Risler Zachary, Magee Mark A, Mazza Jacob M, Goodsell Kelly, Au Arthur K, Lewiss Resa E, Pugliese Robert S, Ku Bon
Emergency Medicine, Thomas Jefferson University, Philadelphia, USA.
Cureus. 2018 Nov 2;10(11):e3536. doi: 10.7759/cureus.3536.
Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation. We utilized an open-source file of a shoulder, available from embodi3D (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom. The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of "see one, do one, teach one" is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection. 3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model.
肩关节前脱位是急诊室（ED）中最常见的大关节脱位。大量研究支持使用关节内局部麻醉注射来安全、有效且省时地复位这些脱位。与床边学习相比，模拟训练是一种替代且有效的训练方法。目前没有市售的与超声兼容的肩关节脱位模型。我们利用三维（3D）打印机打印了一个模型，该模型能够显示肩关节前脱位的超声解剖结构（超声解剖学）。我们使用了一个可从embdi3D（美国华盛顿州贝尔维尤）获取的肩部开源文件。在前脱位中近似肱骨与关节盂的相对方位后，使用聚乳酸细丝，通过Ultimaker-2 Extended+ 3D®（美国马萨诸塞州剑桥市的Ultimaker公司）打印机打印肱骨和肩胛骨模型。然后使用3D扫描仪Structure Sensor®（美国加利福尼亚州旧金山奥克西皮塔尔公司）创建一个真人模型肩部外部解剖结构的3D模型。我们将打印的肱骨和肩胛骨脱位模型在所得的肩部外部模具中对齐。使用可灌注的弹道凝胶溶液制作最终的肩部模型。鉴于工作时间限制以及对患者安全的重新关注，模拟在医学中的应用广泛且不断增加。“看一个，做一个，教一个”这句格言正被刻意练习所取代。模拟使得这种训练能够在安全的教学环境中进行。弹道凝胶和聚乳酸结构有效地再现了肩关节前脱位的超声解剖学。3D打印模型对于练习平面内超声引导下关节内注射是有效的。3D打印在制作模拟肩关节前脱位的低成本、具备超声功能的模型方面是有效的。未来的研究将确定在使用该模型后，医疗人员的信心以及使用关节内麻醉治疗肩关节脱位的情况是否会得到改善。
