完全内镜技术治疗腰椎间盘突出症的学习曲线

 目的 评价应用完全内镜技术经椎板间入路手术治疗腰椎间盘突出症的学习曲线。方法 回顾性总结 2008年 8月至 2009年 2月应用完全内镜技术治疗的 30例腰椎间盘突出症患者临床资料, 根据开展手术时间分为三组(早期组、中期组和后期组), 每组各 10例患者, 学习曲线评价内容包括手术时间、住: 时间、腿痛与腰痛视觉模拟评分(visual analogue scale, VAS)和并发症发生情况。结果所有患者均获随访, 平均随访时间(1.61±0.22)年(1.2~2年)。三组完全内镜患者术中出血量均可忽略不计, 且无术后感染和复发病例出现。与早期组比较, 中期组手术时间明显减少(P0.05)。早期组并发症发生率为 12.5%, 中期组为 10%, 后期组无。早期组有 2例转为开放手术, 而中期和后期组无转为开放手术病例。结论应用完全内镜技术经椎板间入路手术治疗腰椎间盘突出症可获得良好的临床疗效与微创结果, 但陡峭的学习曲线需引起关注。术者的微创手术经验与合理的病例选择有助于缩短学习曲线和减少并发症。

Learning curve of full endoscopic technique for the surgical treatment of lumbar disc herniation

Objective To evaluate the learning curve of utilizing the full endoscopic technique for the surgical treatment of lumbar disc herniation.Methods From August 2008 to February 2009,30 patients with lumbar disc herniation underwent lumbar discectomy by the full endoscopic-only approach were retrospectively analyzed.The patients were divided into three groups of 10 sequential cases each.Group of early time consisted of the first 10 cases,Group of medium term the subsequent 10 cases,and Group of later time the last 10 cases.The clinical evaluation data included operative time,length of hospital stay,leg and back pain visual analogue scale (VAS),and complications.Results All patients were observed prospectively for (1.61±0.22) years.There was no measurable intraoperative bleeding,no postoperative infections and symptomatic recurrences in the three groups.Compared to group of early time,the operative time in group of medium term was significantly decreased (P＜0.05).The patients in group of later time had much less operative time than that in group medium term(P＜0.05).There was no significant difference with length of hospital stay between the three groups (P＞0.05).The improvement of leg and back VAS in each group was similar:there was a significant improvement 3 months post-operation compared with pre-operation (P ＜0.05),but no statistical difference between 3 months post-operation and final foliow-up(P＞0.05).The complication rate was 12.5％ for group of early time,10％ for group of medium term,and 0 for group of later time.There were two cases conversed to an open procedure for group of early time compared with 0 cases in both other groups.Conclusion Excellent clinical and minimally invasive outcomes can be obtained in the surgical treatment of lumbar disc herniation via the interlaminar approach assisted by full endoscopic technique.However,attention must be paid to the steep learning curve with use of this complex technique.Obtaining microsurgical experience and suitable patient selection can help shorten the learning curve and decrease the complications.