Qian Chuang, Zheng Yiming, Meng Junrong, Mo Yueqiang, Sun Jinhua, Li Hao, Wang Dahui
Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
Department of Neurosurgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
Front Pediatr. 2022 Jul 7;10:945616. doi: 10.3389/fped.2022.945616. eCollection 2022.
This study aimed to identify the threshold for success in supracondylar humeral fracture surgery by describing the learning curve for beginners and exploring the relationship between the learning curve and the prognosis of supracondylar fractures of the humerus.
Surgical information was collected of the first 100 humeral fractures treated by four pediatric orthopedic surgeons. The relationship between operation time, wire placement success rate, and surgical experience was determined using the restricted cubic strip (RCS). The inflection point in the curve and other risk factors that may affect fracture prognosis were collected and subjected to multiple logistic regression to clarify the relationship between the learning curve and prognosis of supracondylar fractures of the humerus. After the training, the four fresh surgeons were interviewed in the form of questionnaires to get feedback from the trainees.
A total of 400 supracondylar fractures of the humerus from four pediatric orthopedists were included in the study. On an RCS analysis, 65 surgical experiences were the inflection point of the learning curve. Before and after these 65 surgical experiences, there were significant differences in the patients' anatomical reduction (186 vs. 122, < 0.001), conversion to incision (33 vs. 6, = 0.008), and supervising physician guidance (28 vs. 2, < 0.001). In the multiple logistic regression analysis, functional recovery after supracondylar fractures of the humerus was significantly associated with surgical experience, intraoperative conversion to incision, and post-operative infection. Four surgeons and a supervisor were interviewed. They believed that self-confidence establishment requires the experience accumulation of about 30 operations. The most critical surgical technique is the reduction of fractures.
Although the accumulated experience of 30 operations can establish the self-confidence of trainers, fresh surgeons must accumulate experience with 65 operations to master closed reduction and internal fixation for supracondylar fractures. Surgical experience significantly impacts the post-operative recovery of patients with fractures.
Level III.
本研究旨在通过描述初学者的学习曲线并探讨学习曲线与肱骨髁上骨折预后之间的关系，确定肱骨髁上骨折手术成功的阈值。
收集了四位小儿骨科医生治疗的前100例肱骨骨折的手术信息。使用受限立方条（RCS）确定手术时间、克氏针置入成功率与手术经验之间的关系。收集曲线中的拐点及其他可能影响骨折预后的危险因素，并进行多因素逻辑回归分析，以阐明学习曲线与肱骨髁上骨折预后之间的关系。培训结束后，对四位新入职的外科医生进行问卷调查，以获取学员的反馈。
本研究共纳入了四位小儿骨科医生治疗的400例肱骨髁上骨折。经RCS分析，65次手术经验是学习曲线的拐点。在这65次手术经验前后，患者的解剖复位情况（186例对122例，<0.001）、改为切开手术的情况（33例对6例，=0.008）以及上级医生指导情况（28例对2例，<0.001）存在显著差异。在多因素逻辑回归分析中，肱骨髁上骨折后的功能恢复与手术经验、术中改为切开手术以及术后感染显著相关。对四位外科医生和一位上级医生进行了访谈。他们认为建立自信心需要约30次手术的经验积累。最关键的手术技术是骨折复位。
虽然30次手术的积累经验可以建立培训者的自信心，但新入职的外科医生必须积累65次手术的经验才能掌握肱骨髁上骨折的闭合复位和内固定术。手术经验对骨折患者的术后恢复有显著影响。
三级。
