Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
BMC Musculoskelet Disord. 2024 May 11;25(1):373. doi: 10.1186/s12891-024-07489-9.
An acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair.
From May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes.
Thirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly.
Minimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the "lumbar puncture needle and oval forceps" technique was accessible to surgeons.
急性跟腱断裂是一种常见的肌腱损伤，其手术方法多年来不断发展。本研究旨在量化微创急性跟腱断裂修复的学习曲线。
从 2020 年 5 月至 2022 年 6 月，回顾了 67 例接受微创跟腱修复的患者病例。收集基线数据和手术细节。使用累积和（CUSUM）控制图进行学习曲线分析。使用跟腱断裂评分（ATRS）、美国矫形足踝协会（AOFAS）踝关节/后足评分和 3/6/9/12 个月的视觉模拟评分（VAS）评估临床结果。
36 例至少随访 1 年并纳入本研究。性别比例和平均年龄分别为 80.5%和 32.5 岁。线性方程拟合良好（R=0.95），手术时间的 CUSUM 在第 12 例达到峰值，分为学习阶段（n=12）和掌握阶段（n=24）。两组在临床变量上除手术时间外无显著差异（71.1±13.2min 与 45.8±7.2min，p=0.004）。此外，我们发现 1 例缝线反应病例，并进行了妥善处理。
微创跟腱修复为早期康复提供了机会。值得注意的是，学习曲线表明，“腰椎穿刺针和椭圆形钳子”技术对外科医生来说是可行的。
