初次反向全肩关节置换术中的肩胛盂骨移植：学习曲线分析
Glenoid Bone Grafting During Primary Reverse Shoulder Arthroplasty: A Learning-Curve Analysis.
作者信息
Hussain Zaamin B, Khawaja Sameer R, Gulzar Musab, Cooke Hayden L, Chopra Krishna N, Roundy Robert S, Gottschalk Michael B, Wagner Eric R
机构信息
Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia.
出版信息
JB JS Open Access. 2025 Apr 25;10(2). doi: 10.2106/JBJS.OA.24.00125. eCollection 2025 Apr-Jun.
BACKGROUND
Reverse shoulder arthroplasty (RSA) with structural bone grafting of the glenoid utilizing an autograft from the resected humeral head is an effective strategy to address severe glenoid bone loss. Although learning curves have been established for RSA, RSA with bone grafting is more technically challenging, with relatively higher complication rates. The number of cases needed for proficiency and the optimal learning strategies have yet to be defined for RSA with bone grafting.
METHODS
All patients who underwent primary, single-stage RSA with bone grafting for severe glenoid bone loss at our institution between November 2018 and February 2022 were identified. Perioperative data, including imaging, operative time, complications, revisions, postoperative functional data, and patient-reported outcomes, were recorded and analyzed. The learning curve for a fellowship-trained shoulder and elbow surgeon was analyzed using linear regression and cumulative sum (CUSUM) analysis. CUSUM analysis objectively evaluated differences in operative time over the course of the surgeon's practice and elucidated the completion of the learning curve.
RESULTS
A total of 32 patients (53% male and 47% female; mean age, 68 years) were included in the analysis. The mean follow-up was 28 months. The mean operative time was 127 minutes, and there was a linear decrease in operative time throughout the study. CUSUM analysis using operative times demonstrated that the surgeon's learning curve was 14 patients. When comparing patients among the first 14 cases and the last 18 cases, there was no difference in shoulder range of motion, American Shoulder and Elbow Surgeons (ASES) scores, and Subjective Shoulder Value (SSV), while visual analog scale (VAS) pain scores at the time of final follow-up were better for patients in the surgeon's proficiency phase compared with the learning phase.
CONCLUSIONS
In this study, we found a significant linear decrease in operative time with the number of cases completed, without associated detriment to the postoperative outcome or complication rate. Our findings suggest that at least 14 cases may be required before proficiency is obtained with RSA using humeral head bone graft.
LEVEL OF EVIDENCE
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
采用切除的肱骨头自体骨移植对肩胛盂进行结构性植骨的反肩关节置换术（RSA）是治疗严重肩胛盂骨缺损的有效策略。尽管已经确定了RSA的学习曲线，但植骨的RSA在技术上更具挑战性，并发症发生率相对较高。对于植骨的RSA，达到熟练所需的病例数和最佳学习策略尚未明确。
方法
确定2018年11月至2022年2月期间在本机构接受原发性单阶段植骨RSA治疗严重肩胛盂骨缺损的所有患者。记录并分析围手术期数据，包括影像学、手术时间、并发症、翻修情况、术后功能数据以及患者报告的结果。使用线性回归和累积和（CUSUM）分析对一名接受过肩肘专科培训的外科医生的学习曲线进行分析。CUSUM分析客观评估了外科医生在手术过程中手术时间的差异，并阐明了学习曲线的完成情况。
结果
共有32例患者（男性53%，女性47%；平均年龄68岁）纳入分析。平均随访时间为28个月。平均手术时间为127分钟，在整个研究过程中手术时间呈线性下降。使用手术时间进行的CUSUM分析表明，外科医生的学习曲线为14例患者。比较前14例和后18例患者，肩关节活动范围、美国肩肘外科医生（ASES）评分和主观肩关节价值（SSV）无差异，而与学习阶段相比，外科医生熟练阶段患者在最终随访时的视觉模拟量表（VAS）疼痛评分更好。
结论
在本研究中，我们发现随着完成病例数的增加，手术时间显著线性下降，且对术后结果或并发症发生率无相关不利影响。我们的研究结果表明，使用肱骨头骨移植进行RSA至少需要14例病例才能达到熟练水平。
证据水平
预后IV级。有关证据水平的完整描述，请参阅作者指南。
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