Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: a comparative study using a cumulative summation test for learning curve
Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: a comparative study using a cumulative summation test for learning curve
复制标题
学习经皮内镜腰椎间盘切除术是否需要选择性神经根阻滞：使用学习曲线累积求和检验的比较研究
DOI：
10.1007/s00264-020-04558-1
复制
发表时间：
2020-05-04
影响因子：
2.7
通讯作者：
Yuan, Wen
中科院分区：
文献类型：
--
作者：
Sun, Bin;Wu, Huiqiao;Yuan, Wen
目的探讨腰椎选择性神经根阻滞(SNRB)经验对初级学员经皮内窥镜腰椎间盘摘除术(PELD)学习效率的影响。受训者根据是否有SNRB经验分为两组(A组，有；B组，没有)。手术熟练程度定义为总手术时间<65分钟，累计放射暴露时间不超过40秒。学习曲线分析采用累积总和(CUSUM)检验。临床评估包括Macnab分级、视觉模拟评分(VAS)-腰背评分、VAS-腿部评分和OSwestry残疾指数(ODI)。结果A组达到可接受手术水平的总例数(47.75 ± 2.50例)明显少于B组(56.50 ± 1.29例，p<； 0.05)，失败累积例数(18.75 ± 0.96例vs.25.50 ± 1.75例，p<； 0.05)。两组的临床结果具有可比性。发生并发症4 7例，A组17例，B组30例(P<； 0.0 5)。SNRB操作可降低并发症发生率，但对症状复发和再次手术无明显影响。
PurposeThe aim of this study was to investigate the effect of lumbar spine selective nerve root block (SNRB) experience on the learning efficiency of percutaneous endoscopic lumbar discectomy (PELD) for junior trainees.MethodsA total of 480 patients undergoing single-level PELD performed by eight junior trainees were included. The trainees were divided into two groups based on whether they had previous SNRB experience (group A, yes; group B, no). Surgical proficiency was defined as total operation time less than 65 minutes and cumulative radiation exposure time no more than 40 seconds. The learning curve was analyzed by cumulative summation (CUSUM) test. Clinical evaluations included Macnab classification, visual analog scale (VAS)-low back score, VAS-leg score, and Oswestry Disability Index (ODI). Follow-up information at 12 months was also obtained.ResultsIntegral number of cases before achieving an acceptable surgical level in group A (47.75 ± 2.50 cases) was significantly smaller than that in group B (56.50 ± 1.29 cases,p< 0.05), along with less accumulated failure (18.75 ± 0.96 cases vs. 25.50 ± 1.75 cases,p< 0.05). The two groups were comparable in clinical outcomes. Forty-seven cases of complications were observed, with 17 in group A and 30 in group B (p< 0.05).ConclusionPrevious experience of SNRB improved the performance of PELD with shorter operation time and less radiation exposure. SNRB practice may reduce the complication rate without a significant effect on the recurrence of symptoms and reoperation.