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1084例牛津单髁膝关节置换术的生存分析:顾问医师与实习医师的比较

A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty: a comparison between consultant and trainee surgeons.

作者信息

Bottomley N, Jones L D, Rout R, Alvand A, Rombach I, Evans T, Jackson W F M, Beard D J, Price A J

机构信息

NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK.

出版信息

Bone Joint J. 2016 Oct;98-B(10 Supple B):22-27. doi: 10.1302/0301-620X.98B10.BJJ-2016-0483.R1.

DOI:10.1302/0301-620X.98B10.BJJ-2016-0483.R1
PMID:27694512
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5047132/
Abstract

AIMS

The aim of this to study was to compare the previously unreported long-term survival outcome of the Oxford medial unicompartmental knee arthroplasty (UKA) performed by trainee surgeons and consultants.

PATIENTS AND METHODS

We therefore identified a previously unreported cohort of 1084 knees in 947 patients who had a UKA inserted for anteromedial knee arthritis by consultants and surgeons in training, at a tertiary arthroplasty centre and performed survival analysis on the group with revision as the endpoint.

RESULTS

The ten-year cumulative survival rate for revision or exchange of any part of the prosthetic components was 93.2% (95% confidence interval (CI) 86.1 to 100, number at risk 45). Consultant surgeons had a nine-year cumulative survival rate of 93.9% (95% CI 90.2 to 97.6, number at risk 16). Trainee surgeons had a cumulative nine-year survival rate of 93.0% (95% CI 90.3 to 95.7, number at risk 35). Although there was no differences in implant survival between consultants and trainees (p = 0.30), there was a difference in failure pattern whereby all re-operations performed for bearing dislocation (n = 7), occurred in the trainee group. This accounted for 0.6% of the entire cohort and 15% of the re-operations.

CONCLUSION

This is the largest single series of the Oxford UKA ever reported and demonstrates that good results can be achieved by a heterogeneous group of surgeons, including trainees, if performed within a high-volume centre with considerable experience with the procedure. Cite this article: Bone Joint J 2016;(10 Suppl B):22-7.

摘要

目的

本研究旨在比较由实习外科医生和会诊医生实施的牛津内侧单髁膝关节置换术(UKA)此前未报道的长期生存结果。

患者与方法

因此,我们确定了一个此前未报道的队列,该队列包括947例患者的1084个膝关节,这些患者在一家三级关节置换中心由会诊医生和实习外科医生为前内侧膝关节关节炎进行了UKA置换,并以翻修为终点对该组进行了生存分析。

结果

假体部件任何部分翻修或更换的十年累积生存率为93.2%(95%置信区间(CI)86.1至100,风险数45)。会诊外科医生的九年累积生存率为93.9%(95%CI 90.2至97.6,风险数16)。实习外科医生的九年累积生存率为93.0%(95%CI 90.3至95.7,风险数35)。尽管会诊医生和实习医生之间的植入物生存率没有差异(p = 0.30),但失败模式存在差异,即所有因轴承脱位进行的再次手术(n = 7)均发生在实习医生组。这占整个队列的0.6%和再次手术的15%。

结论

这是有史以来报道的牛津UKA最大的单一系列研究,表明如果在一个对此手术有丰富经验的高容量中心进行手术,包括实习医生在内的不同外科医生群体都能取得良好的结果。引用本文:《骨与关节杂志》2016年;(10增刊B):22 - 7。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e78/5047132/79dd05867c5d/BJJ-2016-0483.R1-galleyfig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e78/5047132/79dd05867c5d/BJJ-2016-0483.R1-galleyfig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e78/5047132/79dd05867c5d/BJJ-2016-0483.R1-galleyfig1.jpg

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