Objective:

To summarize the characteristics of the learning curve and the occurrence of postoperative adverse events during the development of unilateral biportal endoscopy (UBE) technique by comparing the clinical data of early and late patients treated with UBE technique.

Methods:

All patients who underwent single-level UBE technique between April 1, 2020 and December 31, 2021 were selected as the research subjects. According to the surgical options, all patients were allocated into 3 groups: unilateral decompression and discectomy (UDD) group, unilateral laminotomy for bilateral decompression (ULBD) group, and lumbar intervertebral fusion (LIF) group. The first 60 cases from each group were extracted and ranked orderly. The endoscopic operation time, the times of fluoroscopy during non-internal fixation implantation, the postoperative hospital stay, the drainage volume, the decrease of hemoglobin, the decrease of hematocrit, and the adverse events were collected. In each group, the patients were allocated into early and late cases according to the operation sequence. The first 30 cases of each group were classified as early cases, and the last 30 cases as late cases. Statistical analysis was performed on the above observation indicators between the early and late cases, and a scatter plot of relevant data changes was drawn to observe the change trend.

Results:

Compared with the early cases, the endoscopic operation time and the times of fluoroscopy during non-internal fixation implantation of late cases in each group were significantly lower ( P<0.05); the postoperative hospital stay of late cases in LIF group was significantly shorter ( P<0.05); the decreased values of hemoglobin and hematokrit of late cases in ULBD group and LIF group were significantly lower ( P<0.05); the postoperative drainage volume of late cases in ULBD group significantly decreased ( P<0.05). The endoscopic operation time and the times of fluoroscopy during non-internal fixation implantation of 3 groups showed a significant downward trend. The adverse events occurred in 3 early cases and 1 late case of the UDD group, in 6 and 3 cases of the UBLD group, and 8 and 3 cases of the LIF group, respectively. The difference was not significant between the early and late cases ( P>0.05).

Conclusion:

In the early practice of UBE technique, there is a high incidence of complication, and the surgical trauma is relatively large, which is related to the lack of understanding of the UBE technique characteristics and insufficient surgical experience. With the proficiency of surgical techniques and accumulation of experience, the operation time and the incidence of postoperative adverse events were significantly reduced.

目的:

通过比较单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）技术前期和后期手术患者临床资料，总结该技术开展过程中学习曲线特征及术后不良事件发生情况。.

方法:

以2020年4月1日—2021年12月31日采用UBE行单节段腰椎减压、融合术患者作为研究对象，包括单侧减压椎间盘摘除（unilateral decompression and discectomy，UDD）、单侧椎板切除双侧减压（unilateral laminotomy for bilateral decompression，ULBD）、椎间融合（lumbar intervertebral fusion，LIF），纳入3种术式前60名患者进行研究。观测指标包括术中内镜下操作时间、非内固定物植入透视次数，术后住院时间、引流量、血红蛋白下降量、红细胞压积下降值，以及不良事件发生情况。每种术式中患者按手术时间排序分为前期及后期2个亚组，各30例，对上述观测指标进行统计学分析，并绘制数据散点图，观察相关指标变化趋势。.

结果:

与前期患者相比，3组后期患者的内镜下操作时间、非内固定物植入透视次数均降低，LIF组术后住院时间减少，ULBD组和LIF组术后血红蛋白下降量和红细胞压积下降值降低，ULBD组术后引流量降低，差异均有统计学意义（ P<0.05）。以上结果表明，随手术经验增加，3组内镜下操作时间和术中非内固定物植入透视次数总体均呈下降趋势。不良事件发生情况：UDD组前期患者3例、后期患者1例，UBLD组分别为6、3例，LIF组分别为8、3例；3组前期患者不良事件发生率均高于后期，但差异无统计学意义（ P>0.05）。.

结论:

UBE技术早期实践过程中并发症发生率较高、手术创伤相对较大，与对UBE技术特征认识不足及术者手术经验不足相关。随着手术技术熟练及经验积累，手术时间及术后不良事件发生率均明显下降。.