微创 Chevron Akin（MICA）截骨术的辐射暴露、手术时间和并发症发生率的学习曲线。
Learning curve in relation to radiation exposure, procedure duration and complications rate for Minimally Invasive Chevron Akin (MICA) osteotomy.
机构信息
Department of Orthopaedics, University Clinical Centre Maribor, Ljubljanska Ulica 5, 2000, Maribor, Slovenia.
出版信息
BMC Musculoskelet Disord. 2023 Jul 15;24(1):575. doi: 10.1186/s12891-023-06706-1.
BACKGROUND
Minimally invasive chevron Akin osteotomy (MICA) has become increasingly common and is compatible with the traditional open approaches for hallux valgus correction. However, it is impeded by concerns regarding the steep learning curve, increased radiation exposure and some specific complications. No standardized method for identifying a learning curve exists. We used a reproducible mathematical model to accurately define the learning curve of MICA with a focus on fluoroscopy time, procedure duration and complications rate.
METHODS
We conducted a retrospective study of MICA procedure performed by a single surgeon during his initial experience with this procedure. The chronologic case number was plotted against variables of interest and learning was identified as the point at which instantaneous rate of change of a curve fit to the data set equalled the average rate of change of the data set.
RESULTS
One hundred cases have been analysed. Learning plateau in operation time was achieved after 29 cases, with the first 29 cases requiring a median of 60 min compared to 40 min for the latter 71 cases. Proficiency in fluoroscopy application occurred in case 30. The median fluoroscopy time for the first 30 cases was 86 seconds compared to 70 seconds in another 70 cases. The complication rate plateau was reached after 42 cases, with 15 of 22 complications occurring in the group operated first.
CONCLUSION
Results demonstrate surgeon's comfort with MICA to minimize operative time and radiation exposure after 30 cases. The plateau is achieved later for complications. Findings impose lag between surgeon feeling comfortable with procedure and a decrease in complications. Further research is reasonable to analyse several surgeons learning curve and to generate a potential reference learning curve that could serve as a normative.
TRIAL REGISTRATION
UKC-MB-KME-33/19, retrospectively registered.
背景
微创 Chevron Akin 截骨术（MICA）越来越普遍，与传统的拇外翻矫正开放方法兼容。然而，它受到了对陡峭学习曲线、增加的辐射暴露和一些特定并发症的担忧的阻碍。目前还没有标准化的方法来确定学习曲线。我们使用了一种可重复的数学模型，以准确确定 MICA 的学习曲线，重点是透视时间、手术持续时间和并发症发生率。
方法
我们对一名外科医生在初次接触该手术时进行的 MICA 手术进行了回顾性研究。病例的时间顺序与感兴趣的变量相关联，学习被定义为曲线拟合数据集的瞬时变化率等于数据集的平均变化率的点。
结果
分析了 100 例病例。手术时间的学习平台在 29 例后达到，前 29 例的中位数为 60 分钟，而其余 71 例为 40 分钟。在第 30 例中实现了透视应用的熟练程度。前 30 例的中位数透视时间为 86 秒，而在另外 70 例中为 70 秒。并发症发生率的平台在 42 例后达到，在第一组手术中有 15 例发生了 22 例并发症。
结论
结果表明，外科医生在进行 30 例手术后能够舒适地进行 MICA，以尽量减少手术时间和辐射暴露。并发症的平台达到较晚。这些发现表明，外科医生对手术的舒适度与并发症的减少之间存在滞后。进一步的研究是合理的，以分析几位外科医生的学习曲线，并生成潜在的参考学习曲线，作为参考。
试验注册
UKC-MB-KME-33/19，回顾性注册。
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