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微创前路腰椎间融合术联合后路经皮内固定术的外科医生学习曲线和临床结果。

Surgeon Learning Curve and Clinical Outcomes of Minimally Invasive Anterior Lumbar Interbody Fusion With Posterior Percutaneous Instrumentation.

机构信息

From the Department of Surgery (Ms. Olson, Ms. Panthofer, and Dr. Matsumura) and Department of Orthopedics and Rehabilitation (Dr. Mirza and Dr. Williams), University of Wisconsin School of Medicine and Public Health, Madison, WI.

出版信息

J Am Acad Orthop Surg Glob Res Rev. 2022 Dec 5;6(12). doi: 10.5435/JAAOSGlobal-D-22-00207. eCollection 2022 Dec 1.

DOI:10.5435/JAAOSGlobal-D-22-00207
PMID:36732304
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9726293/
Abstract

OBJECTIVES

This study reports the learning phase of the minimally invasive anterior lumbar interbody fusion (mini-ALIF) approach with a vascular and orthopaedic spine surgeon team.

METHODS

Adult patients who underwent primary mini-ALIF at the lowest two segments of the lumbar spine (i.e., L4/5, L5/S1) between January 2010 and December 2018 were analyzed.

RESULTS

One hundred twenty-seven patients were included. There was no notable change in total surgical time over the study period. Estimated blood loss markedly decreased until stabilizing at case 30 and slowly declined thereafter. The mean estimated blood loss was 184 mL for L5/S1, 232 mL for L4/L5, and 458 mL for two-level mini-ALIF. There were 20 vascular issues requiring primary repair or packing. Vascular issues declined over time, with a rate of 32% in the first 25 cases and 0% in the last 25. The postoperative complication rate was highest in the first 25 cases (7 of 21 total complications). The odds ratio of vascular injury with body mass index (BMI) > 35 was 4.09 (1.4 to 11.7 confidence interval, P ≤ 0.008). Total surgical time and postoperative complications increased with increasing BMI.

CONCLUSION

Performance of the mini-ALIF approach is associated with a learning curve of 25 to 30 cases before complications begin to decline. BMI > 35 is associated with increased surgical time and complications.

摘要

目的

本研究报告了血管和矫形脊柱外科医生团队进行微创前路腰椎椎间融合术（mini-ALIF）的学习阶段。

方法

分析了 2010 年 1 月至 2018 年 12 月期间在腰椎最下段（即 L4/5、L5/S1）进行初次 mini-ALIF 的成年患者。

结果

共纳入 127 例患者。在研究期间，总手术时间无明显变化。估计失血量明显减少，直到第 30 例稳定，此后缓慢下降。L5/S1 的平均估计失血量为 184mL，L4/L5 为 232mL，两水平 mini-ALIF 为 458mL。有 20 例血管问题需要进行初次修复或填塞。随着时间的推移，血管问题逐渐减少，前 25 例中有 32%，后 25 例中为 0%。前 25 例的术后并发症发生率最高（21 例总并发症中有 7 例）。BMI>35 时发生血管损伤的比值比为 4.09（1.4 至 11.7 置信区间，P≤0.008）。总手术时间和术后并发症随 BMI 增加而增加。

结论

mini-ALIF 方法的实施与 25 至 30 例的学习曲线相关，在此期间并发症开始下降。BMI>35 与手术时间延长和并发症增加有关。

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