Yoshimizu Takaki, Saito Sanshiro, Miyake Teruaki, Mizuno Tetsutaro, Nosaka Ushio, Ishii Keisuke, Watanabe Mizuki, Sasaki Kanji
Department of Orthopedic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Chuou-ward, Hamamatsu, 430-8558, Shizuoka, Japan.
Department of Spine and Bone Tumor, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Chuou-ward, Hamamatsu, 430-8558, Shizuoka, Japan.
J Orthop Surg Res. 2025 Apr 2;20(1):335. doi: 10.1186/s13018-025-05763-7.
Unilateral biportal endoscopy (UBE) is gaining popularity owing to its versatility as a spinal endoscopic procedure. However, the general value of the learning curve for discectomy by UBE is unknown. This retrospective study aimed to determine the learning curve of UBE for lumbar discectomy using a cumulative summation (CUSUM) method. We examined the learning curves of four surgeons at an institution and factors that shortened the learning curves.
The study included 200 patients (mean age 44.2 years) who underwent lumbar discectomy by UBE at our hospital and four male orthopedic surgeons who had performed 50 UBE discectomies. An approximate curve using the CUSUM method was created using the mean operative time for each case as the target. All surgeons had performed lumbar discectomy and over 200 spinal surgeries before inducing UBE. Surgeon A received specialized training in shoulder arthroscopic surgery. The surgical times before and after the curve reached its maximum value were compared; a point of significant difference was defined as case to proficiency.
The mean operative times for surgeons A, B, C, and D were 48, 66, 90, and 87 min, respectively. The approximate curves obtained using the CUSUM method had maxima at x = 22, 20, 27, and 13. The operating times of Surgeons A and B showed significant differences before and after the maxima (59 vs. 39 and 75 vs. 60), whereas those of Surgeons C and D did not (96 vs. 84 and 95 vs. 85).
UBE is generally considered to have a steep learning curve; in this study, the learning curve differed depending on the surgeon. The surgeon with the best learning curve was trained as an arthroscopic surgeon. Coordination for endoscopic surgery influenced the learning curve compared to the experience with spine surgery.
单侧双通道内镜技术（UBE）作为一种脊柱内镜手术，因其多功能性而越来越受欢迎。然而，UBE椎间盘切除术学习曲线的一般价值尚不清楚。本回顾性研究旨在使用累积求和（CUSUM）方法确定UBE腰椎间盘切除术的学习曲线。我们研究了一家机构中四位外科医生的学习曲线以及缩短学习曲线的因素。
本研究纳入了200例在我院接受UBE腰椎间盘切除术的患者（平均年龄44.2岁）以及四位完成了50例UBE椎间盘切除术的男性骨科医生。以每例手术的平均手术时间为目标，使用CUSUM方法创建近似曲线。所有外科医生在开展UBE手术前均已进行过腰椎间盘切除术及200余例脊柱手术。外科医生A接受过肩关节镜手术的专业培训。比较曲线达到最大值前后的手术时间；将显著差异点定义为熟练病例。
外科医生A、B、C和D的平均手术时间分别为48分钟（48 min）、66分钟（66 min）、90分钟（90 min）和87分钟（87 min）。使用CUSUM方法获得的近似曲线在x = 22、20、27和13处达到最大值。外科医生A和B在最大值前后的手术时间有显著差异（分别为59分钟对39分钟和75分钟对60分钟），而外科医生C和D则没有（分别为96分钟对84分钟和95分钟对85分钟）。
UBE通常被认为学习曲线较陡；在本研究中，学习曲线因外科医生而异。学习曲线最佳的外科医生接受过关节镜外科医生培训。与脊柱手术经验相比，内镜手术的协调性对学习曲线有影响。
