Rong Li-Min, Xie Pei-Gen, Shi De-Hai, Dong Jian-Wen, Liu Bin, Feng Feng, Cai Dao-Zhang
Department of Orthopaedics, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Chin Med J (Engl). 2008 Nov 5;121(21):2148-51.
Microendoscopic discectomy (MED) is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve. We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons' learning curve.
Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each: A - E. The control group F was ten MED patients treated later by the same medical team (September - October 2006). All operations were performed by the same team of spinal surgeons with no MED experience before June 2002. We compared groups by operation time, blood loss, complications and need for open surgery after MED failure.
Operation times by group were: A, (107 +/- 14) minutes; B, (85 +/- 13) minutes; C, (55 +/- 19) minutes; D, (52 +/- 12) minutes; E, (51 +/- 13) minutes; and F, (49+/- 15) minutes. Blood loss were: A, (131 +/- 73) ml; B, (75 +/- 20) ml; C, (48 +/- 16) ml; D, (44 +/- 17) ml; E, (45 +/- 18) ml; and F, (45 +/- 16) ml. Both operation time and blood loss in groups C, D, E and F were smaller and more stable compared with groups A and B. Japanese Orthopedic Association assessment (JOA) score of each group in improvement rate immediately and one year after operation were as follows (in percentage): A, (79.8 +/- 8.8)/(89.8 +/- 7.7); B, (78.6 +/- 8.5)/(88.5 +/- 7.8); C, (80.8 +/- 11.3)/(90.8 +/- 6.7); D, (77.7 +/- 11.4)/(88.9 +/- 9.3); E, (84.0 +/- 8.7)/(89.6 +/- 9.0); and F, (77.8 +/- 11.6)/(86.9 +/- 8.4). Groups showed no statistical difference in improvement rates. Complications developed in three patients in group A, two in group B, and none in the other groups.
Spinal surgeons performing MED become proficient after 10 - 20 operations, when their skill becomes fairly sophisticated. Patients' improvement rate is the same regardless of surgeons' phase of learning curve.
显微内镜下椎间盘切除术（MED）是一种微创手术，可使腰椎间盘突出症患者术后快速康复，但在少数医院已取代传统开放手术，因为大多数外科医生避开其较长的学习曲线。我们评估了脊柱外科医生学习曲线各阶段腰椎MED的有效性和安全性。
2002年6月至2003年2月接受MED的50例患者按时间顺序分为每组10人的5组：A组至E组。对照组F组为同一医疗团队后来治疗的10例MED患者（2006年9月至10月）。所有手术均由同一组脊柱外科医生完成，他们在2002年6月之前无MED经验。我们比较了各组的手术时间、失血量、并发症以及MED失败后转为开放手术的必要性。
各组手术时间分别为：A组，（107±14）分钟；B组，（85±13）分钟；C组，（55±19）分钟；D组，（52±12）分钟；E组，（51±13）分钟；F组，（49±15）分钟。失血量分别为：A组，（131±73）毫升；B组，（75±20）毫升；C组，（48±16）毫升；D组，（44±17）毫升；E组，（45±18）毫升；F组，（45±16）毫升。与A组和B组相比，C组、D组、E组和F组的手术时间和失血量均较少且更稳定。各组术后即刻及术后一年的日本矫形外科学会评估（JOA）评分改善率如下（百分比）：A组，（79.8±8.8）/（89.8±7.7）；B组，（78.6±8.5）/（88.5±7.8）；C组，（80.8±11.3）/（90.8±6.7）；D组，（77.7±11.4）/（88.9±9.3）；E组，（84.0±8.7）/（89.6±9.0）；F组，（77.8±11.6）/（86.9±8.4）。各组改善率无统计学差异。A组有3例患者发生并发症，B组有2例，其他组无并发症发生。
脊柱外科医生在进行10 - 20例MED手术后会变得熟练，此时他们的技术相当成熟。无论外科医生处于学习曲线的哪个阶段，患者的改善率相同。
