Peng Jing, Lin Rongzhen, Fang Duopei, He Zhaojun, Zhao Qinghao, Li Qingchu
Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Eur Spine J. 2025 Mar;34(3):954-973. doi: 10.1007/s00586-024-08632-9. Epub 2025 Jan 3.
This study systematically assesses the learning curve of Unilateral Biportal Endoscopic (UBE) techniques across various spinal surgeries, focusing on its influence on operative efficiency and complication rates to guide optimized training and practice.
Systematic searches in PubMed, Web of Science, Embase, Scopus, and Cochrane Library identified studies on UBE learning curves for patients aged 18 or older, comparing early and mastery phases. Two reviewers independently extracted data on surgery type, operative time, and complications. Study quality was assessed using the Newcastle-Ottawa Scale. We performed subgroup analyses based on different UBE surgery types, examining variations in operative time and complication rates across each procedure.
Thirteen studies, including 1217 patients, were included, focusing on lumbar spine surgeries. The average learning curve cutoff for UBE procedures was 32.18 cases, with the mastery phase reducing operative time by an average of 48.14 min (95% CI 35.80, 60.47; p < 0.001), although high heterogeneity observed. In the mastery phase, single-group analysis of 707 patients showed a mean operative time of 92.38 min (95% CI 77.35, 107.41). Complication analysis across 12 studies (1182 patients) revealed a significantly lower rate in the mastery phase (odds ratio, OR = 0.29; p < 0.001). Subgroup analyses revealed significant reductions in both operative time and complications for UBE-LIF and UBE-LD/ULBD during the mastery phase, while no significant changes were observed for UBE-PCF. Additionally, specific complications, such as dural tears and incomplete decompression, were significantly reduced in the mastery phase.
This systematic review confirms a learning curve in UBE surgery, with improvements in operative time and complications. Procedure-specific cutoff points provide guidance for training and future research.
本研究系统评估了单侧双通道内镜（UBE）技术在各种脊柱手术中的学习曲线，重点关注其对手术效率和并发症发生率的影响，以指导优化培训和实践。
在PubMed、Web of Science、Embase、Scopus和Cochrane图书馆进行系统检索，确定了关于18岁及以上患者UBE学习曲线的研究，比较早期和熟练阶段。两名研究者独立提取手术类型、手术时间和并发症的数据。使用纽卡斯尔-渥太华量表评估研究质量。我们根据不同的UBE手术类型进行亚组分析，检查每个手术的手术时间和并发症发生率的差异。
纳入了13项研究，共1217例患者，重点是腰椎手术。UBE手术的平均学习曲线切点为32.18例，熟练阶段平均手术时间减少48.14分钟（95%CI 35.80，60.47；p＜0.001），尽管观察到高度异质性。在熟练阶段，对707例患者的单组分析显示平均手术时间为92.38分钟（95%CI 77.35，107.41）。对12项研究（1182例患者）的并发症分析显示，熟练阶段的发生率显著降低（优势比，OR = 0.29；p＜0.001）。亚组分析显示，在熟练阶段，UBE-LIF和UBE-LD/ULBD的手术时间和并发症均显著减少，而UBE-PCF未观察到显著变化。此外，在熟练阶段，硬膜撕裂和减压不全等特定并发症显著减少。
本系统评价证实了UBE手术存在学习曲线，手术时间和并发症有所改善。特定手术的切点为培训和未来研究提供了指导。
