Gatehouse Simon C, Izatt Maree T, Adam Clayton J, Harvey Jason R, Labrom Robert D, Askin Geoffrey N
Paediatric Spine Research Group, Queensland University of Technology and Mater Health Services, Mater Children's Hospital, South Brisbane, Australia.
J Spinal Disord Tech. 2007 Jun;20(4):317-23. doi: 10.1097/01.bsd.0000248256.72165.b9.
The reported benefits of endoscopic versus open scoliosis surgery include improved visualization, a muscle sparing approach, reduced pulmonary morbidity, reduced pain, and improved cosmesis. Some aspects of the surgical learning curve for this technically demanding method have been previously reported; however, improvements in other factors with increasing experience have not been quantified. This paper presents a series of 100 consecutive endoscopic anterior scoliosis corrections performed between April 2000 and February 2006. We report changes in the following perioperative factors with increasing experience; operative set-up time, operative time, x-ray irradiation time, number of instrumented levels, blood loss, intercostal catheter drainage, chest drain removal time, days in intensive care, days to mobilize, days in hospital, and early complications. Statistical comparisons were made between the first 20 (1 to 20), middle 20 (41 to 60), and last 20 (81 to 100) cases. Results showed statistically significant improvements and increased consistency in operative time, operative set-up time, x-ray irradiation time, blood loss, hospital stay, and mobilization time with experience. The complication rate was comparable to other recently published endoscopic studies. In the last 20 cases of the series, operative times had reduced to 35 minutes per level, x-ray irradiation times to 15 seconds per level, and blood loss to 38 mL per level. Most perioperative surgical factors therefore improve significantly with increasing experience in endoscopic anterior scoliosis correction.
与开放手术相比，内镜下脊柱侧弯手术的优势包括视野更清晰、采用保留肌肉的术式、肺部并发症减少、疼痛减轻以及美观度提高。此前已有报道这种技术要求较高的手术方式在学习曲线方面的一些情况；然而，随着经验增加在其他因素方面的改善尚未进行量化。本文介绍了2000年4月至2006年2月间连续进行的100例内镜下前路脊柱侧弯矫正手术。我们报告了随着经验增加以下围手术期因素的变化：手术准备时间、手术时间、X线照射时间、固定节段数量、失血量、肋间导管引流情况、胸腔引流管拔除时间、重症监护天数、活动时间、住院天数以及早期并发症。对前20例（第1至20例）、中间20例（第41至60例）和最后20例（第81至100例）进行了统计学比较。结果显示，随着经验增加，手术时间、手术准备时间、X线照射时间、失血量、住院时间和活动时间在统计学上有显著改善且一致性增加。并发症发生率与近期发表的其他内镜手术研究相当。在该系列的最后20例病例中，手术时间降至每节段35分钟，X线照射时间降至每节段15秒，失血量降至每节段38毫升。因此，随着内镜下前路脊柱侧弯矫正经验的增加，大多数围手术期手术因素都有显著改善。
