经皮微创接骨板技术治疗胫骨骨折的学习曲线

Learning Curve of Minimally Invasive Percutaneous Plate Osteosynthesis for Fracture of the Tibia

目的探讨经皮微创接骨板技术（MIPPO）达到熟练的学习曲线规律。方法回顾分析我科2007年3月-2009年12月期间由同一组医生应用MIPPO技术治疗36例胫骨骨折的临床资料,按手术先后次序分为A、B、C 3组,每组12例,3组年龄、性别、骨折类型、伤后距离手术时间差异均无显著性（P〉0.05）,具有可比性。比较各组的手术时间及手术并发症等情况。结果 A、B、C组的手术时间分别为（115.0±22.3）min、（81.3±20.3）min、（80.6±21.1）min,A组手术时间明显长于B、C组（t=3.884,3.965,P均=0.000）,B、C组手术时间无统计学差异（P=0.936）。A组中因为内固定钢板位置放置不当及复位不佳而转为切开手术2例,B、C组无转为切开手术。3组均无明显术中及术后并发症。随访时间12-36个月,平均23.4月,各组间骨折愈合时间（P=0.183）、优良率（P=0.549）差异无显著性。结论如有开放性手术经验,12例后MIPPO技术即可达到比较熟练程度。

Objective To explore the learning curve of minimally invasive plate percutaneous osteosynthesis（MIPPO）.Methods Data from 36 cases of tibia fracture between March 2007 and December 2009 were reviewed.The cases were divided into groups A,B and C with 12 in each according to the sequence of the operations.No significant difference existed in the age,sex,fracture type,and time between injury and operation among the three groups.The operation time and intra-and post-operative complications were compared among the 3 groups.Results The operation time was（115.0±22.3） min in group A,which was significantly longer than that in groups B and C [（81.3±20.3） and（80.6±21.1） min,respectively,t=3.884 and 3.965,both P=0.000],while no statistically significant difference between B and C（P=0.936）.Two patients in group A were converted to open surgery because of improper positioning of the plate or unsatisfactory reduction.No patients in groups B and C were converted to open surgery.No intra-and postoperative complications occurred in the groups.The patients were followed up for 12 to 36 months with a mean of 23.4 months.No significant difference was observed in union time,and good and excellent rates（P=0.183 and 0.549 respectively）.Conclusion If the surgeons can complete conventional thyroidectomy proficiently,they can master MIPPO after practicing 12 cases.