Wang Hongwei, Huang Bo, Li Changqing, Zhang Zhengfeng, Wang Jian, Zheng Wenjie, Zhou Yue
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, PR China.
Clin Neurol Neurosurg. 2013 Oct;115(10):1987-91. doi: 10.1016/j.clineuro.2013.06.008. Epub 2013 Jul 2.
To evaluate the differences of learning curve for PELD depending on the surgeon' s training level of minimally invasive spine surgery.
We retrospectively reviewed the medical records of 120 patients (surgeon A with his first 60 patients, surgeon B with his first 60 patients) with sciatica and single-level L4/5 disk herniation who underwent PELD by the two surgeons with different training level of minimally invasive spine surgery (Group A: surgeon with little professional training of PELD; Group B: surgeon with 2 years of demonstration teaching of PELD).
Significant differences were observed in the operation time (p=0.000), postoperative hospital stay (p=0.026) and reoperation rate (p=0.050) between the two groups. In the operation time, significant differences were observed between the 1-20 patients group and 41-60 patients group in Group B (p=0.041), but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group A. In the postoperative hospital stay, the significant differences were observed in the 1-20 patients group between Group A and Group B (p=0.011). Significant differences were observed between preoperative and postoperative VAS back score, VAS leg score and JOA score. Higher improvement in the VAS leg score was observed in Group B than Group A (p=0.031). In the rate of reoperation, the significant difference was observed between the 1-20 patients group and 41-60 patients group in Group A (p=0.028) but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group B.
The surgeons' training level of minimally invasive spine surgery was an important factor for the success of PELD, especially the demonstration teaching of PELD for the new minimally invasive spine surgeons.
评估根据外科医生微创脊柱手术培训水平不同，经皮内镜下腰椎间盘切除术（PELD）学习曲线的差异。
我们回顾性分析了120例因坐骨神经痛和单节段L4/5椎间盘突出症接受PELD手术患者的病历（外科医生A的前60例患者，外科医生B的前60例患者），这两位外科医生的微创脊柱手术培训水平不同（A组：PELD专业培训较少的外科医生；B组：接受过2年PELD示范教学的外科医生）。
两组之间在手术时间（p = 0.000）、术后住院时间（p = 0.026）和再次手术率（p = 0.050）方面存在显著差异。在手术时间上，B组中1 - 20例患者组与41 - 60例患者组之间存在显著差异（p = 0.041），但A组中1 - 20例患者组、21 - 40例患者组和41 - 60例患者组之间无显著差异。在术后住院时间方面，A组和B组的1 - 20例患者组之间存在显著差异（p = 0.011）。术前和术后的视觉模拟评分法（VAS）背部评分、VAS腿部评分和日本骨科协会（JOA）评分之间存在显著差异。B组的VAS腿部评分改善程度高于A组（p = 0.031）。在再次手术率方面，A组中1 - 20例患者组与41 - 60例患者组之间存在显著差异（p = 0.028），但B组中1 - 20例患者组、21 - 40例患者组和41 - 60例患者组之间无显著差异。
外科医生的微创脊柱手术培训水平是PELD成功的重要因素，尤其是对新的微创脊柱外科医生进行PELD示范教学。
