显微内镜髓核摘除术围手术期并发症与学习曲线相关性研究

Relationship Between Operative Complication Occurrence and the Stages of Learning Curve of Microendoscopic Lumbar Discectomy

目的通过研究显微内镜腰椎间盘髓核摘除术围手术期并发症和学习曲线的关系,旨在了解椎间盘镜在学习曲线期的安全性,为椎间盘镜技术的推广提供参考。方法回顾2007年4月至2010年10月由1名脊柱外科医生开展的100例MED手术,根据手术时间先后,每组20人,分为A、B、C、D、E 5组。进行学习曲线分析。依据手术时间,出血量和病例数汇出学习曲线,分别统计各组并发症发生情况。结果手术时间与出血量A组与B、C、D、E各组有显著性差异(P<0.05),提示20例为学习曲线期。B、C、D、E各组间手术时间及出血量没有显著性差异(P>0.05)。所记录并发症包括:术中发现硬膜撕裂、术中神经损伤、术后脑脊液漏、伤口延迟愈合、硬膜外血肿形成、术中节段定位错误、再次手术。所有并发症发生率各组间比较没有统计学差异性。结论 MED学习曲线约为20例左右。MED并发症在学习曲线的早期和成熟期没有区别,具有同样的安全性。

Objective To compare the rate of complications between the learning stage and the experienced stage of learning curve, and to provide some information and guidance for the promotion of microendoscopic discectomy （MED）. Methods From April 2007 to October 2010, the same surgeons started training in MED with 100 cases. We estimated the learning curve of surgeons by analyzing the change of operation time and blood loss amount. All 100 cases were divided into 5 groups judged by the sequence of operation. Each group was compared to the other group in terms of the rate of complications. Results The operation time and blood loss amount had significant difference between group A and the other 4 groups, however, these 4 groups had no significant difference. The occurrence rate of complications had no statistically significant difference between the 5 groups （P〉0.05）. Conclusions The turning point falls to 20 cases in spinal surgeons＇ learning curve. MED learning curve has no statistical difference of the rate of complications between the learning stage and the experienced stage, which indicates MED technique is also safe at the learning stage of learning curve.