固定平台假体膝单髁置换术治疗膝骨关节炎的学习曲线研究  

Study of learning curve of fixed bearing unicompartmental knee arthroplasty in the treatment of osteoarthritis

作　　者：赵锦伟 黄明利 孙孟帅 高广凌 姜红江 鞠昌军 ZHAO Jin-wei;HUANG Ming-li;SUN Meng-shuai;GAO Guang-ling;JIANG Hong-jiang;JU Chang-jun(Department of Orthopedics,Shandong Wendeng Osteopathic Hospital,Weihai,Shandong,264400,ChinA)

机构地区：[1]山东省文登整骨医院骨关节科,威海264400 [2]山东省中医骨伤研究院,威海264400

出　　处：《中国骨与关节杂志》2025年第4期319-324,共6页Chinese Journal of Bone and Joint

基　　金：山东省中医药高层次人才培育项目[鲁卫函(2023)143号];2018年国家中医药管理局全国名老中医药专家孙文学传承工作室建设项目[国中医药人教函(2018)134号]。

摘　　要：目的研究固定平台假体膝单髁置换术(fixed bearing unicompartmental knee arthroplasty,FB-UKA)治疗膝骨关节炎的学习曲线特点。方法回顾分析2021年6月至2022年12月由同一组医师完成的符合条件的100例采用FB-UKA的膝骨关节炎患者,根据累积和分析法(culmulative sum analysis,CUSUM)绘制学习曲线并分组,记录并比较学习曲线不同阶段患者的手术时间,手术切口长度,假体安放角度,术后7天、1个月和1年时膝关节疼痛视觉模拟评分(visual analogue scale,VAS)和美国特种外科医院(Hospital for Special Surgery,HSS)评分,术后6个月及1年的关节遗忘评分(forgotten joint score,FJS)、术后并发症发生情况。结果两组患者均获至少12个月随访,均未发生感染、假体移位及假体周围骨折等严重并发症。平稳组的手术时间、手术切口长度、术后6个月的FJS、术后7天及1个月的VAS评分及HSS评分均优于上升组(P均<0.05);两组并发症发生率、术后1年的VAS评分、HSS评分及FJS评分比较,差异无统计学意义(P均>0.05)。术后影像学测量:平稳组FCA与上升组相比更偏内翻,差异有统计学意义(P<0.001),两组的FSA、TCA和TSA相比,差异无统计学意义(P均>0.05)。结论FB-UKA治疗膝骨关节炎的学习曲线上升期大约为29例,术者与助手需要不断总结改进术前规划和术中操作,缩短手术时间并减少并发症发生,熟练掌握假体放置,尤其是避免FCA外翻放置,进而提高手术的临床疗效。Objective To investigate the learning curve characteristics of fixed bearing unicompartmental knee arthroplasty(FB-UKA)in the treatment of osteoarthritis.Methods A retrospective analysis of 100 patients with knee osteoarthritis who underwent FB-UKA completed by the same group of surgeons from June 2021 to December 2022 was performed.Learning curve was formulated according to the Cumulative Sum Analysis Method(CUSUM).All were divided into Ascending Group(29 cases)and Stationary Group(71 cases).We recorded and compared the duration of surgery,length of surgical incision,angle of prosthesis placement,visual analogue scale(VAS)and Hospital for Special Surgery(HSS)scores of knee at 7 days,1 month and 1 year after surgery,forgotten joint scores(FJS)at 6 months and 1 year after surgery,and the occurrence of postoperative complications of the two groups.Results The patients in both groups were followed up for at least 12 months without serious complications such as infection,prosthesis displacement and periprosthetic fracture.In the Stationary Group,the operation time,length of surgical incision,FJS at 6 months after operation,VAS score and HSS score at 7 days and 1 month after operation were better than those in the Ascending Group(P<0.05);there was no statistically significant difference in complication rate,VAS,HSS and FJS score at 1 year after operation between the two groups(P>0.05).The postoperative imaging measurements:compared with the Ascending Group,the FCA of Stationary Group kept larger varus angles and the differences were statistically significant(P<0.001).But the FSA,TCA and TSA of the two groups were not statistically significant when compared with each other(all P>0.05).Conclusions The learning curve ascending part of FB-UKA for osteoarthritis of the knee includes about 29 cases,and the surgeons and assistants need to continuously summarize and improve the preoperative planning and intraoperative operation skills to shorten the operation time,reduce the complications,and ultimately improve the clinical e

关 键 词：关节成形术 置换 膝 学习曲线 骨关节炎 膝 

分 类 号：R684.3[医药卫生—骨科学]