Department of Orthopaedic Surgery, Academic Medical Centre, Orthopaedic Research Centre Amsterdam, G4-262 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1529-35. doi: 10.1007/s00167-013-2545-5. Epub 2013 Jun 6.
When performing knee arthroscopy, joint stressing is essential to increase the operative joint space. Adequate training of joint stressing is important, since high stressing forces can damage knee ligaments, and low stressing might not give sufficient operative space. As forces are difficult to transfer since they cannot be seen, simulators might be suited to train joint stressing as they can visualise the amount of applied stress. This requires the joint stressing thresholds to be validated. The purpose of this study was to measure the variation in the maximum joint stressing forces applied by various surgeons in vivo in a human population and based on that derive thresholds for safe stressing.
From studies on ligament failure properties, we inferred a theoretical maximum stressing force of 78 N. Twenty-one patients were included, and knee arthroscopies were performed by five experienced surgeons. Forces solely performed in the varus and in valgus direction were measured. A load sensor was mounted on a belt, which was rotated along the hip to measure both varus and valgus stressing. The measurements started as soon as the interior of the knee joint was visualised using joint stressing.
The average maximum stressing force was 60 N (SD = 28 N). The mean first frame force was 47 N (SD = 34 N). No significant differences were found between varus and valgus stressing.
Since variation in stressing forces is high, offering training cases on simulators where the complete range of stressing forces can be experienced is recommended. Abiding to safety levels is essential to increase patient safety.
在进行膝关节镜检查时，关节施压对于增加手术关节间隙至关重要。充分的关节施压训练非常重要，因为过高的施压力量可能会损伤膝关节韧带，而过低的施压可能无法提供足够的手术空间。由于无法看到力的传递，因此模拟器可能适合用于训练关节施压，因为它们可以可视化施加的力的大小。这就需要验证关节施压的阈值。本研究的目的是测量不同外科医生在人体中实际进行的最大关节施压力的变化，并据此得出安全施压的阈值。
从韧带失效特性的研究中，我们推断出理论上的最大施压力为 78 N。纳入了 21 名患者，并由 5 名经验丰富的外科医生进行膝关节镜检查。仅在内外翻方向上测量力。在膝关节内部可视化后，将负载传感器安装在一条沿着臀部旋转的皮带上，以测量内外翻施压。
平均最大施压力为 60 N（标准差=28 N）。平均第一帧力为 47 N（标准差=34 N）。内外翻施压之间无显著差异。
由于施压力的变化很大，因此建议在模拟器上提供培训案例，以便体验完整的施压力范围。遵守安全水平对于提高患者安全性至关重要。
