单孔同轴大通道与双通道内镜下腰椎椎间融合术的学习曲线评价

Evaluation of learning curves of uniportal coaxial large-channel and unilateral biportal endoscopic lumbar interbody fusions

中文关键词:  腰椎椎间融合术  内镜  学习曲线  单孔  双通道

英文关键词:Lumbar interbody fusion  Endoscopic  Learning curve  Uniportal  Biportal

中文摘要:

  【摘要】 目的：评价单孔同轴大通道内镜下腰椎椎间融合术（uniportal coaxial large-channel endoscopic lumbar interbody fusion，UCLE-LIF）和单侧双通道内镜下腰椎椎间融合术（unilateral biportal endoscopic lumbar interbody fusion，UBE-LIF）的学习曲线差异。方法：回顾性分析2018年10月～2021年2月我院90例采用内镜下腰椎椎间融合术治疗的腰椎疾病患者临床资料，手术均由同一术者完成。参照手术方式分为UCLE-LIF组（n=45例）和UBE-LIF组（n=45例），每组按手术完成顺序依次分3个亚组：a组（第1～15例）、b组（第16～30例）和c组（第31～45例）。记录和统计UCLE-LIF组和UBE-LIF组组内各亚组手术时间、并发症、腰痛和下肢痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）以及术后1年时融合情况；构建多项式回归模型及绘制学习曲线。结果：两组患者均至少完成1年随访。UCLE-LIF组中a、b和c亚组手术时间分别为264.85±43.52min、220.56±22.44min和175.27±15.50min，a和b亚组间无统计学差异（P>0.05），a和c亚组间的有统计学差异（P<0.05）；UBE-LIF组a、b和c亚组手术时间分别为248.32±30.42min、185.76±18.13min和169.17±12.26min，各亚组之间均有统计学差异（P<0.05）。两组中手术相关并发症发生率a亚组均大于b、c亚组，但各亚组间的差异均无统计学意义（P>0.05）。UCLE-LIF组VAS评分的改善在各亚组间的差异均无统计学意义（P>0.05），而UBE-LIF组VAS评分的改善a亚组大于b、c亚组，差异有统计学意义（P<0.05）。UCLE-LIF组和UBE-LIF组ODI评分的改善在各亚组间的差异均无统计学意义（P>0.05）。术后1年随访时，各亚组患者按照Bridwell标准均达到Ⅰ级或Ⅱ级融合。UCLE-LIF组和UBE-LIF组的学习曲线多项式回归模型分别为y=259.440e^（-0.14t）（R2=0.683）和y=274.088-6.744t+0.105t2（R2=0.878）。结论：UCLE-LIF和UBE-LIF两种术式治疗腰椎疾病均可获得满意的临床疗效；UBE-LIF的学习曲线陡峭、易于掌握，而UCLE-LIF的学习曲线则较为平坦、学习周期稍长。

英文摘要:

  【Abstract】 Objectives: To evaluate the learning curve difference between uniportal coaxial large-channel endoscopic lumbar interbody fusion(UCLE-LIF) and unilateral biportal endoscopic lumbar interbody fusion(UBE-LIF). Methods: The clinical data of 90 patients with lumbar degenerative diseases(LDD) treated with endoscopic lumbar interbody fusion in our hospital from October 2018 to February 2021 were retrospectively analyzed. The operations were all performed by one same surgeon. The patients were divided into UCLE-LIF group(n=45 cases) and UBE-LIF group(n=45 cases) according to the operation method, and each group was divided into 3 subgroups in accordance with the order of operation: a(cases 1-15), b(cases 16-30) and c(cases 31-45). The operative time, complications, low back and leg pain visual analogue scale(VAS) and Oswestry disability index(ODI) in each subgroup of both UCLE-LIF group and UBE-LIF group were recorded and analyzed, as well as the fusion status at 1 year follow-up; Polynomial regression model and learning curve were constructed. Results: The patients in both groups completed at least 1 year of follow-up. The operative time of subgroups a, b and c in UCLE-LIF group were 264.85±43.52min, 220.56±22.44min and 175.27±15.50min, respectively, and there was no statistical difference between subgroups a and b(P>0.05), while there was statistical difference between subgroups a and c(P<0.05); The operative time of subgroups a, b and c in UBE-LIF group were 248.32±30.42min, 185.76±18.13min and 169.17±12.26min, respectively, which differed significantly between subgroups a, b, and c(P<0.05). The incidence of surgery-related complications of subgroup a was higher than that of subgroups b and c in both two groups, but there was no significant difference between subgroups(P>0.05). There was no significant difference in the improvement of VAS score between subgroups in UCLE-LIF group(P>0.05), while the improvement of VAS score in UBE-LIF group was higher in subgroup a than in subgroups b and c, and the difference was statistically significant(P<0.05). There was no significant difference in the improvement of ODI scores between subgroups both in UCLE-LIF group and UBE-LIF group(P>0.05). According to Bridwell criteria, all subgroups achieved grade Ⅰ or Ⅱ fusion at 1 year follow-up. The learning curve polynomial regression models for UCLE-LIF group and UBE-LIF group were y=259.440e^(-0.14t)(R2=0.683) and y=274.088-6.744t+0.105t2(R2=0.878), respectively. Conclusions: Both UCLE-LIF and UBE-LIF can achieve satisfactory clinical efficacy in the treatment of LDD. UBE-LIF is steep in learning curve and easy to learn, while UCLE-LIF is relative flat in learning curve which needs a slightly longer learning cycle.