Foot and Ankle Section, Fundación Favaloro-Hospital Universitario, Buenos Aires, Argentina.
Foot and Ankle Surgery and Limb Salvage Fellowship, Foot and Ankle Section, Orthopaedics Department, Hospital Universitario-Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentine.
Foot Ankle Spec. 2024 Aug;17(4):343-351. doi: 10.1177/19386400221079198. Epub 2022 Mar 3.
The expression "learning curve" indicates the relation between the time needed to learn a new technique and the technique-related outcome. Percutaneous surgery (also called "minimally invasive surgery") has experienced sustained and respectable growth, especially in forefoot deformities. The main purpose was to assess the number of feet necessary to become skilled in a specific minimally invasive surgery (MIS) procedure.
From January 2015 to June 2018, 46 consecutive patients were evaluated and included in the study. Patients were divided into 2 groups according to the surgery period: first 30 feet (Group 1), and subsequent 30 feet (Group 2) from the whole population evaluated. Age, body mass index, and operative time were evaluated. Hallux valgus angle and the 1 to 2 intermetatarsal angle were also measured. Patients were assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scale, the Foot and Ankle Ability Measure activities of daily living (FAAM ADL) subscale and the visual analog scale (VAS).
The comparison of the 2 groups showed statistically significant differences in hallux valgus angle (HVA) but not in intermetatarsal angle (IMA). The mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS score in Group 1 were 12.83, 3.93, and 24.77 points, respectively. In Group 2, the mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS scores were 15.19, 4.3, and 24.5 points, respectively. The differences between groups in FAAM ADL score was statistically significant (P = 0.0364). Group 1 showed a global complication rate of 16.67% (n = 5) while group 2 showed 3,3% (n = 1).
After the first 30 cases, radiographic, clinical, and functional outcomes substantially improved, and the level of the perioperative complications decreased. The results suggest that the learning curve plateau for performing a percutaneous subcapital osteotomy can be reached after 30 surgeries.
Level III.
“学习曲线”表示学习新技术所需的时间与技术相关结果之间的关系。经皮手术（也称为“微创手术”）持续且可观地增长，尤其是在前足畸形中。主要目的是评估掌握特定微创外科（MIS）手术所需的足数。
从 2015 年 1 月到 2018 年 6 月，对 46 例连续患者进行了评估并纳入研究。根据手术期将患者分为两组：前 30 例（第 1 组）和整个评估人群中的后 30 例（第 2 组）。评估了年龄、体重指数和手术时间。还测量了拇外翻角和 1 至 2 跖骨间角。根据美国矫形足踝协会（AOFAS）前足量表、足踝能力日常生活活动（FAAM ADL）量表和视觉模拟量表（VAS）对患者进行评估。
两组比较显示，拇外翻角（HVA）存在统计学显著差异，但跖骨间角（IMA）无统计学显著差异。第 1 组的 FAAM ADL、VAS 和 AOFAS 评分的术前和术后平均改善分别为 12.83、3.93 和 24.77 分。在第 2 组中，FAAM ADL、VAS 和 AOFAS 评分的术前和术后平均改善分别为 15.19、4.3 和 24.5 分。FAAM ADL 评分的组间差异具有统计学意义（P = 0.0364）。第 1 组的总并发症发生率为 16.67%（n = 5），第 2 组为 3.3%（n = 1）。
在前 30 例之后，放射学、临床和功能结果得到了显著改善，围手术期并发症水平降低。结果表明，经皮骨干下截骨术的学习曲线在 30 例手术后可以达到平台期。
III 级。
