Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Orthop Trauma. 2013 Feb;27(2):87-92. doi: 10.1097/BOT.0b013e3182604b49.
: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill.
A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement.
Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other.
The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill.
股骨颈骨折是影响医疗系统的最常见骨科损伤之一。使用空心螺钉进行此类骨折的手术治疗是一种常见的操作。执行此操作所需的手术技能的获取通常涉及在有透视引导的真实患者身上进行学习。本研究试图确定一种新型计算机导航培训模型是否可以提高这种基本手术技能的学习效果。
本研究采用多中心、前瞻性、随机和对照研究，纳入了没有股骨颈骨折手术管理经验的外科受训者。在培训课程后，参与者使用透视引导在模拟髋部骨折上进行手术任务（螺钉放置），然后进行预测试。之后，参与者随机分为使用常规透视或基于计算机的导航进行培训的两组。立即进行即时后测试、保留（4 周后）和转移测试。测试期间的表现通过硬件放置的放射学分析确定。
受训者的螺钉放置最终与任何一种培训技术的专家外科医生水平相当。使用计算机导航进行培训的参与者在定位硬件时尝试的次数更少，使用的透视时间也更少。当使用透视的参与者在转移测试中使用计算机导航时，透视时间和剂量减少。计算机导航提供的同时增强反馈并未影响手术新手对这种基本手术技能的学习。如果手术新手使用一种技术进行培训并转移到使用另一种技术，学习不会受到影响。
本研究的结果表明，计算机导航可以安全地用于培训手术新手的基本操作。这种模型避免了在不影响获取 3 维技术技能的情况下使用活体患者和有害辐射。
