AO Research Institute Davos, 7270 Davos, Switzerland.
Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland.
Medicina (Kaunas). 2022 Jun 7;58(6):773. doi: 10.3390/medicina58060773.
Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics-number of X-rays, nail hole roundness, drill tip position and drill hole accuracy-between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Face validity: mean realism of the training device was rated 6.3 (range 4-7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5-7), with no significant differences between experts and novices, ≥ 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 ± 6.4 versus 15.5 ± 5.3, = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: = 15; 55.6%; experts hit: = 19; 83%, = 0.040). The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks.
徒手髓内钉远端锁定技术要求高，且易于出现操作问题。它需要在透视引导下通过髓内钉精确放置螺钉，这可能会导致耗时且昂贵的放射程序。专门的培训可以帮助克服这些问题。本研究旨在评估新的数字化增强实操手术训练（DEHST）概念和设备用于髓内钉远端锁定的构建和表面有效性。29 名新手和 24 名专家外科医生在 DEHST 设备上进行了锁定。通过比较专家和新手之间的捕获性能指标（X 射线数量、钉孔圆度、钻头尖端位置和钻孔准确性）来评估构建有效性。使用 7 分李克特量表评估培训潜力和模拟现实的质量来评估表面有效性。表面有效性：培训设备的平均逼真度评分为 6.3（范围 4-7）。对培训潜力和远端锁定培训的需求的评分均为 6.5（范围 5-7），专家和新手之间没有显著差异，≥0.234。所有参与者（100%）都表示该设备对于程序训练很有用，96%希望在自己的机构中拥有该设备，98%愿意将其推荐给同事。构建有效性：新手的 X 射线总数明显更高（20.9±6.4 比 15.5±5.3， = 0.003）。专家的成功率（命中和未命中尝试的比例）明显更高（新手命中： = 15；55.6%；专家命中： = 19；83%， = 0.040）。评估的髓内钉远端锁定实操培训设备在培训能力和逼真度方面得分很高。此外，通过可靠地区分专家和新手证明了构建有效性。参与者表示具有很高的进一步培训潜力，因为该设备可以轻松适应其他手术任务。
