经皮内镜椎间孔入路腰4/5与腰5/骶1腰椎间盘切除术学习曲线对比
Comparisons of the Learning Curve at the L4/5 and L5/S1 Level for Percutaneous Endoscopic Transforaminal Discectomy
- 中山大学学报（医学科学版） 2022年43卷第5期 页码：845-851
- 作者机构：
广州市番禺区中心医院脊柱外科，广东 广州511400
- 作者简介：
陈锦旭，硕士，住院医师，研究方向：脊柱退行性变，E-mail： 314442934@qq.com
- 基金信息：广州市科技计划项目(202201011710)
DOI：10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2022.0519
中图分类号： R687.1纸质出版日期：2022-09-20，
收稿日期：2022-06-17，
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陈锦旭,邓德礼,梁和胜.经皮内镜椎间孔入路腰4/5与腰5/骶1腰椎间盘切除术学习曲线对比[J].中山大学学报（医学科学版）,2022,43(05):845-851.
CHEN Jin-xu,DENG De-li,LIANG He-sheng.Comparisons of the Learning Curve at the L4/5 and L5/S1 Level for Percutaneous Endoscopic Transforaminal Discectomy[J].Journal of Sun Yat-sen University(Medical Sciences),2022,43(05):845-851.
陈锦旭,邓德礼,梁和胜.经皮内镜椎间孔入路腰4/5与腰5/骶1腰椎间盘切除术学习曲线对比[J].中山大学学报（医学科学版）,2022,43(05):845-851. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2022.0519.
CHEN Jin-xu,DENG De-li,LIANG He-sheng.Comparisons of the Learning Curve at the L4/5 and L5/S1 Level for Percutaneous Endoscopic Transforaminal Discectomy[J].Journal of Sun Yat-sen University(Medical Sciences),2022,43(05):845-851. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2022.0519.
摘要
目的
2
探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗L4/5与 L5/S1椎间盘突出症学习曲线的对比。
方法
2
纳入2019年12月至2020年11月由同一术者施行PETD治疗L4/5和L5/S1椎间盘突出症患者各51例。根据治疗时间把每个节段分为3个小组：最早的第1~17名患者为A组，第18~34名患者分为B组，第35~51名患者分为C组。对各组各阶段手术时间、射线暴露时间、视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评分进行评估。
结果
2
随访时间平均为 8.4 个月［最短 6 个月，最长 12 个月，中位数为8.0（7.0~9.3）个月］。L4/5节段手术时间在A组和B组（
P
=0.006）和A组和C组（
P
=0.000）之间的差异均有统计学意义，而L5/S1节段 A组和 C组差异有统计学意义（
P
=0.000），但A组和 B组差异无统计学意义（
P
=0.344）。与L4/5节段相比，L5/S1每个节段的手术时间明显更长，A组差异无统计学意义，B组、C组及合计差异均有统计学意义（A组：
P
=0.080，B组：
P
=0.000，C组：
P
=0.016，Total：
P
=0.000）。L4/5节段的平均射线暴露时间组内差异均有统计学意义，A组和B组（
P
=0.000）以及 A组和 C组（
P
=0.000）。然而，在 L5/S1节段上，A组和 B组之间差异无统计学意义（
P
=0.995），但A组和C组差异有统计学意义（
P
=0.000）。L5/S1各组的射线暴露时间明显长于L4/5水平，差异有统计学意义（A组：
P
=0.000，B组：
P
=0.000，C组：
P
=0.000，总计：
P
=0.000）。L4/5节段VAS 评分组内差异均无统计学意义，A组和 B组（
P
=0.967）和 A组和 C组（
P
=0.927）。ODI 评分组内差异均有统计学意义，A组和B组 （
P
=0.036） 以及A组和 C组 （
P
=0.011）。L5/S1 节段VAS 评分组内差异无统计学意义，A组和 B组 （
P
=0.397） 和 A组和 C组 （
P
=0.960），ODI 评分改善差异同样无统计学意义A组和 B组（
P
=0.207）以及A组和 C组（
P
=0.109）。
结论
2
PETD治疗L4/5和L5/S1腰椎间盘突出症都可以取得满意的临床疗效。L5/S1节段的手术时间和射线暴露时间均长于L4/5节段。L4/5节段学习曲线比L5/S1节段更陡峭。选择合适的病例对于缩短PETD的学习曲线非常重要。
Abstract
Objectives
2
To evaluate the learning curve for percutaneous endoscopic transforaminal discectomy（PETD）at L4/5 level and L5/S1 level respectively， and to evaluate the differences of learning curve for PETD between the two levels.
Methods
2
Two batches of the first 51 cases who were each treated with PETD for L4/5 or for L5/S1 disc herniation respectively in the department between December 2019 and November 2020 were reviewed. The operation time， radiation exposure time， VAS score， preoperative ODI score， and the postoperative follow-up were reviewed. Each level was divided into three groups： for the earliest stage， Patients #1~17 were assigned to Group A； for the middle stage， Patients #18~34 were assigned to Group B； and for the latest stage， Patients #35~51 were assigned to Group C.
Results
2
All patients were observed postoperatively for 8.4 months ［range： 6 months-12 months，
M
（
P
25
~
P
75
） = 8.0（7.0~9.3）months］. Significant differences were observed in the mean operation time for L4/5 level both between Group A and Group B （
P
=0.006） and between Group A and Group C （
P
=0.000）， while for the average operation time for L5/S1 level there was significant difference between Group A and Group C （
P
=0.000）， but not between Group A and Group B （
P
=0.344）. Compared with the operation time at L4/5 level， the operation time at L5/S1 was significantly longer for each stage （Group A：
P
=0.080， Group B：
P
=0.000， Group C：
P
=0.016， Total：
P
=0.000）. The average X-ray exposure period at each Group A L4/5 level was shortened successively， and there were significant differences between Group A and Group B （
P
=0.000）， also between Group A and Group C （
P
=0.000）. However， the mean radiation time of the three stages in L5/S1 level improved less rapidly than that in L4/5 level， in which significant difference was not observed between Group A and Group B （
P
=0.995）， but was between Group A and Group C （
P
=0.000）. The radiation exposure time at L5/S1 was significantly longer than L4/5 level for each stage （Group A：
P
=0.000， Group B：
P
=0.000， Group C：
P
=0.000， Total：
P
=0.000）. In the improvement of VAS score among 3 stages for L4/5 level， no significant differences were observed neither between Group A and Group B （
P
=0.967） nor between Group A and Group C （
P
=0.927）. Higher improvement in the ODI score was observed in L4/5 level both between Group A and Group B （
P
=0.036） and between Group A and Group C （
P
=0.011）. There was no significant difference in the improvement of VAS score for L5/S1 level neither between Group A and Group B （
P
=0.397） nor between Group A and Group C （
P
=0.960）； neither was there any significant difference in the improvement of ODI score both between Group A and Group B （
P
=0.207） and between Group A and Group C （
P
=0.109）.
Conclusions
2
The learning curve in the L4/5 level is steeper than that in the L5/S1 level. Suitable patient selection is of much importance for shortening the learning curve for PETD.
关键词
腰椎间盘突出症经皮内镜椎间孔入路腰椎间盘切除术学习曲线
Keywords
lumbar disk herniationpercutaneous endoscopic transforaminal discectomylearning curve
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