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。
Objective To explore the learning curve of SuperPATH minimally invasive total hip ar-throplasty and evaluate its clinical application value.Methods A retrospective study was conducted of con-secutive 85 osteoporotic femoral neck fracture patients who had been treated with SuperPATH minimally in-vasive 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 aver-age age of(62±3.3)years(57-70 years).All operations were completed by the same medical group.The pa-tients 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,perioper-ative complications,anteversion of acetabular prosthesis and Harris hip score at 6 weeks were statistically an-alyzed 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 compara-ble 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 in-fection 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 opera-tion 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(
作者
刘璇
胡正霞
王晓东
兰海
李开南
Liu Xuan;Hu Zhengxia;Wang Xiaodong;Lan Hai;Li Kainan(Department of Orthopedics,Affiliated Hospital&Clinical Medical Collage of Chengdu Uni-versity,Chengdu 610081,China)
出处
《中华老年骨科与康复电子杂志》
2023年第2期73-80,共8页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
国家重点研发计划项目(2019YFB1311403)
四川省科技计划项目(2016FZ0066)。
