Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London NW1 2BU, England.
J Bone Joint Surg Am. 2011 May;93 Suppl 2:52-6. doi: 10.2106/JBJS.J.01587.
The aim of this study was to objectively quantify a surgeon's learning experience for hip arthroscopy.
We prospectively reviewed the first 100 hip arthroscopic procedures performed between 1999 and 2004 by a single experienced consultant orthopaedic surgeon. In the second part of the study, three groups of patients were sequentially analyzed: Group 1 included the first thirty patients treated by the surgeon; group 2, the sixty-first through ninetieth patients; and group 3, the 121st through 150th patients. The groups were compared with regard to the diagnosis, the duration of the central and peripheral compartment procedure, patient satisfaction, conversion to arthroplasty, and the nonarthritic hip score.
There was a decrease in complications from the first thirty cases to the remaining seventy operations. There was an overall decrease in operative time over the 100 cases, representing a gradual learning process. A marked decrease in the operative time for central compartment arthroscopy was noted when we compared group 1 (mean, seventy minutes; range, forty-five to ninety-eight minutes), group 2 (mean, forty-eight minutes; range, twenty-six to fifty-nine minutes), and group 3 (mean, thirty-seven minutes; range, eighteen to sixty-one minutes). The operative time for peripheral compartment arthroscopy also decreased from group 2 (mean, ninety-one minutes; range, sixty to 126 minutes) to group 3 (mean, forty-five minutes; range, thirty-six to sixty-two minutes). There was an overall decrease in operative time over the first 100 cases. No difference among groups was noted in the number of cases requiring a reoperation or conversion to arthroplasty. There was a higher complication rate in the first thirty cases. An increase in the nonarthritic hip scores was noted postoperatively in the two groups in which the preoperative score had been measured. The postoperative score improved from group 1 (mean, 69; range, 39 to 84) to group 2 (mean, 79; range, 58 to 92) to group 3 (mean, 86; range, 51 to 98). Patient satisfaction was highest in group 3.
Hip arthroscopy is associated with high patient satisfaction and good short-term outcomes, but there is a learning curve that we estimate to be approximately thirty cases.
本研究旨在客观量化髋关节镜手术医生的学习经验。
我们前瞻性地回顾了 1999 年至 2004 年间一位经验丰富的顾问骨科医生完成的前 100 例髋关节镜手术。在研究的第二部分，我们依次分析了三组患者：第 1 组包括前 30 例患者；第 2 组包括第 61 至第 90 例患者；第 3 组包括第 121 至 150 例患者。我们比较了各组的诊断、中央和外周间隙手术的持续时间、患者满意度、转为关节成形术以及非关节炎髋关节评分。
从前 30 例到其余 70 例手术，并发症有所减少。100 例手术中手术时间总体呈下降趋势，表明存在逐渐学习的过程。当我们比较第 1 组（平均 70 分钟；范围 45 至 98 分钟）、第 2 组（平均 48 分钟；范围 26 至 59 分钟）和第 3 组（平均 37 分钟；范围 18 至 61 分钟）时，我们注意到中央间隙关节镜手术的手术时间明显缩短。外周间隙关节镜手术的手术时间也从第 2 组（平均 91 分钟；范围 60 至 126 分钟）减少到第 3 组（平均 45 分钟；范围 36 至 62 分钟）。前 100 例手术中手术时间总体呈下降趋势。三组中需要再次手术或转为关节成形术的病例数无差异。第 1 组的并发症发生率较高。术前评分已测量的两组患者术后非关节炎髋关节评分均升高。第 2 组（平均 69；范围 39 至 84）到第 3 组（平均 79；范围 58 至 92）的术后评分均有所提高。第 3 组患者满意度最高。
髋关节镜手术患者满意度高，短期效果好，但我们估计有一个大约 30 例的学习曲线。
