UCSF School of Medicine, San Francisco, California.
Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
J Surg Educ. 2022 Nov-Dec;79(6):1516-1525. doi: 10.1016/j.jsurg.2022.06.007. Epub 2022 Jul 9.
OBJECTIVE: To examine the efficacy of virtual reality (VR) to prepare surgical trainees for a pediatric orthopedic surgery procedure: pinning of a slipped capital femoral epiphysis (SCFE). DESIGN: Participants were randomly assigned to a standard, study guide (SG) group or to a VR training group. All participants were provided a technique video and SG; the VR group additionally trained via an Osso VR surgical trainer (ossovr.com) with real-time feedback and coaching from an attending pediatric orthopedic surgeon. Following training, participants performed a SCFE guidewire placement on a SawBones model embedded in a soft-tissue envelope (SawBones model 1161). Participants were asked to achieve "ideal placement" based on the training provided. Participants were evaluated on time, number of pin "in-and outs," penetration of the articular surface, angle between the pin and the physis, distance from pin tip to subchondral bone and distance from the center-center point of the epiphysis. SETTING: Orthopedic Institute for Children, Los Angeles, CA. PARTICIPANTS: Twenty fourth-year medical students, first- and second-year orthopedic residents without experience with the SCFE procedure. RESULTS: Twenty participants were randomized to SG (n = 10) or VR (n = 10). Average time to final pin placement was 19% shorter in VR group (706 vs 573 seconds, p = 0.26). When compared to SG, the VR group had, on average, 70% less pin in-and-outs (1.7 vs 0.5, p = 0.28), 50% less articular surface penetrations (0.4 vs 0.2, p = 0.36), and 18% smaller distance from pin tip to subchondral bone on lateral view (7.1 vs 5.8 mm, p = 0.42). Moreover, the VR group had a lower average angle deviation between pin and line perpendicular to the physis on coronal view (4.9° vs 2.5°, p < 0.05). CONCLUSIONS: VR training is potentially more effective than traditional preparatory methods. This pilot study suggests that VR training may be a viable surgical training tool, which may alleviate constraints of time, money, and safety concerns with resultant broad applicability for surgical education.
目的：研究虚拟现实（VR）在小儿矫形外科手术中的应用效果：股骨颈骨骺滑脱（SCFE）的钢针固定。
设计：参与者被随机分配到标准、学习指南（SG）组或 VR 训练组。所有参与者都提供了技术视频和 SG；VR 组还通过 Osso VR 手术训练器（ossovr.com）进行训练，接受一名主治小儿矫形外科医生的实时反馈和指导。培训后，参与者在一个嵌入软组织包膜的 SawBones 模型（SawBones 模型 1161）上进行 SCFE 导丝放置。参与者被要求根据提供的培训达到“理想放置”。参与者的评估标准为时间、钢针“进出”次数、关节面穿透、钢针与骨骺的角度、针尖到软骨下骨的距离以及骨骺中心点到中心的距离。
地点：洛杉矶，加州，骨科研究所。
参与者：20 名四年级医学生，无 SCFE 手术经验的第一和第二年骨科住院医师。
结果：20 名参与者被随机分为 SG（n=10）或 VR（n=10）组。VR 组最终钢针放置时间平均缩短 19%（706 秒比 573 秒，p=0.26）。与 SG 相比，VR 组的钢针进出次数平均减少 70%（1.7 次比 0.5 次，p=0.28），关节面穿透次数减少 50%（0.4 次比 0.2 次，p=0.36），侧位针尖距软骨下骨的距离减少 18%（7.1 毫米比 5.8 毫米，p=0.42）。此外，VR 组冠状位上针与垂直于骨骺的线之间的角度偏差平均较小（4.9°比 2.5°，p<0.05）。
结论：VR 培训比传统的准备方法更有效。这项初步研究表明，VR 培训可能是一种可行的手术培训工具，它可能减轻时间、金钱和安全问题的限制，因此广泛适用于手术教育。
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