Laverdiere Carl, Harvey Eric, Schupbach Justin, Boily Mathieu, Burman Mark, Martineau Paul A
Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada.
Orthop J Sports Med. 2020 Mar 12;8(3):2325967120905795. doi: 10.1177/2325967120905795. eCollection 2020 Mar.
Femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) is an intricate procedure that requires highly specific surgical skills.
To report the ability of residents to identify femoral landmarks and the native ACL footprint before and after a structured formal teaching session as a reflection of overall surgical skill training for orthopaedic surgery residents in Canada.
Controlled laboratory study.
A total of 13 senior orthopaedic residents were asked to identify a femoral landmark and an ACL footprint on ten 3-dimensional (3D)-printed knee models before and after a teaching session during the fall of 2018. The 3D models were made based on actual patients with different anatomic morphologic features. ImageJ software was used to quantify the measurements, which were then analyzed through use of descriptive statistics.
Before and after the teaching session, residents attempted to identify a specific anatomic location (bifurcate and intercondylar ridge intersection) with a mean error per participant ranging from 5.00 to 10.95 mm and 4.79 to 12.13 mm in magnitude, respectively. Furthermore, before and after the teaching session, residents identified the specific position to perform the surgical procedure (ACL femoral footprint), with a mean error per participant ranging from 4.58 to 8.80 mm and 3.87 to 11.07 mm in magnitude, respectively. The teaching session resulted in no significant improvement in identification of either the intersection of the bifurcate and intercondylar ridges ( = .9343 in the proximal-distal axis and = .8133 in the anteroposterior axis) or the center of the femoral footprint ( = .7761 in the proximal-distal axis and = .9742 in the anteroposterior axis).
Although a formal teaching session was combined with a hands-on session that entailed real surgical instrumentation and fresh cadaveric specimens, the intervention seemed to have no direct impact on senior residents' performance or their ability to demonstrate the material taught. This puts into question the format and efficacy of present teaching methods. Also, it is possible that the 3D spatial perception required to perform these skills is not something that can be taught effectively through a teaching session or at all. Further investigation is required regarding the effectiveness and application of surgical skill laboratories and simulations on the competencies of orthopaedic residents.
前交叉韧带重建术（ACLR）中股骨隧道定位是一个复杂的过程，需要高度专业化的手术技能。
报告在结构化的正式教学课程前后，住院医师识别股骨标志点和天然前交叉韧带足迹的能力，以此反映加拿大骨科住院医师整体手术技能培训情况。
对照实验室研究。
2018年秋季，共有13名骨科高年级住院医师在一次教学课程前后，被要求在10个三维（3D）打印的膝关节模型上识别一个股骨标志点和一个前交叉韧带足迹。这些3D模型是根据具有不同解剖形态特征的实际患者制作的。使用ImageJ软件对测量结果进行量化，然后通过描述性统计进行分析。
在教学课程前后，住院医师试图识别一个特定的解剖位置（分叉与髁间嵴交点），每位参与者的平均误差分别为5.00至10.95毫米和4.79至12.13毫米。此外，在教学课程前后，住院医师识别进行手术操作的特定位置（前交叉韧带股骨足迹），每位参与者的平均误差分别为4.58至8.80毫米和3.87至11.07毫米。教学课程在识别分叉与髁间嵴交点（近远轴上P = 0.9343，前后轴上P = 0.8133）或股骨足迹中心（近远轴上P = 0.7761，前后轴上P = 0.9742）方面均未产生显著改善。
尽管正式教学课程与涉及真实手术器械和新鲜尸体标本的实践课程相结合，但该干预似乎对高年级住院医师的表现或其展示所学内容的能力没有直接影响。这使当前教学方法的形式和效果受到质疑。此外，执行这些技能所需的3D空间感知能力可能无法通过教学课程有效传授，甚至根本无法传授。需要进一步研究手术技能实验室和模拟在骨科住院医师能力培养方面的有效性和应用。
