J Grad Med Educ. 2020 Jun;12(3):329-334. doi: 10.4300/JGME-D-19-00553.1.
Arthroscopic surgical simulation, including the use of cadaveric tissue, is valuable for training orthopedic surgery residents. However, it is unclear how often fresh-frozen cadaveric tissue can be reused to provide a reproducible model for developing arthroscopic skills.
We determined the usefulness of ultrasound in evaluating tissue degradation in fresh-frozen shoulder and knee joints used for surgical simulation.
Between February 7 and April 11, 2017, orthopedic residents participated in 6 wet lab sessions during 1 rotation. Knee and shoulder specimens were subjected to ultrasound using a SonoSite Edge machine and a linear probe after each freeze-and-thaw cycle. Degradation of each structure was determined based on standards created for living tissue and comparisons to previous images of the same tissue before initial use.
Ultrasonographic assessment of the 2 knee and 2 shoulder specimens revealed lost integrity in subcutaneous fat and muscle with evidence of increased hypoechoicity and loss of normal fiber orientation and density in all specimens examined. Tendons, ligaments, cartilage, iliotibial band, and bone did not lose integrity during freezing and thawing. Ultrasonographic assessment revealed no loss of joint structure integrity. However, the intra-articular work assigned for the simulation curriculum had been carried out to a degree that by the third use, little opportunity remained for further arthroscopic practice on that specimen.
In this study, ultrasound findings showed that fresh-frozen shoulder and knee specimens maintained structural integrity useful for simulation training after 3 cycles of freezing.
关节镜手术模拟，包括使用尸体组织，对于培训骨科住院医师非常有价值。然而，目前尚不清楚新鲜冷冻尸体组织可以重复使用多少次，以提供用于发展关节镜技能的可重复模型。
我们旨在确定超声在评估用于手术模拟的新鲜冷冻肩和膝关节组织降解方面的作用。
2017 年 2 月 7 日至 4 月 11 日，骨科住院医师在 1 个轮转周期内参加了 6 次湿实验室课程。在每个冷冻和解冻循环后，使用 SonoSite Edge 机器和线性探头对膝关节和肩关节标本进行超声检查。根据为活体组织制定的标准以及与同一组织在初始使用前的先前图像进行比较，确定每个结构的降解情况。
对 2 个膝关节和 2 个肩关节标本的超声评估显示，所有检查的标本中的皮下脂肪和肌肉完整性丧失，表现为回声降低，正常纤维方向和密度丧失。肌腱、韧带、软骨、阔筋膜张肌和骨骼在冷冻和解冻过程中没有失去完整性。超声评估显示关节结构完整性没有丢失。然而，为模拟课程分配的关节内工作已经进行到一定程度，以至于在第三个使用周期中，该标本上几乎没有进一步进行关节镜实践的机会。
在这项研究中，超声检查结果表明，新鲜冷冻的肩和膝关节标本在经历 3 个冷冻循环后，仍保持有用的结构完整性，可用于模拟培训。
