Dietrich Florian, Ries Christian, Eiermann Claus, Miehlke Wolfgang, Sobau Christian
ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Germany,
Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):953-8. doi: 10.1007/s00167-014-2893-9. Epub 2014 Feb 12.
The aim of this study was to determine whether the learning curve of arthroscopic treatment of femoroacetabular impingement (FAI) could be verified by analyzing the complication rate of this procedure. Additionally, it was investigated whether supervision by an experienced surgeon leads to a steeper learning curve (lower number of complications) when starting to perform arthroscopic FAI treatment.
The complications occurring in 317 consecutive patients treated with the sole diagnosis of FAI were analyzed. 256 patients (collective A) were treated by surgeon A between June 2005 and January 2010. Sixty-one patients (collective B) were treated by surgeon B between August 2008 and December 2009. From January to June 2008, surgeon B performed many hip arthroscopies under supervision of surgeon A. Complications were recorded in a central complication register. Statistic analysis of the complication rates was performed using Fischer's exact T test.
Subdividing collective A chronologically into thirds a significant decline of complications (p = 0.0044) was found with growing experience of the surgeon. Comparing the first 61 patients of both surgeons a significantly lower complication rate was discovered in the patients of surgeon B (p = 0.0375). In total there were 21 complications (6.6 %; CI 4.4-9.9 %). The observed complication rate was 7.0 % in collective A and 4.9 % in collective B.
The learning curve can be comprehended by the distribution of complications in collective A. Having spent 6 months performing under supervision of surgeon A, surgeon B has a lower complication rate than surgeon A when comparing the first 61 patients each surgeon operated on. This implies that surgeon B benefits from the experience of surgeon A. According to this analysis, beginners in arthroscopic FAI treatment should be taught at a specialized centre to reduce the number of complications.
本研究的目的是通过分析关节镜治疗股骨髋臼撞击症（FAI）的并发症发生率来验证该手术的学习曲线。此外，还研究了在开始进行关节镜下FAI治疗时，由经验丰富的外科医生进行监督是否会导致更陡峭的学习曲线（更低的并发症发生率）。
分析了317例仅诊断为FAI的连续患者中发生的并发症。256例患者（A组）在2005年6月至2010年1月期间由外科医生A治疗。61例患者（B组）在2008年8月至2009年12月期间由外科医生B治疗。2008年1月至6月，外科医生B在外科医生A的监督下进行了多次髋关节镜检查。并发症记录在中央并发症登记册中。使用费舍尔精确T检验对并发症发生率进行统计分析。
按时间顺序将A组细分为三等份，发现随着外科医生经验的增加，并发症显著减少（p = 0.0044）。比较两位外科医生的前61例患者，发现外科医生B的患者并发症发生率显著更低（p = 0.0375）。总共有21例并发症（6.6%；CI 4.4 - 9.9%）。A组观察到的并发症发生率为7.0%，B组为4.9%。
通过A组并发症的分布可以理解学习曲线。在外科医生A的监督下进行了6个月的手术之后，比较每位外科医生最初手术的61例患者，外科医生B的并发症发生率低于外科医生A。这意味着外科医生B受益于外科医生A的经验。根据该分析，关节镜下FAI治疗的初学者应在专业中心接受培训，以减少并发症的数量。
