Simon Peter, Streit Jonathan J, Abboud Joseph A, Mighell Mark A, Williams Gerald R, Frankle Mark A
Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
Department of Orthopaedics and Sport Medicine, University of South Florida, Tampa, FL, USA.
JSES Open Access. 2018 Mar 13;2(1):18-22. doi: 10.1016/j.jses.2017.11.001. eCollection 2018 Mar.
It is believed that both patient and surgeon factors contribute to premature implant loosening. This video study was designed to answer the following questions: Can orthopedic surgeons reliably differentiate between procedures done well and those that will lead to early glenoid failure? Do the difficulty of the operation and the surgeon's performance predict a patient's outcome? Does the presence of a Walch B2 glenoid result in surgery that is evidently more difficult and performed in such a way to suggest early glenoid component failure?
Eleven upper extremity surgeons blindly graded a set of intraoperative videos of 15 total shoulder arthroplasty patients (grouped by outcome at 2 years). Evaluation questionnaires consisted of questions about the perceived difficulty and the surgeon's performance. Total and partial patient scores were calculated for each video. Higher calculated score would indicate worse postsurgical outcome.
The loosening group had a significantly higher total score ( = .0057). Also, patients with B2 glenoids scored significantly higher than patients with other wear type. The analysis of overall procedure performance indicated difference between outcome groups ( = .0063).
Our results indicate that surgeons could review surgical videos and differentiate the cases that were difficult or those that were more likely to lead to loosening of the glenoid component. The presence of a B2 glenoid was predictive of difficult surgery. The results of this study should serve as a starting point for surgeons interested in critically evaluating performance and also for those interested in finding ways to maximize patient outcomes after total shoulder arthroplasty.
人们认为患者因素和外科医生因素均会导致种植体过早松动。本视频研究旨在回答以下问题：骨科医生能否可靠地区分手术操作良好的病例和那些会导致早期关节盂失败的病例？手术难度和外科医生的表现能否预测患者的预后？Walch B2型关节盂的存在是否会导致手术明显更困难，并且以提示早期关节盂部件失败的方式进行？
11名上肢外科医生对15例全肩关节置换患者的一组术中视频进行盲法评分（按2年时的结果分组）。评估问卷包括关于感知难度和外科医生表现的问题。计算每个视频的患者总分和部分得分。计算得分越高表明术后结果越差。
松动组的总分显著更高（=0.0057）。此外，B2型关节盂患者的得分显著高于其他磨损类型的患者。对整体手术表现的分析表明结果组之间存在差异（=0.0063）。
我们的结果表明，外科医生可以查看手术视频，并区分困难病例或更可能导致关节盂部件松动的病例。B2型关节盂的存在预示着手术困难。本研究结果应作为对外科医生严格评估手术表现感兴趣的人的起点，也应作为对那些对全肩关节置换术后最大化患者预后方法感兴趣的人的起点。
