Haskell Andrew, Mann Roger A
University of California, San Francisco General Hospital, USA.
Foot Ankle Int. 2004 May;25(5):283-9. doi: 10.1177/107110070402500502.
Recent studies suggest the perioperative complication rate of total ankle arthroplasty decreases as a surgeon becomes familiar with the procedure. This study tests the hypothesis that the number of perioperative adverse events will decrease as surgeon experience with total ankle replacement increases.
Ten surgeons completed retrospective chart and radiographic reviews of their first 10 cases as well as 10 subsequent cases of the Scandinavian Total Ankle Replacement (STAR). Not all surgeons completed 10 cases within the allotted time periods, and two patients were excluded for less than 3-month follow-up, resulting in 187 cases for review. The surgeons performed an average of 12.8 (range, 0-61) STARs between these two time periods. Cases were divided into Early Group if they were among the first five STARs a surgeon performed and Late Group if they were after the first five.
The average patient age was 60.4 +/- 12.8 years. The etiology of arthrosis included 96 (51%) of 187 posttraumatic, 49 (26%) idiopathic, and 33 (18%) rheumatoid. Patients in Early Group had a 3.1 times greater chance of having a perioperative adverse event (95% CI 1.6-6.1, p <.001), and a 3.2 times greater chance of having a perioperative wound problem (95% CI 1.5-6.8, p =.002) than patients in Late Group. Patients in Early Group took 1 week longer to heal their wounds than patients in Late Group (4.5 vs. 3.5 weeks, p =.046).
This study shows a decrease in the perioperative adverse event rate commensurate with surgeon experience with STAR. In contrast to other reports, this study was unable to show a decrease in the number of perioperative fractures with increasing surgeon experience. This information is important for planning how best to train surgeons new to total ankle replacement and for patient counseling regarding the potential risks of the procedure.
近期研究表明，随着外科医生对全踝关节置换术的逐渐熟悉，围手术期并发症发生率会降低。本研究旨在验证以下假设：随着外科医生进行全踝关节置换手术经验的增加，围手术期不良事件的数量会减少。
10位外科医生对其最初的10例以及随后的10例斯堪的纳维亚全踝关节置换术（STAR）病例进行了回顾性病历和影像学检查。并非所有外科医生都在规定时间内完成了10例病例，且有2例患者因随访时间不足3个月而被排除，最终纳入审查的病例有187例。在这两个时间段内，外科医生平均进行了12.8例（范围0 - 61例）STAR手术。如果病例是外科医生进行的前5例STAR手术，则分为早期组；如果是在前5例之后，则分为晚期组。
患者平均年龄为60.4 ± 12.8岁。关节病的病因包括187例中的96例（51%）创伤后、49例（26%）特发性和33例（18%）类风湿性。早期组患者发生围手术期不良事件的几率比晚期组患者高3.1倍（95%置信区间1.6 - 6.1，p <.001），发生围手术期伤口问题的几率高3.2倍（95%置信区间1.5 - 6.8，p =.002）。早期组患者伤口愈合时间比晚期组患者长1周（4.5周对3.5周，p =.046）。
本研究表明，围手术期不良事件发生率随着外科医生进行STAR手术经验的增加而降低。与其他报告不同的是，本研究未能显示随着外科医生经验的增加，围手术期骨折数量有所减少。这些信息对于规划如何最好地培训初次进行全踝关节置换手术的外科医生以及就该手术的潜在风险向患者提供咨询非常重要。
