| 张笑然,琚顺林,李晶,等.基于累积求和法分析后路单通道内镜治疗单节段腰椎间盘突出症的学习曲线及短期疗效.骨科,2024,15(4): 300-307. |
| 基于累积求和法分析后路单通道内镜治疗单节段腰椎间盘突出症的学习曲线及短期疗效 |
| Learning Curve and Short-term Efficacy of Posterior Single-channel Endoscopic Lumbar Discectomy for Single-segment Lumbar Disc Herniation Based on Cumulative Summation |
| 投稿时间：2024-04-07 |
| DOI：10.3969/j.issn.1674-8573.2024.04.003 |
| 中文关键词: 腰椎间盘突出症 脊柱内镜 累积求和法 学习曲线 疗效 |
| 英文关键词: Lumbar disc herniation Spinal endoscopy Cumulative summation The learning curve Efficacy |
| 基金项目:国家自然科学基金（81560363、81860398）；石河子大学2023年度兵团指导性科技计划项目（2023ZD061） |
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| 中文摘要: |
| 目的 探讨后路单通道内镜治疗单节段腰椎间盘突出症（LDH）的学习曲线和短期临床疗效。方法 对2019年11月至2022年12月我院收治的111例LDH病人进行回顾性分析：应用累积求和（cumulative summation，CUSUM）法分析手术学习曲线并将病人划分为技术学习组和熟练掌握组；比较两组病人的手术时间、Oswestry功能障碍指数（ODI）、腰部及下肢疼痛视觉模拟量表（VAS）评分、术后并发症及手术满意度（改良MacNab评分）。结果 根据CUSUM的拐点将111例病人分为技术学习组（46例）和熟练掌握组（65例）。两组病人性别、年龄、术前身体质量指数（BMI）、糖尿病及高血压病史、吸烟及饮酒史、手术节段之间差异无统计学意义（P＞0.05）。手术时间从技术学习组的（105.52±15.62） min减少到熟练掌握组的（69.19±9.68） min，差异有统计学意义（P＜0.05）。两组术前及术后各随访节点的腰痛及腿痛VAS评分、ODI指数、手术满意度比较，差异均无统计学意义（P＞0.05）；且两组在术后各随访时间节点的VAS评分、ODI指数均显著低于术前（P＜0.05）。技术学习组的并发症发生率明显高于熟练掌握组（P＜0.05），前者并发症发生率为19.57%（9/46），其中5例为腰椎间盘突出复发，2例为硬膜损伤，2例为神经根损伤；后者并发症发生率为4.62%（3/65），其中2例为腰椎间盘突出复发，1例为硬膜损伤。结论 本研究应用CUSUM分析后路单通道内镜治疗单节段LDH的学习曲线，从技术学习期到熟练掌握期所需的手术例数为46例。当手术例数达到学习曲线平台期后，手术时间将明显缩短。单通道内镜技术是治疗单节段LDH的有效微创手段。 |
| 英文摘要: |
| Objective To discuss the learning curve and short-term efficacy of posterior single-channel endoscopic lumbar discectomy for single-segment lumbar disc herniation (LDH). Methods A total of 111 patients with LDH in our hospital from November 2019 to December 2022 were analyzed. The surgical learning curve was analyzed by cumulative summation (CUSUM), and patients were divided into the technical learning group and the proficient group. The operation time, Oswestry Disability Index (ODI), and visual analogue scale (VAS) for low back and leg pain, postoperative complications and surgical satisfaction (modified MacNab score) were recorded and compared between the two groups. Results According to the inflection point of CUSUM, the 111 patients were divided into the technical learning group (46 cases) and the proficient group (65 cases). There were no significant differences in gender, age, preoperative body mass index (BMI), history of diabetes and hypertension, history of smoking and drinking, and surgical segment between the two groups (P＞0.05). The operation time was significantly shortened from (105.52±15.62) min in the technique learning group to (69.19±9.68) min in the proficient group (P＜0.05). There were no significant differences in VAS scores for low back pain and leg pain, ODI and satisfaction with surgery between the two groups before and after operation (P＞0.05), and the scores of these three items at all postoperative follow-up time were significantly lower than those before operation (P＜0.05). The incidence of complications in the technical learning group was significantly higher than that in the proficient group (P＜0.05). The incidence of complications in the technical learning group was 19.57% (9/46), including 5 cases of recurrent LDH, 2 cases of dural injury and 2 cases of nerve root injury. The incidence of complications in the proficient group was 4.62% (3/65), including 2 case of recurrent LDH, 1 case of dural injury. Conclusion In this study, the CUSUM was used to analyze the learning curve of single-channel posterior endoscopic surgery for single-segment LDH. The number of operations required from the technical learning period to the proficiency period was 46 cases. When the number of surgical cases reaches the plateau of the learning curve, the operation time will be significantly shortened. Single-channel endoscopic technique can be considered as an effective minimally invasive method for the treatment of single-segment LDH. |
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