The learning curve associated with thoracoscopic spinal instrumentation
The learning curve associated with thoracoscopic spinal instrumentation
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DOI：
10.1097/01.brs.0000192241.29644.6e
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发表时间：
2005-12-15
期刊：
影响因子：
3
通讯作者：
Panagopoulos, G
中科院分区：
文献类型：
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作者：
Lonner, BS;Scharf, C;Panagopoulos, G
研究设计。连续病例前瞻性放射学和病历审查。目的。通过评估 1 个外科医生 (B. L.) 病例的手术数据和早期结果来定义与胸腔镜脊柱器械相关的学习曲线。背景数据摘要。用于治疗胸椎青少年特发性脊柱侧凸的胸腔镜脊柱器械已成为开放式前路和后路技术的替代方法。该技术技术要求很高，并且被认为具有令人望而却步的学习曲线。方法。手术报告、图表和外科医生数据库用于评估手术时间、估计失血量、融合水平、并发症发生率、输血和曲线校正等变量。出于分析目的，将整个队列分为2组，分别为28名和29名患者，然后使用4组14名患者（最后一组为15名）进行比较。评估了 57 名患者的记录。任一比较中均未发现估计失血量或融合水平数量存在显着差异（分别为 P = 0.46 和 P = 0.66）。输血需求无显着差异，第 1 组为 7%，第 2 组为 18%（P = 0.35）。 28 名患者的手术时间为 6.2 +/- 1.3 小时，与 5.3 +/- 1.2 小时相比，手术时间显着缩短（P = 0.011）。进行 28 例治疗后，曲线矫正百分比明显改善，前组为 54.4 +/- 17.9，后半组为 65.7 +/- 10.4（P = 0.005）。并发症在整个系列中均匀分布。两组并发症发生率无显着差异（P=0.50）。没有观察到主要并发症，例如神经功能缺损或严重出血。结论。与胸腔镜脊柱器械相关的学习曲线似乎是可以接受的。 28 例手术后，手术时间和曲线矫正百分比存在显着差异。在整个外科医生的经验中，并发症发生率保持稳定。
Study Design. Consecutive case prospective radiographic and medical record review.Objective. To define the learning curve associated with thoracoscopic spinal instrumentation by evaluating operative data and early outcomes of 1 surgeon's ( B. L.) cases.Summary of Background Data. Thoracoscopic spinal instrumentation for the treatment of thoracic adolescent idiopathic scoliosis has emerged as an alternative to open anterior and posterior techniques. The technique is technically demanding and has been perceived as having a prohibitive learning curve.Methods. The operative reports, charts, and surgeon's database were used to evaluate operating time, estimated blood loss, levels fused, complication rate, blood transfusions, and curve correction, among other variables. For purposes of analysis, the entire cohort was divided into 2 groups of 28 and 29 patients, respectively, and then 4 groups of 14 patients ( the last group with 15) were used for comparison.Results. The records of 57 patients were evaluated. No significant difference in estimated blood loss or number of levels fused was noted for either comparison ( P = 0.46 and P = 0.66, respectively). There was no significant difference in blood transfusion requirements, with 7% in group 1 and 18% in group 2 ( P = 0.35). Operating time was significantly less after 28 patients were operated on 6.2 +/- 1.3 hours versus 5.3 +/- 1.2 hours ( P = 0.011). Percent curve correction was significantly better after 28 cases were performed, 54.4 +/- 17.9 in the former groups versus 65.7 +/- 10.4 in the latter half of cases ( P = 0.005). Complications were evenly distributed throughout the series. No significant differences were observed between the 2 groups in terms of rate of complication ( P = 0.50). No major complications, such as neurologic deficit or significant hemorrhage, were observed.Conclusions. The learning curve associated with thoracoscopic spinal instrumentation appears to be acceptable. Significant differences were noted in operating time and percent curve correction after 28 cases. The complication rates remained stable throughout the surgeon's experience.