Bioengineering Unit, University of Strathclyde, Glasgow, United Kingdom.
J Surg Educ. 2012 Jul-Aug;69(4):504-10. doi: 10.1016/j.jsurg.2012.01.001. Epub 2012 Mar 3.
This study evaluated the utility of a porcine flexor tendon model and standard biomechanical testing procedures to quantify the acquisition of surgical skills associated with Zone II flexor tendon repair in a trainee by benchmarking task performance outcomes relative to evidence-based standards.
Single-subject repeated measures research design. Bench-top set-up of apparatus undertaken in a University Research laboratory. After initial directed learning, a trainee repaired 70 fresh flexor digitorum profundus tendons within the flexor sheath using either a Pennington or ventral-locking-loop modification of a two-strand Kessler core repair. Tendon repairs were then preconditioned and distracted to failure. Key biomechanical parameters of the repair, including the ultimate tensile strength (UTS), yield strength, 3 mm gap force and stiffness, were calculated. Repairs were divided into 3 categories, early (first 10 days), intermediate (ensuing 10 days), and late repairs (final 10 days), and potential changes in repair properties over the training period were evaluated using a general linear modeling approach.
There was a significant change in the mechanical characteristics of the repairs over the training period, evidencing a clear learning effect (p < 0.05). Irrespective of the repair technique employed, early and intermediate repairs were characterized by a significantly lower UTS (29% and 20%, respectively), 3 mm gap (21% and 16%, respectively), and yield force (18% and 23%, respectively), but had a higher stiffness (33% and 38%, respectively) than late repairs (p < 0.05). The UTS of late repairs (47-48 N) were comparable to those published within the literature (45-51 N), suggesting surgical competence of the trainee.
This simple, low-cost porcine model appears to be useful for providing preclinical training in flexor tendon repair techniques and has the potential to provide a quantitative index to evaluate the competency of surgical trainees. Further research is now required to identify optimal training parameters for flexor tendon repair and to develop procedure-specific standards for adequate benchmarking.
本研究通过将手术技能的获取与基于证据的标准相关联，评估猪屈肌腱模型和标准生物力学测试程序在量化接受者的 II 区屈肌腱修复相关手术技能方面的效用。
单个体重复测量研究设计。在大学研究实验室中进行仪器的单项设置。在初始定向学习之后，接受者使用改良的双股 Pennington 或改良的双股 Kessler 核心修复技术中的掌侧锁扣环修复技术，在屈肌腱鞘内修复了 70 根新鲜的屈指深肌腱。然后对肌腱修复进行预处理和拉伸至断裂。计算修复的关键生物力学参数，包括极限拉伸强度（UTS）、屈服强度、3mm 间隙力和刚度。将修复分为 3 个类别，早期（前 10 天）、中期（随后的 10 天）和晚期（最后 10 天），并使用一般线性建模方法评估培训期间修复特性的潜在变化。
在培训期间，修复的机械特性发生了显著变化，表明存在明显的学习效应（p < 0.05）。无论使用何种修复技术，早期和中期修复的 UTS（分别为 29%和 20%）、3mm 间隙（分别为 21%和 16%）和屈服力（分别为 18%和 23%）均显著降低，但刚度（分别为 33%和 38%）则显著高于晚期修复（p < 0.05）。晚期修复的 UTS（47-48N）与文献中报道的相似（45-51N），这表明接受者的手术能力达到了一定水平。
这种简单、低成本的猪模型似乎可用于提供屈肌腱修复技术的临床前培训，并且具有提供评估手术接受者能力的定量指标的潜力。目前需要进一步研究来确定屈肌腱修复的最佳培训参数，并制定适当的基准测试程序的具体标准。
