Amano Takafumi, Hasegawa Yukiharu, Kawasaki Masashi, Yamaguchi Jin, Seki Taisuke, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya - Japan.
Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya - Japan.
Hip Int. 2016 Mar-Apr;26(2):180-5. doi: 10.5301/hipint.5000314. Epub 2016 Feb 23.
Periacetabular osteotomy is an excellent intervention for patients at early-stage osteoarthritis, but surgical education for this technique is more difficult than that for total hip arthroplasty.
47 joints were included from patients who underwent eccentric rotational acetabular osteotomy (ERAO) performed by 6 trainees under the instructing physician's guidance. We evaluated operative time, blood loss, radiographic parameters, clinical scores, perioperative complications, and 10-year survival rates. We also compared trainees' cases with 47 joints from patients in a sex- and age-matched control group that underwent ERAO performed by the instructing physician.
Hip surgery trainees took an average of 152 minutes and the instructor took 103 minutes. Blood loss during surgery by the trainees and the instructor was 382 and 276 g, respectively. Postoperatively, for the trainee and instructor groups, respectively, the Harris Hip Score improved to 88.9 and 93.7 points; the average centre-edge angle improved to 34.0°and 36.1°; and the average acetabular head index was 93.9% and 95.7%. Perioperative and postoperative complications were observed in 14 patients of the trainee group and 3 patients of the instructor group, which were significantly different (p = 0.0061). The 10-year survival rates were 97.8% and 100% for the trainee and instructor groups, respectively.
Postoperative imaging evaluations showed no evident differences in coverage. Postoperative clinical outcomes were also satisfactory. Thus, under proper guidance, education to hip surgery trainees on operative techniques is possible. Instructors need to make more effort to prevent complications by providing good education.
髋臼周围截骨术是早期骨关节炎患者的一种优秀干预措施，但该技术的手术教学比全髋关节置换术更困难。
纳入6名学员在指导医师指导下进行偏心旋转髋臼截骨术（ERAO）的患者的47个关节。我们评估了手术时间、失血量、影像学参数、临床评分、围手术期并发症和10年生存率。我们还将学员的病例与由指导医师进行ERAO的性别和年龄匹配对照组的47个关节进行了比较。
髋关节手术学员平均用时152分钟，指导医师用时103分钟。学员和指导医师手术中的失血量分别为382克和276克。术后，学员组和指导医师组的Harris髋关节评分分别提高到88.9分和93.7分；平均中心边缘角分别提高到34.0°和36.1°；平均髋臼头指数分别为93.9%和95.7%。学员组14例患者和指导医师组3例患者观察到围手术期和术后并发症，差异有统计学意义（p = 0.0061）。学员组和指导医师组的10年生存率分别为97.8%和100%。
术后影像学评估显示覆盖范围无明显差异。术后临床结果也令人满意。因此，在适当的指导下，对髋关节手术学员进行手术技术教育是可行的。指导医师需要通过提供良好的教育来更加努力地预防并发症。
