使用患者专用器械进行高胫骨截骨术的学习曲线：病例对照研究

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-07-03 DOI:10.1515/iss-2024-0007

Davide Stimolo, Filippo Leggieri, F. Matassi, Angelo Barra, R. Civinini, M. Innocenti

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We calculated the variation (Δ delta) between the planned target and the postoperative result for Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA) and tibial slope (TS) and compared it both groups. We also recorded the complication rate. We then calculated the learning curves for surgery time, number of fluoroscopic shots, Δ from target in both groups. CUSUM analysis charts for learning curves were applied between the two groups. Results Mean surgical time and mean number of fluoroscopic shots were lower in PSI group (48.58±7.87 vs. 58.75±6.86 min; p=0.034 and 10.75±3.93 vs. 18.16±4.93 shots; p<0.001). The postoperative ΔHKA was 0.42±0.51° in PSI vs. 1.25±0.87° in conventional, p=0.005. ΔMPTA was 0.50±0.67° in PSI vs. 3.75±1.48° in conventional, p<0.001; ΔTS was 1.00±0.82° in PSI vs. 3.50±1.57° in conventional, p<0.001. ΔJLCA was 1.83±1.11° in PSI vs. 4±1.41° in conventional, p<0.001. 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引用次数: 0

摘要

摘要目的三维（3D）规划和患者专用器械（PSI）可帮助外科医生在胫骨内侧开口楔形高位截骨术（mOW-HTO）中获得比传统技术更可预测的结果。我们比较了 PSI 和标准技术的准确性，并测量了手术时间和透视次数的学习曲线。方法我们纳入了使用三维规划和 PSI 切削指南进行的前 12 例连续 mOW-HTO 和使用标准技术进行的前 12 例非监督 mOW-HTO 病例。我们记录了手术时间和透视时间。我们计算了髋膝踝角度（HKA）、机械性胫骨内侧近端角度（MPTA）、关节线收敛角度（JLCA）和胫骨斜度（TS）的计划目标与术后结果之间的差异（Δ delta），并对两组进行了比较。我们还记录了并发症发生率。然后，我们计算了两组患者的手术时间、透视次数、离目标Δ的学习曲线。两组学习曲线均采用 CUSUM 分析图。结果 PSI 组的平均手术时间和平均透视次数更少（48.58±7.87 vs. 58.75±6.86分钟；P=0.034；10.75±3.93 vs. 18.16±4.93次；P<0.001）。PSI 术后的 ΔHKA 为 0.42±0.51° 对常规术后的 1.25±0.87°，P=0.005。PSI 的 ΔMPTA 为 0.50±0.67° vs. 传统的 3.75±1.48°，p＜0.001；PSI 的 ΔTS 为 1.00±0.82° vs. 传统的 3.50±1.57°，p＜0.001。PSI 的 ΔJLCA 为 1.83±1.11° vs. 传统的 4±1.41°，p<0.001。CUSUM分析显示，PSI组在手术时间（p=0.034）和手术次数（p<0.001）方面更胜一筹，而ΔHKA、ΔMPTA、ΔJLCA和ΔTS则没有学习曲线效应。结论 PSI 切削导板和 HTO 的三维规划可有效减少操作时间和透视次数的学习曲线。从第一批病例开始，手术的准确性就得到了提高。

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Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study

Abstract Objectives Three-dimensional (3D) planning and Patient Specific Instrumentation (PSI) can help the surgeon to obtain more predictable results in Medial Opening Wedge High Tibial Osteotomy (mOW-HTO) than the conventional techniques. We compared the accuracy of the PSI and standard techniques and measured the learning curve for surgery time and number of fluoroscopic shots. Methods We included the first 12 consecutive cases of mOW-HTO performed with 3D planning and PSI cutting guides and the first 12 non-supervised mOW-HTO performed with the standard technique. We recorded surgery time and fluoroscopic time. We calculated the variation (Δ delta) between the planned target and the postoperative result for Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA) and tibial slope (TS) and compared it both groups. We also recorded the complication rate. We then calculated the learning curves for surgery time, number of fluoroscopic shots, Δ from target in both groups. CUSUM analysis charts for learning curves were applied between the two groups. Results Mean surgical time and mean number of fluoroscopic shots were lower in PSI group (48.58±7.87 vs. 58.75±6.86 min; p=0.034 and 10.75±3.93 vs. 18.16±4.93 shots; p<0.001). The postoperative ΔHKA was 0.42±0.51° in PSI vs. 1.25±0.87° in conventional, p=0.005. ΔMPTA was 0.50±0.67° in PSI vs. 3.75±1.48° in conventional, p<0.001; ΔTS was 1.00±0.82° in PSI vs. 3.50±1.57° in conventional, p<0.001. ΔJLCA was 1.83±1.11° in PSI vs. 4±1.41° in conventional, p<0.001. The CUSUM analysis favoured PSI group regarding surgery time (p=0.034) and number of shots (p<0.001) with no learning curve effect for ΔHKA, ΔMPTA, ΔJLCA and ΔTS. Conclusions PSI cutting guides and 3D planning for HTO are effective in reducing the learning curves for operation time and number of fluoroscopic shots. Accuracy of the procedure has been elevated since the first cases.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.