Hasegawa Yukiharu, Amano Takafumi
Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2015 Feb;77(1-2):51-7.
A total of 483 hips treated by primary total hip arthroplasty (THA) were investigated to evaluate the surgical skill of the performing surgeon. Surgical trainees operated on 259 hips and instructors on 224 hips. The average age of the patients at the time of THA in the trainee and instructor group was 61.9 and 60.8 years old, respectively. The average follow-up duration was 5.1 years. The operative time in the trainee group and instructor group was 87.0 and 73.1 min, respectively (p=0.031). Complications were noted in 11 hips (3.5%) in the trainee group; acetabular fracture, 3 hips; dislocation, 3 hips; femoral artery lacerations that needed repair surgery, 2 hips; sciatic nerve palsy, 2 hips; and skin necrosis, 1 hip. Complication were noted in three hips (1.3%) in the instructor group; femoral fracture, 1 hip; acetabular fracture, 1 hip; dislocation, 1 hip. Complication rate in the trainee group was higher than in the instructor group. The monitored quality of the surgeries performed by trainees and instructors was not significantly different. Poor quality was identified in 14 hips in the trainee group and 6 hips in instructor group. No significant difference was found in the hip score between the trainees and instructors before and after surgery. Revision arthroplasty was defined as the end-point for primary THA. Kaplan-Meier survivorship at 5 years after primary THA was 97.2% in trainee group and 97.3% in the instructor group. Short-term clinical and radiographic results of primary THA in the trainee and instructor groups were considered safe and satisfactory.
对总共483例接受初次全髋关节置换术（THA）的髋关节进行了调查，以评估主刀医生的手术技巧。外科实习生为259例髋关节进行了手术，带教老师为224例髋关节进行了手术。实习生组和带教老师组患者在进行THA时的平均年龄分别为61.9岁和60.8岁。平均随访时间为5.1年。实习生组和带教老师组的手术时间分别为87.0分钟和73.1分钟（p = 0.031）。实习生组有11例髋关节（3.5%）出现并发症；髋臼骨折3例；脱位3例；需要修复手术的股动脉撕裂2例；坐骨神经麻痹2例；皮肤坏死1例。带教老师组有3例髋关节（1.3%）出现并发症；股骨骨折1例；髋臼骨折1例；脱位1例。实习生组的并发症发生率高于带教老师组。实习生和带教老师所实施手术的监测质量没有显著差异。实习生组有14例髋关节、带教老师组有6例髋关节被判定为手术质量差。实习生和带教老师组手术前后的髋关节评分没有显著差异。翻修置换术被定义为初次THA的终点。初次THA后5年，实习生组的Kaplan-Meier生存率为97.2%，带教老师组为97.3%。实习生组和带教老师组初次THA的短期临床和影像学结果被认为是安全且令人满意的。
