经皮辅助全髋关节置换术（PATH）和经囊外辅助全髋关节置换术（SuperPATH）：学习曲线和早期结果。
Percutaneously assisted total hip (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes.
机构信息
The Ottawa Hospital-Civic Campus, Ottawa, Ontario K1Y 4E9, Canada.
出版信息
Ann Transl Med. 2015 Aug;3(13):179. doi: 10.3978/j.issn.2305-5839.2015.08.02.
BACKGROUND
A new family of micro-posterior approaches, percutaneously assisted total hip (PATH), SuperCapsular (SuperCap) and Supercapsular percutaneously assisted total hip (SuperPATH) allow preservation of the short external rotators. This study assesses early outcomes and learning curves of the PATH and SuperPATH approaches.
METHODS
Early outcomes of the first consecutive 49 PATH and 50 SuperPATH cases performed by a non-developer surgeon were evaluated. Analysis of variance (ANOVA) was used to compare age, body mass index (BMI), and pre-operative hemoglobin. Gender was compared using a Chi-square test. Clinical outcomes were compared using a nonparametric Wilcoxon test or a Chi-square test. Learning curves were assessed using operative time as a surrogate. Acetabular cup abduction and anteversion were compared using the first post-operative radiograph and a modified protractor.
RESULTS
Both cohorts were similar with respect to diagnosis, gender, and BMI. Mean operative time in minutes was recorded for the PATH (114.5±17.5) and SuperPATH (101.7±18.3) cohorts (P value =0.0002). PATH operative time reached a plateau by case 40, but SuperPATH operative time continued to decrease by case 50. Transfusion rates were low in the PATH (4%) and SuperPATH (6%) cohorts. Mean length of stay (LOS) in days for the SuperPATH and PATH cohorts were 2.2 and 3.0, respectively (P value <0.0001). Complication rates were low in the SuperPATH (4.0%) and PATH (4.1%) cohorts. Acetabular cups in the SuperPATH cohort (anteversion: 23.5°±8.2°, abduction: 39.0°±8.4°) were significantly more anteverted (P value <0.0001) and less abducted (P value <0.05) than in the PATH cohort (anteversion: 13.1°±7.1°; abduction: 42.9°±7.6°).
CONCLUSIONS
Early results demonstrate that the PATH and SuperPATH approaches can be adopted with minimal complications and outcomes consistent with innovator outcomes, even during the learning curve. The SuperPATH technique was associated with shorter operative time that continued to decrease, suggesting that proficiency continues to decrease beyond the first 50 cases. In this author's experience, acetabular cups implanted using the SuperPATH technique were more anteverted than those implanted using the PATH technique. Greater use of the transverse acetabular ligament to guide cup alignment reduced this effect.
背景
一种新的微创后路入路家族，经皮辅助全髋关节置换术（PATH）、SuperCapsular（SuperCap）和经皮辅助全髋关节置换术（SuperPATH）允许保留短外旋肌群。本研究评估了非开发者外科医生进行的前 49 例 PATH 和 50 例 SuperPATH 病例的早期结果和学习曲线。
方法
评估了由一位非开发者外科医生连续进行的前 49 例 PATH 和 50 例 SuperPATH 病例的早期结果。使用方差分析（ANOVA）比较年龄、体重指数（BMI）和术前血红蛋白。使用卡方检验比较性别。使用非参数 Wilcoxon 检验或卡方检验比较临床结果。使用手术时间作为替代指标评估学习曲线。使用术后第一幅 X 线片和改良量角器比较髋臼杯外展角和前倾角。
结果
两个队列在诊断、性别和 BMI 方面相似。PATH 组（114.5±17.5 分钟）和 SuperPATH 组（101.7±18.3 分钟）的平均手术时间记录（P 值=0.0002）。PATH 手术时间在第 40 例时达到平台期，但 SuperPATH 手术时间在第 50 例时继续下降。PATH 组（4%）和 SuperPATH 组（6%）的输血率较低。SuperPATH 组和 PATH 组的平均住院时间（LOS）分别为 2.2 和 3.0 天（P 值<0.0001）。SuperPATH 组（4.0%）和 PATH 组（4.1%）的并发症发生率较低。SuperPATH 组髋臼杯的前倾角（23.5°±8.2°）和外展角（39.0°±8.4°）明显更大（P 值<0.0001），外展角更小（P 值<0.05），而 PATH 组的髋臼杯前倾角（13.1°±7.1°）和外展角（42.9°±7.6°）。
结论
早期结果表明，即使在学习曲线期间，PATH 和 SuperPATH 方法也可以采用，并发症少，结果与创新者的结果一致。SuperPATH 技术与较短的手术时间相关，且持续下降，表明在完成前 50 例病例后，熟练度仍在继续下降。在作者的经验中，使用 SuperPATH 技术植入的髋臼杯比使用 PATH 技术植入的髋臼杯更前倾。更广泛地使用横形髋臼韧带来指导髋臼杯的对准可以减少这种影响。
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