Learning Curve and Short-term Efficacy of Posterior Single-channel Endoscopic Lumbar Discectomy for Single-segment Lumbar Disc Herniation Based on Cumulative Summation
Objective To discuss the learning curve and short-term efficacy of posterior single-channel endoscopic lumbar discectomy for single-segment lumbar disc herniation(LDH).Methods A total of 111 patients with LDH in our hospital from November 2019 to December 2022 were analyzed.The surgical learning curve was analyzed by cumulative summation(CUSUM),and patients were divided into the technical learning group and the proficient group.The operation time,Oswestry Disability Index(ODI),and visual analogue scale(VAS)for low back and leg pain,postoperative complications and surgical satisfaction(modified MacNab score)were recorded and compared between the two groups.Results According to the inflection point of CUSUM,the 111 patients were divided into the technical learning group(46 cases)and the proficient group(65 cases).There were no significant differences in gender,age,preoperative body mass index(BMI),history of diabetes and hypertension,history of smoking and drinking,and surgical segment between the two groups(P＞0.05).The operation time was significantly shortened from(105.52±15.62)min in the technique learning group to(69.19±9.68)min in the proficient group(P＜0.05).There were no significant differences in VAS scores for low back pain and leg pain,ODI and satisfaction with surgery between the two groups before and after operation(P＞0.05),and the scores of these three items at all postoperative follow-up time were significantly lower than those before operation(P＜0.05).The incidence of complications in the technical learning group was significantly higher than that in the proficient group(P＜0.05).The incidence of complications in the technical learning group was 19.57％(9/46),including 5 cases of recurrent LDH,2 cases of dural injury and 2 cases of nerve root injury.The incidence of complications in the proficient group was 4.62％(3/65),including 2 case of recurrent LDH,1 case of dural injury.Conclusion In this study,the CUSUM was used to analyze the learning curve of single-channel posterior endoscopic surgery for single-segment LDH.The number of operations required from the technical learning period to the proficiency period was 46 cases.When the number of surgical cases reaches the plateau of the learning curve,the operation time will be significantly shortened.Single-channel endoscopic technique can be considered as an effective minimally invasive method for the treatment of single-segment LDH.
NETL
NSTL
万方数据
