计算机辅助术前规划可改善 PFNA-II 在治疗股骨转子间骨折中的学习曲线。
Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures.
机构信息
Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
出版信息
BMC Musculoskelet Disord. 2020 Jan 16;21(1):34. doi: 10.1186/s12891-020-3048-4.
BACKGROUND
Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures.
METHODS
A total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1-20, case 21-40, case 41-53 or case 41-72).
RESULTS
The average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P < 0.01). Average radiation frequency and blood loss were 13.02 ± 2.32, 160.00 (140.00, 170.00) ml and 20.92 ± 3.27, 250.00 (195.00, 279.50) ml, respectively, with significant differences (P < 0.01). The learning curve of the surgical procedure in group A was steeper than that in group B. There were no significant differences in patient reported outcomes, hospital stay and complication rate between the two groups. Significant differences were observed between group A and B in Harris score at last follow-up in the AO/OTA type 31-A2 intertrochanteric fracture (P < 0.05).
CONCLUSION
Compared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty.
TRIAL REGISTRATION
researchregistry4770. Registered 25 March 2019.
背景
股骨转子间骨折在老年人中较为常见，通常需要手术治疗。股骨近端防旋髓内钉亚洲版（PFNA-II）被广泛用于治疗转子间骨折。计算机辅助术前规划（CAPP）系统有可能降低 PFNA-II 治疗转子间骨折的难度。本研究旨在探讨和比较 CAPP 与传统术前规划方法在股骨转子间骨折治疗中的学习曲线。
方法
回顾性分析 2012 年 3 月至 2015 年 6 月采用 PFNA-II 治疗的 125 例转子间骨折患者的临床资料。由一位初级医师采用 CAPP 手术程序进行手术的患者归入 A 组（n=53）；另一位初级医师采用传统手术的患者归入 B 组（n=72）。每组再分为三个亚组（病例 1-20、病例 21-40、病例 41-53 或病例 41-72）。
结果
A 组的平均手术时间为 45.00（42.00，50.00）min，B 组为 55.00（50.00，60.00）min（P<0.01）。A 组的平均辐射频率和出血量分别为 13.02±2.32、160.00（140.00，170.00）ml 和 20.92±3.27、250.00（195.00，279.50）ml，差异有统计学意义（P<0.01）。A 组的手术操作学习曲线比 B 组更陡峭。两组患者的术后报告结果、住院时间和并发症发生率无显著差异。在 AO/OTA 31-A2 转子间骨折中，A 组和 B 组在末次随访时的 Harris 评分存在显著差异（P<0.05）。
结论
与传统术前规划方法相比，CAPP 系统可显著缩短手术时间、减少辐射频率和出血量，从而降低 PFNA-II 治疗的学习难度。
试验注册
researchregistry4770. 2019 年 3 月 25 日注册。
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