Fukushima Takashi, Takahashi Tsuneari, Takeshita Katsushi
Department of Orthopaedic Surgery, Tochigi Medical Center Shimotsuga, Tochigi, Japan.
Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan.
Geriatr Orthop Surg Rehabil. 2025 Apr 25;16:21514593251338596. doi: 10.1177/21514593251338596. eCollection 2025.
The posterior approach is widely used in hemiarthroplasty for femoral neck fractures. However, it has a high dislocation rate. In hemiarthroplasty, the joint capsule is commonly incised. This study aimed to identify a posterior surgical technique that completely preserves the joint capsule without incision and the use of special devices to remove the head, perform a trial, and place an implant. Further, the learning curves (LCs) of trainee surgeons and the associated complications of the posterior approach were evaluated via a retrospective case series. The LCs of trainee surgeons for surgical duration and volume of intraoperative blood loss in 60 cases were examined. The surgical procedures were conducted by three trainee surgeons for femoral neck fractures at a single institution between September 2018 and June 2021. Each surgeon consecutively performed 20 surgical procedures. Each surgeon's cases were divided into four groups, with 15 cases each: 1-5, group A; 6-10, group B; 11-15, group C; and 16-20, group D. Then, these cases were analyzed. Surgery-related complications, such as dislocation, femoral fractures, paralysis, and infection were investigated. The four groups significantly differed in terms of the median operative duration ( = 0.017). In particular, there was a significant difference between groups A and C ( = 0.007) and between groups A and D ( = 0.006). There was an LC for the surgical duration. In 10 cases, the surgical duration was shorter. However, there was no significant difference in the volume of intraoperative blood loss among the four groups. None of the patients presented with dislocation or major complications. An LC was observed for the surgical duration in 10 cases among the trainee surgeons. Moreover, the volume of intraoperative blood loss did not significantly increase during the LC period.
后路手术在股骨颈骨折半髋关节置换术中被广泛应用。然而，其脱位率较高。在半髋关节置换术中，关节囊通常会被切开。本研究旨在确定一种后路手术技术，该技术能在不切开关节囊且不使用特殊器械移除股骨头的情况下完整保留关节囊，进行试验并植入假体。此外，通过回顾性病例系列评估实习外科医生的学习曲线（LCs）以及后路手术相关并发症。检查了60例患者中实习外科医生手术持续时间和术中失血量的学习曲线。2018年9月至2021年6月期间，由三名实习外科医生在单一机构对股骨颈骨折进行手术操作。每位外科医生连续进行20例手术。每位外科医生的病例分为四组，每组15例：1 - 5例为A组；6 - 10例为B组；11 - 15例为C组；16 - 20例为D组。然后，对这些病例进行分析。调查手术相关并发症，如脱位、股骨骨折、瘫痪和感染。四组在中位手术持续时间方面存在显著差异（= 0.017）。特别是，A组和C组之间（= 0.007）以及A组和D组之间（= 0.006）存在显著差异。手术持续时间存在学习曲线。在10例病例中，手术持续时间较短。然而，四组术中失血量无显著差异。所有患者均未出现脱位或重大并发症。在实习外科医生的10例病例中观察到手术持续时间的学习曲线。此外，在学习曲线期间术中失血量没有显著增加。
