直接前入路学习曲线对人工股骨头置换治疗股骨颈骨折临床疗效的影响

Effect of Direct Forward Approach Learning Curve on the Clinical Effect of Artificial Femoral Head Replacement for Femoral Fracture and Neck Fracture

目的评估直接前入路学习曲线是否影响人工股骨头置换治疗股骨颈骨折临床疗效。方法回顾性分析莆田市第一医院2014年8月-2016年1月采用直接前入路人工股骨头置换治疗股骨颈骨折的100例患者临床资料,手术均由同一名具有高级职称的医师完成,按实施手术次序先后分为2组,A组:前50例;B组:后50例。两组的人口统计学数据及术前ASA评分,差异无统计学意义(P>0.05),比较两组临床疗效和围手术期并发症的差异。结果术后平均随访12个月(6~24个月),所有患者均获得随访。A组平均手术时间(125±30)min比B组(98±14)min长,差异有统计学意义(t=3.058,P<0.05),术中出血量(375±81)mL比B组(125±91)mL多,差异有统计学意义(t=2.209,P<0.05),A组术前后肌酸激酶差值(328±181)U/L比B组(170±132)U/L大,差异有统计学意义(t=2.217,P<0.05),术后第2天TUG检测步行速度(15.6±2.12)min亦快于A组(18.8±3.21)min(t=2.012,P=0.001),术后2周TUG检测步行速度两组,差异无统计学意义(t=0.272,P=0.786),A组住院时间(13±4)d大于B组(9±2)d,差异有统计学意义(t=3.368,P<0.05),A组术后VAS评分(3.5±0.3)分高于B组(1.5±0.5)分,差异有统计学意义(t=2.258,P=0.012)。A组较B组更高的并发症发生率。结论直接前入路学习曲线对人工股骨头置换治疗股骨颈骨折临床疗效具有明显的影响,初学者需要慎重选择高龄股骨颈骨折病例,同时通过理论学习、尸体培训缩短学习曲线和减少并发症。

Objective To evaluate whether the learning curve of direct forward approach affects the clinical effect of artificial femoral head replacement for femoral neck fracture. Methods Retrospective analysis was made on the clinical data of 100 patients with femoral neck fracture treated by direct anterior approach artificial femoral head replacement in putian first hospital from August 2014 to January 2016. All the surgeries were performed by the same senior title physician, and were divided into 2 groups according to the operation sequence. Group A: the first 50 cases;Group B: the last 50 cases.There was no significant difference in demographic data and preoperative ASA score between the two groups(P>0.05), and the differences in clinical efficacy and perioperative complications between the two groups were compared. Results The mean postoperative follow-up was 12 months(6-24 months), and all patients were followed up. The average operation time of group A(125±30)min was longer than that of group B(98±14)min,the difference was statistically significant(t=3.058, P<0.05), the intraoperative blood loss(375±81)mL was higher than that of group B(125±91)mL,the difference was statistically significant(t=2.209, P<0.05), and the preoperative creatine kinase difference(328±181)U/L was greater than that of group B(170±132)U/L,the difference was statistically significant(t=2.217, P <0.05). Postoperative day 2 TUG test walking speed(15.6±2.12)min is also faster than group A(18.8±3.21)min,the difference was statistically significant(t=2.012, P=0.001), 2 weeks after TUG detection walking speed no statistical differences in the two groups,the difference was statistically significant(t=0.272, P=0.786), length of hospital stay(13±4)d group A than group B(9±2)d,the difference was statistically significant(t=3.368, P<0.05), postoperative VAS score in group A(3.5±0.3)points higher than that of group B(1.5±0.5)points,the difference was statistically significant(t=2.258, P=0.012). Group A had A higher complication rate than group B.Conclusion The learning curve of direct forward approach has a significant impact on the clinical efficacy of artificial femoral head replacement in the treatment of femoral neck fractures. Beginners need to carefully select elderly cases of femoral neck fractures, and shorten the learning curve and reduce complications through theoretical learning and cadaver training.