CAJ | 학술논문

目的评价应用完全内镜技术经椎板间入路手术治疗腰椎间盘突出症的学习曲线.方法回顾性总结2008年8月至2009年2月应用完全内镜技术治疗的30例腰椎间盘突出症患者临床资料,根据开展手术时间分为三组(早期组、中期组和后期组),每组各10例患者,学习曲线评价内容包括手术时间、住院时间、腿痛与腰痛视觉模拟评分(visual analogue scale,VAS)和并发症发生情况.结果所有患者均获随访,平均随访时间(1.61±0.22)年(1.2～2年).三组完全内镜患者术中出血量均可忽略不计,且无术后感染和复发病例出现.与早期组比较,中期组手术时间明显减少(P＜ 0.05),后期组的手术时间明显少于中期组(P＜0.05).三组的住院时间差异无统计学意义(P=0.897).每组的腿痛与腰痛VAS评分结果相似:术后3个月与术前相比差异有统计学意义(P＜0.05),末次随访与术后3个月比较差异无统计学意义(P＞0.05).早期组并发症发生率为12.5％,中期组为10％,后期组无.早期组有2例转为开放手术,而中期和后期组无转为开放手术病例.结论应用完全内镜技术经椎板间入路手术治疗腰椎间盘突出症可获得良好的临床疗效与微创结果,但陡峭的学习曲线需引起关注.术者的微创手术经验与合理的病例选择有助于缩短学习曲线和减少并发症.
목적 평개응용완전내경기술경추판간입로수술치료요추간반돌출증적학습곡선.방법 회고성총결2008년8월지2009년2월응용완전내경기술치료적30례요추간반돌출증환자림상자료,근거개전수술시간분위삼조(조기조、중기조화후기조),매조각10례환자,학습곡선평개내용포괄수술시간、주원시간、퇴통여요통시각모의평분(visual analogue scale,VAS)화병발증발생정황.결과 소유환자균획수방,평균수방시간(1.61±0.22)년(1.2～2년).삼조완전내경환자술중출혈량균가홀략불계,차무술후감염화복발병례출현.여조기조비교,중기조수술시간명현감소(P＜ 0.05),후기조적수술시간명현소우중기조(P＜0.05).삼조적주원시간차이무통계학의의(P=0.897).매조적퇴통여요통VAS평분결과상사:술후3개월여술전상비차이유통계학의의(P＜0.05),말차수방여술후3개월비교차이무통계학의의(P＞0.05).조기조병발증발생솔위12.5％,중기조위10％,후기조무.조기조유2례전위개방수술,이중기화후기조무전위개방수술병례.결론 응용완전내경기술경추판간입로수술치료요추간반돌출증가획득량호적림상료효여미창결과,단두초적학습곡선수인기관주.술자적미창수술경험여합리적병례선택유조우축단학습곡선화감소병발증.
Objective To evaluate the learning curve of utilizing the full endoscopic technique for the surgical treatment of lumbar disc herniation.Methods From August 2008 to February 2009,30 patients with lumbar disc herniation underwent lumbar discectomy by the full endoscopic-only approach were retrospectively analyzed.The patients were divided into three groups of 10 sequential cases each.Group of early time consisted of the first 10 cases,Group of medium term the subsequent 10 cases,and Group of later time the last 10 cases.The clinical evaluation data included operative time,length of hospital stay,leg and back pain visual analogue scale (VAS),and complications.Results All patients were observed prospectively for (1.61±0.22) years.There was no measurable intraoperative bleeding,no postoperative infections and symptomatic recurrences in the three groups.Compared to group of early time,the operative time in group of medium term was significantly decreased (P＜0.05).The patients in group of later time had much less operative time than that in group medium term(P＜0.05).There was no significant difference with length of hospital stay between the three groups (P＞0.05).The improvement of leg and back VAS in each group was similar:there was a significant improvement 3 months post-operation compared with pre-operation (P ＜0.05),but no statistical difference between 3 months post-operation and final foliow-up(P＞0.05).The complication rate was 12.5％ for group of early time,10％ for group of medium term,and 0 for group of later time.There were two cases conversed to an open procedure for group of early time compared with 0 cases in both other groups.Conclusion Excellent clinical and minimally invasive outcomes can be obtained in the surgical treatment of lumbar disc herniation via the interlaminar approach assisted by full endoscopic technique.However,attention must be paid to the steep learning curve with use of this complex technique.Obtaining microsurgical experience and suitable patient selection can help shorten the learning curve and decrease the complications.