Rikli Daniel, Goldhahn Sabine, Blauth Michael, Mehta Samir, Cunningham Michael, Joeris Alexander
University Hospital Basel, Clinic for Orthopaedic and Trauma Surgery, Basel, Switzerland.
AO Foundation, AO Clinical Investigation and Documentation, Duebendorf, Switzerland.
Injury. 2018 Feb;49(2):339-344. doi: 10.1016/j.injury.2017.11.024. Epub 2017 Nov 21.
Formal training for surgeons regarding intraoperative imaging is lacking. This project investigated the effect of an educational intervention focusing on obtaining and assessing a standardized lateral view of the proximal femur during intramedullary nailing of a pertrochanteric fracture.
Anatomical landmarks of the proximal femur that can be identified using intraoperative fluoroscopy and criteria for image quality, i.e. quality of projection were defined in a consensus process, followed by the development of educational materials and a 7-item checklist. Five surgeons from 5 Trauma Centers in 4 countries participated. Each surgeon a) assessed 5 of their own retrospective cases and 5 retrospective cases from 4 colleagues from their clinic, b) viewed an educational video and poster and re-assessed the same cases, and c) assessed the intraoperative images of 5 prospectively collected consecutive cases of their own and of colleagues afterwards.
The percentage of positive ratings for image quality increased from 72% prior to educational intervention to 88% after intervention (p<0.001), and number of "not assessable" images decreased significantly. Percentage agreement between surgeons on the assessments increased from 75% to 87%. The proportion of best possible ratings for fracture reduction and implant position increased from 58% to 72% and from 49% to 66%, respectively. Percentage agreement between surgeons on assessment of reduction and implant position increased.
A focused educational intervention can improve surgeons' ability to obtain and assess lateral view intraoperative images of the proximal femur and can improve the quality of reduction and implant positioning.
外科医生缺乏关于术中成像的正规培训。本项目研究了一种教育干预措施的效果，该措施聚焦于在股骨转子间骨折髓内钉固定术中获取并评估标准化的股骨近端侧位视图。
通过共识过程确定了可在术中透视下识别的股骨近端解剖标志以及图像质量标准，即投影质量标准，随后开发了教育材料和一份包含7项内容的检查表。来自4个国家5个创伤中心的5名外科医生参与其中。每位外科医生a）评估了他们自己的5例回顾性病例以及来自其诊所4位同事的5例回顾性病例，b）观看了教育视频和海报并重新评估相同病例，c）之后评估了他们自己和同事前瞻性收集的连续5例病例的术中图像。
图像质量的正面评级百分比从教育干预前的72%增至干预后的88%（p<0.001），“不可评估”图像数量显著减少。外科医生之间评估的百分比一致性从75%增至87%。骨折复位和植入物位置的最佳可能评级比例分别从58%增至72%以及从49%增至66%。外科医生之间在复位和植入物位置评估上的百分比一致性提高。
有针对性的教育干预可以提高外科医生获取和评估股骨近端侧位术中图像的能力，并可提高复位和植入物定位的质量。
