Wang Wenlong, Liu Zheng, Wu Sijun, Zhang Shuo, Bai Haibin, Wang Jiyue
Department of Orthopedics, Peking University Shougang Hospital, Beijing, 100144, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Oct 15;36(10):1221-1228. doi: 10.7507/1002-1892.202205133.
To summarize the characteristics of the learning curve and the occurrence of postoperative adverse events during the development of unilateral biportal endoscopy (UBE) technique by comparing the clinical data of early and late patients treated with UBE technique.
All patients who underwent single-level UBE technique between April 1, 2020 and December 31, 2021 were selected as the research subjects. According to the surgical options, all patients were allocated into 3 groups: unilateral decompression and discectomy (UDD) group, unilateral laminotomy for bilateral decompression (ULBD) group, and lumbar intervertebral fusion (LIF) group. The first 60 cases from each group were extracted and ranked orderly. The endoscopic operation time, the times of fluoroscopy during non-internal fixation implantation, the postoperative hospital stay, the drainage volume, the decrease of hemoglobin, the decrease of hematocrit, and the adverse events were collected. In each group, the patients were allocated into early and late cases according to the operation sequence. The first 30 cases of each group were classified as early cases, and the last 30 cases as late cases. Statistical analysis was performed on the above observation indicators between the early and late cases, and a scatter plot of relevant data changes was drawn to observe the change trend.
Compared with the early cases, the endoscopic operation time and the times of fluoroscopy during non-internal fixation implantation of late cases in each group were significantly lower ( <0.05); the postoperative hospital stay of late cases in LIF group was significantly shorter ( <0.05); the decreased values of hemoglobin and hematokrit of late cases in ULBD group and LIF group were significantly lower ( <0.05); the postoperative drainage volume of late cases in ULBD group significantly decreased ( <0.05). The endoscopic operation time and the times of fluoroscopy during non-internal fixation implantation of 3 groups showed a significant downward trend. The adverse events occurred in 3 early cases and 1 late case of the UDD group, in 6 and 3 cases of the UBLD group, and 8 and 3 cases of the LIF group, respectively. The difference was not significant between the early and late cases ( 0.05).
In the early practice of UBE technique, there is a high incidence of complication, and the surgical trauma is relatively large, which is related to the lack of understanding of the UBE technique characteristics and insufficient surgical experience. With the proficiency of surgical techniques and accumulation of experience, the operation time and the incidence of postoperative adverse events were significantly reduced.
通过比较单侧双通道内镜（UBE）技术治疗早期和晚期患者的临床资料，总结UBE技术发展过程中学习曲线的特点及术后不良事件的发生情况。
选取2020年4月1日至2021年12月31日期间接受单节段UBE技术治疗的所有患者作为研究对象。根据手术方式，将所有患者分为3组：单侧减压髓核摘除术（UDD）组、单侧椎板切开双侧减压术（ULBD）组和腰椎椎间融合术（LIF）组。从每组中抽取前60例并按顺序排列。收集内镜手术时间、非内固定植入期间的透视次数、术后住院时间、引流量、血红蛋白下降值、血细胞比容下降值及不良事件。在每组中，根据手术顺序将患者分为早期和晚期病例。每组前30例为早期病例，后30例为晚期病例。对早期和晚期病例的上述观察指标进行统计分析，并绘制相关数据变化的散点图以观察变化趋势。
与早期病例相比，每组晚期病例的内镜手术时间和非内固定植入期间的透视次数均显著降低（<0.05）；LIF组晚期病例的术后住院时间显著缩短（<0.05）；ULBD组和LIF组晚期病例的血红蛋白和血细胞比容下降值显著降低（<0.05）；ULBD组晚期病例的术后引流量显著减少（<0.05）。3组的内镜手术时间和非内固定植入期间的透视次数均呈显著下降趋势。UDD组早期病例发生3例不良事件，晚期病例发生1例；ULBD组分别为6例和3例；LIF组分别为8例和3例。早期和晚期病例之间差异无统计学意义（>0.05）。
在UBE技术的早期实践中，并发症发生率较高，手术创伤相对较大，这与对UBE技术特点的认识不足及手术经验不足有关。随着手术技术的熟练和经验的积累，手术时间和术后不良事件的发生率显著降低。
