[1]李骏然 翟婧秀① 赵洪波 梁卫东 张洪斌 梁俊生* 李力更.牵引床直接前侧入路人工全髋关节置换术的学习曲线分析[J].中国微创外科杂志,2021,01(11):1024-1030.
　Li Junran*,Zhai Jingxiu,Zhao Hongbo*,et al.Learning Curve Analysis of Total Hip Arthroplasty Through the Direct Anterior Approach With the Use of a Traction Table[J].Chinese Journal of Minimally Invasive Surgery,2021,01(11):1024-1030.
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牵引床直接前侧入路人工全髋关节置换术的学习曲线分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年11期
页码:
1024-1030
栏目:
临床研究
出版日期:
2021-11-25

文章信息/Info

Title:
Learning Curve Analysis of Total Hip Arthroplasty Through the Direct Anterior Approach With the Use of a Traction Table
作者:
李骏然 翟婧秀① 赵洪波 梁卫东 张洪斌 梁俊生* 李力更
（唐山市第二医院老年骨科，唐山063000）
Author(s):
Li Junran*;  Zhai Jingxiu;  Zhao Hongbo*;  et al.
*Department of Geriatric Orthopedics, Second Hospital of Tangshan, Tangshan 063000, China
关键词:
牵引床; 全髋关节置换术; 直接前侧入路; 学习曲线
Keywords:
Traction table; Total hip arthroplasty; Direct anterior approach; Learning curve
文献标志码:
A
摘要:
目的探讨牵引床直接前侧入路（direct anterior approach，DAA）人工全髋关节置换术（total hip arthroplasty，THA）的学习曲线。方法回顾分析2016年10月～2017年7月120例股骨颈骨折或髋关节疾病采用牵引床DAATHA治疗的临床资料，按时间先后顺序分为A～D组，每组30例，比较4组围手术期指标（手术时间、术中出血量、切口长度）、术后影像学指标（髋臼杯外展角、前倾角、股骨柄-髓腔轴线夹角）、术后（2周、1个月、3个月、6个月）Harris髋关节功能评分以及围术期并发症发生情况。 结果手术时间A～D组分别为（115.9±15.9）、（104.6±15.2）、（91.1±11.6）（87.8±7.8）min，术中出血量分别为（301.7±36.3）、（251.8±30.0）、（225.8±20.3）、（217.2±23.7）ml，A组手术时间和术中出血量明显长于/多于B、C、D组（P＜005），B组明显长于/多于C、D组（P＜0.05），C、D组比较差异无统计学意义（P＞0.05）。股骨中心性固定率A～D组分别为400%（12/30）、66.7%（20/30）、93.3%（28/30）、90.0%（27/30），A组显著低于B、C、D组(P＜0.05)，B组显著低于C、D组(P＜0.05)，C、D组比较差异无统计学意义(P＞0.05)。4组切口长度、髋臼杯外展角、前倾角、髋臼杯位于安全区比率和股骨柄-髓腔轴线夹角差异均无统计学意义（P＞0.05）。A～D组术后Harris评分差异均无统计学意义（P＞0.05）。A组并发症6例，其中大转子骨折3例，股外侧皮神经损伤3例；B组并发症3例，其中大转子骨折1例，股外侧皮神经损伤2例；C组与D组各出现股外侧皮神经损伤1例。4组随访13～34个月，(22.4±5.1)月，无脱位、感染及切口相关并发症发生。结论牵引床DAATHA学习曲线显示在60例左右达到技术稳定期（成熟期）。
Abstract:
ObjectiveTo evaluate the learning curve of total hip arthroplasty (THA) through the direct anterior approach (DAA) with the use of a traction table.MethodsA retrospective analysis was performed on 120 patients with femoral neck fracture or hip joint diseases who underwent DAATHA with the use of a traction table from October 2016 to July 2017.They were divided chronologically into 4 groups (front to back, group A,B,C,D) with 30 cases in each group. Perioperative data (operative time, intraoperative blood loss, and length of incision), postoperative radiologic data (cup abduction, cup anteversion, and angle between stem and femoral axis), the Harris scores in 2 weeks, 1 month, 3 months and 6 months after operation and perioperative complications were recorded and compared among the 4 groups. Results The operation time was (115.9±15.9) min, (104.6±15.2) min, (91.1±11.6) min, and (87.8±7.8) min for group A-D, respectively. The intraoperative blood loss was (301.7±36.3) ml, (251.8±30.0) ml, (225.8±20.3) ml, and (217.2±23.7) ml for group A-D, respectively. The median fixation ratio of femoral prosthesis was 40.0%(12/30), 66.7%(20/30), 933%(28/30), and 90.0%(27/30) for group A-D, respectively. The comparison of the operative time, intraoperative blood loss, the median fixation ratio of femoral prosthesis demonstrated statistically significance (P＜0.05) between group A and group B, C, D, and between group B and group C, D, but were not statistically different between group C and D (P＞0.05). There was no significant difference in length of incision, cup abduction, cup anteversion, angle between stem and femoral axis, and the ratio of the acetabular cup located in the safety zone among the 4 groups (P＞0.05). For Harris scores after the operation, no significant difference was found in all groups (P＞0.05). Complications were noted in 6 cases in the group A, which included 3 cases of greater trochanteric fracture (GTF) and 3 cases of lateral femoral cutaneous nerve (LFCN) injury. There were 1 case of GTF and 2 cases of LFCN injury in the group B. In the group C and group D, LFCN injury was noted in one patient in each group. All the patients were followed up for 13-34 months ［mean, (22.4±5.1) months］.During the followups, no dislocation, infection or wound related complication was observed.ConclusionThe learning curve of DAATHA with the use of a traction table reveals that it reaches a technical stable stage (mature stage) in approximate 60 cases.

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备注/Memo

备注/Memo:
*通迅作者，Email：452455738@qq.com ①综合内科
更新日期/Last Update: 2022-02-10