Biau David J, Milet Alexandre, Thévenin Fabrice, Anract Philippe, Porcher Raphaël
Département de chirurgie orthopédique, Hôpital Cochin, AP-HP, Université Paris 5, France.
J Eval Clin Pract. 2009 Jun;15(3):420-4. doi: 10.1111/j.1365-2753.2008.01029.x. Epub 2009 Apr 2.
RATIONALE, AIMS AND OBJECTIVES: Inadequate surgical implantation of a hip replacement may result in decreased patient satisfaction and reduced implant survival. The objective was to monitor surgical performance in hip replacement.
The study took place at a teaching centre. All primary total hip replacements were prospectively included in the series. For each hip replacement, intraoperative technical errors, cup and stem fixation and position, and postoperative complications were recorded. If all items rated were correct, the procedure was considered as correct. The Cumulative Sums (CUSUM) test was used to monitor the performance of the centre. A 90% proportion of successful procedures was considered as adequate performance and a 75% proportion of successful procedures was deemed as inadequate performance. Meetings were conducted to discuss the results of monitoring.
Eighty-three total hip replacements were monitored. Overall, 28 procedures (34%) were considered inadequate. The most potent reasons for inadequate performance were cup positioning and stem fixation. The CUSUM test signalled after the second procedure that performance was inadequate. After the first meeting, despite an improvement was seen, the CUSUM test raised an alarm indicating inadequate performance. The study was stopped after the second meeting because of funding reasons before it could be demonstrated that performance had reached the desired level.
This study has demonstrated that implementing a dedicated system to monitor surgical performance in a teaching hospital improves the quality of implantation of total hip replacements. Nonetheless, the target of ninety percent of adequate primary total hip replacement could not be reached and efforts should be continued.
原理、目的和目标：髋关节置换手术植入不当可能会导致患者满意度下降和植入物存活率降低。本研究的目的是监测髋关节置换手术的操作情况。
该研究在一个教学中心进行。所有初次全髋关节置换手术均被前瞻性纳入该系列研究。对于每例髋关节置换手术，记录术中技术失误、髋臼杯和股骨柄的固定及位置，以及术后并发症。如果所有评定项目均正确，则该手术被视为正确。采用累积和（CUSUM）检验来监测该中心的手术操作情况。90%的手术成功率被认为是操作情况良好，75%的手术成功率则被视为操作情况不佳。通过召开会议来讨论监测结果。
共监测了83例全髋关节置换手术。总体而言，28例手术（34%）被认为操作不当。操作不当的最主要原因是髋臼杯位置和股骨柄固定。CUSUM检验在第二例手术后就显示手术操作情况不佳。在第一次会议之后，尽管情况有所改善，但CUSUM检验仍发出警报，表明手术操作情况不佳。由于资金原因，该研究在第二次会议后停止，此时尚未证明手术操作情况已达到预期水平。
本研究表明，在教学医院实施专门的系统来监测手术操作情况可提高全髋关节置换手术的植入质量。尽管如此，仍未达到初次全髋关节置换手术90%成功率的目标，仍需继续努力。
