Brun Ole-Christian L, Månsson Lukas, Nordsletten Lars
1 Oslo University Hospital, Ullevål, Oslo - Norway.
2 Drammen Hospital, Vestre Viken, Drammen - Norway.
Hip Int. 2018 Mar;28(2):156-160. doi: 10.5301/hipint.5000542. Epub 2017 Oct 16.
Introduction of new surgical techniques is normal, but seldom monitored in real time. The purpose of this study was to monitor the learning curve when introducing a new surgical technique to a department. We did a prospective evaluation of the learning curve when introducing the minimally invasive direct anterior approach in total hip arthroplasty. We wish to investigate whether there is a learning curve for the direct anterior minimal invasive approach in total hip replacement and what are the early complications to this approach.
The department changed from the direct lateral approach to the minimally invasive direct anterior approach. We monitored the first 522 patients operated using this approach with regards to patient outcome scores and complications 6 months postoperatively.
The last 250 patients operated all had significantly better results with regard to patient outcome scores and cup placement. We investigated 100 patients at a time and compared them with the rest of the patient and found the same pattern. This pattern ends when we reach patients somewhere between 200-300.
We established the learning curve on a departmental level with regards to introduction of the minimal invasive direct anterior approach. We see a steady improvement in scores with regards to patient outcome scores and cup positioning until we reach a steady-state. The learning curve here flattens out. Departments must understand that one should expect early complications and somewhat less than optimal results at first when introducing this new surgical technique.
新手术技术的引入很常见，但很少进行实时监测。本研究的目的是在一个科室引入新手术技术时监测学习曲线。我们对在全髋关节置换术中引入微创直接前路手术的学习曲线进行了前瞻性评估。我们希望研究在全髋关节置换术中直接前路微创方法是否存在学习曲线，以及该方法的早期并发症有哪些。
该科室从直接外侧入路改为微创直接前路入路。我们对首批采用该入路手术的522例患者术后6个月的患者预后评分和并发症情况进行了监测。
最后接受手术的250例患者在患者预后评分和髋臼置入方面均有明显更好的结果。我们每次调查100例患者，并将他们与其他患者进行比较，发现了相同的模式。当我们调查到200 - 300例患者之间时，这种模式结束。
我们在科室层面建立了关于引入微创直接前路入路的学习曲线。在达到稳定状态之前，我们看到患者预后评分和髋臼定位评分稳步提高。这里的学习曲线趋于平缓。各科室必须明白，在引入这种新手术技术时，一开始会出现早期并发症，且结果可能不太理想。
