应用累积和控制图分析全膝关节置换术中电子压力垫片指导软组织平衡的学习曲线

Cumulative sum control chart analysis of soft tissue balance in total knee replacement assisted by electronic pressure sensor

目的:使用累积和(cumulative sum,CUSUM)控制图绘制学习曲线,探讨术者在电子压力垫片(sensor)辅助全膝关节置换术(total knee arthoplasty,TKA)中软组织平衡的学习能力。方法:回顾性分析一位高年资医师最初完成的73膝sensor辅助TKA数据,其中男性8例(8膝),女性52例(65膝),平均年龄(67.5±5.9)岁(57~82岁)。测量膝关节伸直(0°)和屈曲45°、90°、120°时内外侧间隙平衡情况,了解内外侧压力分布,绘制CUSUM学习曲线。结果:膝关节0°时内侧压力显著高于外侧(P<0.01),屈曲后内外侧压力均快速下降,屈曲45°~120°时内外侧压力相似。0°时的学习曲线在第34膝自上而下穿过可接受控制线,表明膝关节伸直位软组织平衡最易通过sensor学习掌握;屈曲45°时的学习曲线始终在不可接受线上方,表明中屈曲角度膝关节平衡最难掌握;屈曲90°和120°时,分别在第68膝和57膝穿过可接受线,表明屈曲及极度屈曲时的软组织平衡技术可经过增加手术例数获得提高。结论:sensor学习过程简单,可以辅助TKA术中的软组织平衡,指导关节外科医师进一步掌握软组织平衡技术。

Objective:To explore the training ability of pad to guide the balance of soft tissue by drawing cumulative sum(CUSUM)control chart total knee arthroplasty(TKA)sensor.Methods:The data of 73 knees of TKA assisted by electronic gasket initially completed by a senior physician were analyzed retrospectively.There were 8 males(8 knees)and 52 females(65 knees),with an average age of(67.5±5.9)years(57-82 years).The balance of the internal and external space of knee joint was measured at 0°,45°,90°,and 120°,in order to observe the pressure distribution of the medial and la-teral compartments,and CUSUM learning curve was drawn.Results:In 0°extension,the medial pressure was higher than the lateral(P<0.01),when flexion began,the medial and lateral pressures decreased,and became stable and approximately equal during 45°-120°.In the learning curve,by knee 34,CUSUM 0°curve crossed the acceptable control line from above,which showed that it was easy to grasp the soft tissue balance at 0°position through sensor learning.CUSUM 45°curve was above the unacceptable control line in the end,which meant that it was difficult to grasp the technique at the mid-flexion angle.CUSUM 90°and 120°crossed the acceptable control line from above by knee 68 and 57 respectively,which showed that the technique of balance could be improved with the aid of more cases.Conclusion:The electronic pressure sensor can effectively guide the soft tissue balance in TKA.The learning process is simple and does not increase the risk of complications.It can be used as a tool for learning TKA soft tissue balance technology to guide joint surgeons to further master or improve the soft tissue balance technology.