Mürbe D, Hüttenbrink K B, Zahnert T, Vogel U, Tassabehji M, Kuhlisch E, Hofmann G
Department of Otorhinolaryngology, Medical Faculty, Technical University, Dresden, Germany.
Otol Neurotol. 2001 Sep;22(5):672-7. doi: 10.1097/00129492-200109000-00019.
The microscopically small middle ear structures require the otosurgeon to have a steady hand because instrument stability is a critical factor for a successful microsurgical procedure. Hand steadiness is mainly influenced by the tremor movements of the hand. The aim of this study was to measure hand tremor under simulated microsurgical conditions and to estimate the influence of different kinds of physical strain (e.g., physical exertion and hand exercise), as well as food abstinence and coffee consumption. Further, the effect of one-or two-handed manipulation and microsurgical experience was investigated.
The hand movements of 16 adult subjects were assessed during a defined manual manipulation using a stapes model to simulate microsurgical procedures. A laserinterferometric-based displacement technique was developed to measure tremor amplitude and frequency, as well as maximum displacement, to evaluate the subjects' fine motor skills.
The mean tremor frequency across all measurements was 8.1 Hz and did not show any dependence on different kinds of physical strain. Two-handed manipulations showed significantly lower tremor amplitudes than one-handed performances. Tremor amplitude and maximum displacement did not change after hand exercise, food abstinence, and coffee consumption. However, after physical exertion, a significant increase in the tremor amplitude was found. Subjects with advanced microsurgical experience showed smaller tremor amplitudes for one-handed runs.
The tremor data are interpreted as a recommendation to avoid physical exertion before microsurgery. In cases of absolute necessity for hand steadiness, two-handed manipulations are preferable. Further, hand steadiness might be improved by microsurgical training and experience.
中耳结构在显微镜下非常小，这就要求耳科医生手部要稳定，因为器械的稳定性是显微外科手术成功的关键因素。手部稳定性主要受手部震颤运动的影响。本研究的目的是测量模拟显微外科手术条件下的手部震颤，并评估不同类型的身体应激（如体力消耗和手部运动）、禁食和饮用咖啡的影响。此外，还研究了单手或双手操作以及显微外科手术经验的影响。
使用镫骨模型模拟显微外科手术，在特定的手动操作过程中评估16名成年受试者的手部运动。开发了一种基于激光干涉测量的位移技术，以测量震颤幅度和频率以及最大位移，从而评估受试者的精细运动技能。
所有测量的平均震颤频率为8.1Hz，且未显示出对不同类型身体应激的任何依赖性。双手操作的震颤幅度明显低于单手操作。手部运动、禁食和饮用咖啡后，震颤幅度和最大位移没有变化。然而，在体力消耗后，震颤幅度显著增加。有丰富显微外科手术经验的受试者单手操作时的震颤幅度较小。
震颤数据被解释为建议在显微手术前避免体力消耗。在绝对需要手部稳定的情况下，双手操作更可取。此外，显微外科手术训练和经验可能会提高手部稳定性。
