从后路全髋关节置换术转为前路保肌入路的优势：最小化学习曲线。
Advantages of an Anterior-Based Muscle-Sparing Approach in Transitioning From a Posterior Approach for Total Hip Arthroplasty: Minimizing the Learning Curve.
机构信息
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; OrthoLA Adult Reconstruction, Thibodaux, LA.
出版信息
J Arthroplasty. 2019 Dec;34(12):2962-2967. doi: 10.1016/j.arth.2019.07.009. Epub 2019 Jul 12.
BACKGROUND
Enthusiasm for anterior-based approaches for total hip arthroplasty (THA) continues to increase but there is concern for increased complications during the learning curve period associated. This study aimed to investigate if there was a difference in perioperative variables, intraoperative and immediate postoperative complications, or patient-reported outcomes when transitioning from a mini-posterior approach (mPA) to an anterior-based muscle-sparing (ABMS) approach for THA.
METHODS
Retrospective cohort study on the first 100 primary THA cases (n = 96 patients) of the senior author (August 2016 to August 2017) using the ABMS approach. These cases were compared to primary THA cases done the year prior (July 2015 to July 2016, n = 91 cases in 89 patients) using an mPA. Data were extracted and analyzed via gamma regression with robust standard errors and using generalized estimating equation regression.
RESULTS
We found no difference in the estimated blood loss (P = .452) and surgical time (P = .564) between the cohorts. The ABMS cases had a slightly shorter length of stay (P = .001) with an adjusted mean length of stay of 1.53 days (95% confidence interval 1.4-1.6) compared to 1.85 days (95% confidence interval 1.8-1.9) in the mPA cases. There was no difference in the frequency of immediate postoperative complications (all, P > .05). There was no difference in the adjusted mean change in patient-reported outcomes (all P > .05). In the ABMS group, there was no difference in surgical time or physical function computerized adaptive test between the first 20 cases (reference) and each subsequent group of 20 cases (all P > .05).
CONCLUSION
This study demonstrates no associated learning curve for an experienced senior surgeon when switching routine THA approach from mPA to ABMS. We advise careful interpretation of our results, as they may not apply to all surgeons and practices.
LEVEL OF EVIDENCE
Level III Therapeutic Study: retrospective comparative study.
背景
对于全髋关节置换术（THA）的前侧入路，人们的热情持续高涨，但对于与之相关的学习曲线期间增加的并发症存在担忧。本研究旨在探讨从微创后入路（mPA）转换为前侧肌保留（ABMS）入路行 THA 时，围手术期变量、术中及术后即刻并发症或患者报告的结局是否存在差异。
方法
对 100 例初次 THA 的患者（n=96 例）进行回顾性队列研究，其中高级作者（2016 年 8 月至 2017 年 8 月）采用 ABMS 入路，这些患者与前一年（2015 年 7 月至 2016 年 7 月，91 例患者中的 89 例）使用 mPA 进行初次 THA 的患者进行比较。使用广义估计方程回归和稳健标准误差进行数据提取和分析。
结果
我们发现两组间的估计失血量（P=0.452）和手术时间（P=0.564）无差异。ABMS 组的住院时间稍短（P=0.001），调整后的平均住院时间为 1.53 天（95%置信区间为 1.4-1.6），而 mPA 组为 1.85 天（95%置信区间为 1.8-1.9）。术后即刻并发症的频率无差异（均 P＞0.05）。患者报告的结局的调整后平均变化无差异（均 P＞0.05）。在 ABMS 组中，前 20 例（参照组）与随后的每 20 例组（均 P＞0.05）之间手术时间或物理功能计算机自适应测试无差异。
结论
本研究表明，对于经验丰富的高级外科医生来说，从 mPA 切换到 ABMS 进行常规 THA 时，不存在学习曲线。我们建议谨慎解释我们的结果，因为它们可能不适用于所有外科医生和实践。
证据水平
三级治疗研究：回顾性比较研究。
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