在学习曲线中导航：评估病例量，并比较计算机导航全髋关节置换术学习曲线前后的结果。
Navigating the learning curve: assessing caseload and comparing outcomes before and after the learning curve of computer-navigated total hip arthroplasty.
机构信息
Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA.
Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
出版信息
J Robot Surg. 2024 Mar 2;18(1):104. doi: 10.1007/s11701-024-01855-4.
PURPOSE
Computer-navigated (CN) total hip arthroplasty (THA) offers improved acetabular component placement and radiographic outcomes, but inconsistent assessment methods of its learning curves render the evaluation of adopting a novel platform challenging. Therefore, we conducted a systematic review to assess the learning curve associated with CN-THA, both tracking a surgeon's performance across initial cases and comparing their performance to manual THA (M-THA).
METHODS
A search was conducted using PubMed, MEDLINE, EBSCOhost, and Google Scholar on June 16, 2023 to find research articles published after January 1, 2000 (PROSPERO registration: CRD4202339403) that investigated the learning curve associated with CN-THA. 655 distinct articles were retrieved and subsequently screened for eligibility. In the final analysis, nine publications totaling 847 THAs were evaluated. The Methodological Index for Nonrandomized Studies (MINORS) tool was utilized to evaluate the potential for bias, with the mean MINORS score of 21.3 ± 1.2.
RESULTS
CN-THA showed early advantages to M-THA for component placement accuracy and radiographic outcomes but longer operative times (+ 3- 20 min). There was a learning curve required to achieve peak proficiency in these metrics, though mixed methodologies made the required caseload unclear.
CONCLUSIONS
CN-THA offers immediate advantages to M-THA for component placement accuracy and radiographic outcomes, though CN-THA's advantages become more pronounced with experience. Surgeons should anticipate longer operative times during the learning curve for CN-THA, which lessen following a modest caseload. A more thorough evaluation of novel computer-navigated technologies would be enhanced by adopting a more uniform method of defining learning curves for outcomes of interest. Registration PROSPERO registration of the study protocol: CRD42023394031, 27 June 2023.
目的
计算机导航（CN）全髋关节置换术（THA）可改善髋臼部件的放置和影像学结果，但学习曲线的评估方法不一致，使得评估采用新平台具有挑战性。因此，我们进行了系统评价，以评估 CN-THA 相关的学习曲线，既跟踪外科医生在初始病例中的表现，又比较他们的表现与手动 THA（M-THA）。
方法
2023 年 6 月 16 日，使用 PubMed、MEDLINE、EBSCOhost 和 Google Scholar 进行了搜索，以查找自 2000 年 1 月 1 日以来发表的研究文章（PROSPERO 注册：CRD4202339403），这些文章研究了与 CN-THA 相关的学习曲线。检索到 655 篇不同的文章，并随后筛选出符合条件的文章。在最终分析中，评估了 9 篇出版物，共 847 例 THA。使用非随机研究方法学指数（MINORS）工具评估潜在的偏倚，平均 MINORS 评分为 21.3±1.2。
结果
CN-THA 在组件放置准确性和影像学结果方面早期优于 M-THA，但手术时间较长（增加 3-20 分钟）。要达到这些指标的最高熟练程度需要一个学习曲线，但混合方法使得所需的病例量不清楚。
结论
CN-THA 在组件放置准确性和影像学结果方面为 M-THA 提供了即时优势，但随着经验的增加，CN-THA 的优势变得更加明显。外科医生应预计在 CN-THA 的学习曲线期间手术时间较长，在完成适度的病例量后，手术时间会减少。通过采用更统一的方法来定义感兴趣的结果的学习曲线，对新型计算机导航技术的更全面评估将得到加强。研究方案的 PROSPERO 注册：CRD42023394031，2023 年 6 月 27 日。
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