Xu Yun-Feng, Le Xiao-Feng, Tian Wei, Liu Bo, Li Qin, Zhang Gui-Lin, Liu Ya-Jun, Yuan Qiang, He Da, Mao Jian-Ping, Xiao Bin, Lang Zhao, Han Xiao-Guang, Jin Pei-Hao
Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
Medicine (Baltimore). 2018 Jul;97(27):e11423. doi: 10.1097/MD.0000000000011423.
Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) is a challenging technique with a long learning curve. We combined computer-assisted navigation and MI TLIF (CAMISS TLIF) to treat lumbar degenerative disease. This study aimed to evaluate the learning curve associated with computer-assisted navigation MI spine surgery (CAMISS) and TLIF for the surgical treatment of lumbar degenerative disease. Seventy four consecutive patients with lumbar degenerative disease underwent CAMISS TLIF between March 2011 and May 2015; all surgeries were performed by a single surgeon. According to the plateau of the asymptote, the initial 25 patients constituted the early group and the remaining patients comprised the latter group. The clinical evaluation data included operative times, anesthesia times, intraoperative blood losses, days until ambulation, postoperative hospital stays, visual analog scale (VAS) leg and back pain scores, Oswestry disability index (ODI) values, Macnab outcome scale scores, complications, radiological outcomes, and rates of conversion to open surgery. The complexity of the cases increased over the series, but the complication rate decreased (12.00%-6.12%). There were significant differences between the early and late groups with respect to the average surgical times and durations of anesthesia, but no differences in intraoperative blood losses, days until ambulation, postoperative hospital stays, complication rate, VAS, ODI, Macnab outcome scale scores, or solid fusion rates. There was no need for conversion to open procedures in either group. Our study showed that a plateau asymptote for CAMISS TLIF was reached after 25 operations. The later patients experienced shorter operative times and anesthesia durations.
微创经椎间孔腰椎椎间融合术（MI TLIF）是一项具有挑战性的技术，学习曲线较长。我们将计算机辅助导航与MI TLIF（CAMISS TLIF）相结合来治疗腰椎退行性疾病。本研究旨在评估与计算机辅助导航MI脊柱手术（CAMISS）和TLIF治疗腰椎退行性疾病相关的学习曲线。2011年3月至2015年5月期间，74例连续的腰椎退行性疾病患者接受了CAMISS TLIF手术；所有手术均由一名外科医生完成。根据渐近线的平稳期，最初的25例患者构成早期组，其余患者组成后期组。临床评估数据包括手术时间、麻醉时间、术中失血量、下床活动天数、术后住院时间、视觉模拟评分（VAS）下肢和背部疼痛评分、Oswestry功能障碍指数（ODI）值、Macnab疗效评定量表评分、并发症、影像学结果以及转为开放手术的比率。在这一系列病例中，病例的复杂性增加，但并发症发生率下降（12.00%-6.12%）。早期组和后期组在平均手术时间和麻醉持续时间方面存在显著差异，但在术中失血量、下床活动天数、术后住院时间、并发症发生率、VAS、ODI、Macnab疗效评定量表评分或坚固融合率方面无差异。两组均无需转为开放手术。我们的研究表明，CAMISS TLIF在25例手术后达到了平稳渐近线。后期患者的手术时间和麻醉持续时间较短。
