评估软性输尿管镜的人体工程学

Evaluating the Ergonomics of Flexible Ureteroscopy.

作者信息

Ludwig Wesley W, Lee Gyusung, Ziemba Justin B, Ko Joan S, Matlaga Brian R

机构信息

1 The James Buchanan Brady Department of Urology, Johns Hopkins University School of Medicine , Baltimore, Maryland.

2 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.

出版信息

J Endourol. 2017 Oct;31(10):1062-1066. doi: 10.1089/end.2017.0378.

DOI:10.1089/end.2017.0378

PMID:28817961

Abstract

INTRODUCTION

To date, the ergonomics of flexible ureteroscopy (URS) have not been well described. We performed a study to assess the biomechanical stresses on urologists performing URS and to investigate the effect of ureteroscope type on these parameters.

METHODS

Electromyography (EMG) was used to quantify the activation level of muscle groups involved in URS. Surface EMG electrodes (Delsys, Boston, MA) were placed on the right and left thenar, flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), biceps, triceps, and deltoid. Three endoscopes were studied: single-use digital (Boston Scientific LithoVue), reusable digital (Karl Storz Flex-X), and reusable fiber-optic (Karl Storz Flex-X). Each ureteroscope was used to perform a set sequence of navigation and procedural tasks in a training model. EMG data were processed and normalized to compare the maximum voluntary contractions between muscle groups. Cumulative muscular workload (CMW) and average muscular work per second (AWS) were used for comparative analysis.

RESULTS

For navigational tasks, CMW and AWS were greatest for the ECU, followed in descending order by right and left thenar, FCU, biceps, deltoid, and triceps. For procedural tasks, CMW and AWS were greatest for the right thenar, followed in descending order by the left thenar, ECU, FCU, triceps, biceps, and deltoid. During navigational tasks, both LithoVue and Flex-X had lower CMWs for every muscle group than Flex-X (p < 0.05). LithoVue and Flex-X had similar AWS and both were lower than Flex-X for the right thenar, ECU, biceps, and deltoid activation (p < 0.05). During procedural tasks, both LithoVue and Flex-X had lower CMWs and AWS for right and left thenar, ECU, and biceps than Flex-X (p < 0.05).

CONCLUSIONS

This study provides the first description of EMG-measured ergonomics of URS. Both the single-use and reusable digital ureteroscopes have similar profiles, and both have significantly better ergonomic metrics than the reusable fiber-optic ureteroscope.

摘要

引言

迄今为止，可弯曲输尿管镜检查（URS）的人体工程学尚未得到充分描述。我们开展了一项研究，以评估进行URS操作的泌尿外科医生所承受的生物力学应力，并研究输尿管镜类型对这些参数的影响。

方法

采用肌电图（EMG）来量化URS过程中参与操作的肌肉群的激活水平。将表面EMG电极（Delsys，马萨诸塞州波士顿）置于左右鱼际肌、尺侧腕屈肌（FCU）、尺侧腕伸肌（ECU）、肱二头肌、肱三头肌和三角肌上。研究了三种输尿管镜：一次性数字输尿管镜（波士顿科学公司的LithoVue）、可重复使用数字输尿管镜（卡尔史托斯Flex-X）和可重复使用纤维光学输尿管镜（卡尔史托斯Flex-X）。每种输尿管镜均用于在训练模型中执行一系列设定的导航和操作任务。对EMG数据进行处理并归一化，以比较肌肉群之间的最大自主收缩。使用累积肌肉工作量（CMW）和每秒平均肌肉工作量（AWS）进行对比分析。

结果

在导航任务中，ECU的CMW和AWS最大，其次依次为左右鱼际肌、FCU、肱二头肌、三角肌和肱三头肌。在操作任务中，右手鱼际肌的CMW和AWS最大，其次依次为左手鱼际肌、ECU、FCU、肱三头肌、肱二头肌和三角肌。在导航任务期间，LithoVue和Flex-X的每个肌肉群的CMW均低于Flex-X（p < 0.05）。LithoVue和Flex-X的AWS相似，且右手鱼际肌、ECU、肱二头肌和三角肌激活时两者均低于Flex-X（p < 0.05）。在操作任务期间，LithoVue和Flex-X的左右鱼际肌、ECU和肱二头肌的CMW和AWS均低于Flex-X（p < 0.05）。