Zhao Binzhi, Liu Yang, Wang Hanzhou, Zhou Junlin, Zhao Yanrui
Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China.
Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China.
Foot Ankle Surg. 2025 Apr;31(3):247-254. doi: 10.1016/j.fas.2024.10.007. Epub 2024 Nov 10.
The purpose of this study was to investigate and compare the learning curve and clinical outcomes of all-inside arthroscopic and open techniques in the treatment of chronic lateral ankle instability (CLAI).
This was a retrospective cohort analysis of 100 consecutive patients who received all-inside arthroscopic or open Brostrom-Gould surgery. These patients with CLAI were all surgically treated by the same surgeon. We applied the CUSUM analysis to assess the surgeons' learning curves, determine the cut-off point, and subsequently divide the patients into learning and proficiency groups. We recorded and compared baseline data, the preoperative and postoperative clinical function scores (AOFAS, K-P, and Tegner scores), VAS scores, time to full weight-bearing, surgery-related parameters (operation time, and postoperative hospital stays), and complications for both surgical methods during their learning and proficiency phases.
The CUSUM analysis identified a learning curve cutoff at 12 cases for open surgery and 22 cases for arthroscopic surgery. In the open surgery group, significant differences were observed in operation time between the learning and proficiency phases (P < 0.05). However, no significant differences were found in clinical function scores and postoperative full weight-bearing time. Similar trends were seen in the arthroscopic surgery group, with significant improvements in operation timeand postoperative hospitalization time in the proficiency phase compared to the learning phase (P < 0.05). However, no significant differences were found in clinical function scores between either surgical method's learning and proficiency stages. Additionally, when comparing the two surgical approaches at the same stage, significant differences emerged in VAS scores, postoperative full weight-bearing time, operation timeand postoperative hospitalization time (P < 0.05), with the arthroscopic technique showing advantages in reduced postoperative discomfort and faster recovery times.
Although arthroscopic surgery takes longer to achieve proficiency, it offers the advantages of reduced postoperative discomfort and faster recovery times during both the learning and proficiency phases while achieving comparable clinical outcomes.
本研究旨在调查和比较全关节镜技术与开放手术技术在治疗慢性外侧踝关节不稳（CLAI）方面的学习曲线和临床结果。
这是一项对100例连续接受全关节镜或开放Brostrom-Gould手术患者的回顾性队列分析。这些CLAI患者均由同一位外科医生进行手术治疗。我们应用累积和分析（CUSUM分析）来评估外科医生的学习曲线，确定分界点，随后将患者分为学习组和熟练组。我们记录并比较了两种手术方法在学习阶段和熟练阶段的基线数据、术前和术后临床功能评分（美国足踝外科协会评分、Karlsson-Peterson评分和Tegner评分）、视觉模拟评分（VAS）、完全负重时间、手术相关参数（手术时间和术后住院时间）以及并发症情况。
CUSUM分析确定开放手术的学习曲线分界点为12例，关节镜手术为22例。在开放手术组中，学习阶段和熟练阶段的手术时间存在显著差异（P < 0.05）。然而，临床功能评分和术后完全负重时间没有显著差异。关节镜手术组也观察到类似趋势，熟练阶段与学习阶段相比，手术时间和术后住院时间有显著改善（P < 0.05）。但是，两种手术方法的学习阶段和熟练阶段之间的临床功能评分没有显著差异。此外，在同一阶段比较两种手术方法时，VAS评分、术后完全负重时间、手术时间和术后住院时间出现显著差异（P < 0.05），关节镜技术在减轻术后不适和缩短恢复时间方面显示出优势。
虽然关节镜手术达到熟练程度所需时间更长，但在学习阶段和熟练阶段均具有术后不适减轻、恢复时间更快的优势，同时临床结果相当。
