 4 groups were comparable due to insignificant difference in age, gender, fracture type, time from injury to operation. There was no sciatic nerve injury in the four groups (n=0) but one hip prosthesis dislocation in group A and one incision infection in group B showing no significant difference in each group (9.5%, 4.7%, 0%, 0%) (P>0.05). There was no significant difference in Harris hip score between 4 groups at six weeks after operation. The operation time for the 4 groups respectively (122.05±6.13)min,(115.43±9.22)min, (106.71±7.23)min, (98.64±4.46) min showing significant differences between 4 groups (P<0.01) and significant differences between group A and B versus group C and D (P<0.01) but no significant differences between group C and D (P>0.05). The Log curve regression analysis showed that the operation time [y=8.778ln(x)+141.11, r2=0.5158, P<0.01] decreased significantly with the increase of operation number but stable in group C and D. There were significant differences among the four groups in the intraoperative hemorrhage (ML), incision length (CM) and the anteversion of acetabular prosthesis (P<0.01).Conclusions:The perioperative complications rate and postoperative hip Harris score of SuperPATH minimally invasive total hip arthroplasty does not change with the number of cases increased but the operation time, incision length and intraoperative hemorrhage decreased significantly with the increase of the number of cases.The anteversion angle of acetabulum prosthesis was close to the ideal anteversion angle of 20° with the increase of the number of cases. The SuperPATH minimally invasive total hip arthroplasty has learning curve but becomes stable very fast, indicating the technique is easy to learn.
基金项目
国家重点研发计划项目(2019YFB1311403)
四川省科技计划项目(2016FZ0066)
万方数据