Patterson Joseph T, Becerra Jacob A, Duong Andrew, Reddy Akhil, Oakes Daniel A
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
JB JS Open Access. 2023 Mar 2;8(1). doi: 10.2106/JBJS.OA.22.00124. eCollection 2023 Jan-Mar.
Bone drilling is a critical skill honed during orthopaedic surgical education. How a bone drill is held and operated (bracing position) may influence drilling performance.
A prospective study with randomized crossover was conducted to assess the effect of 4 bracing positions on orthopaedic surgical trainee performance in a simulated bone drilling task. Linear mixed effects models considering participant training level, preferred bracing position, height, weight, and drill hole number were used to estimate pairwise and overall comparisons of the effect of each bracing position on 2 primary outcomes of drilling depth and accuracy.
A total of 42 trainees were screened and 19 were randomized and completed the study. Drill plunge depth with a 1-handed drilling position was significantly greater by pairwise comparison to any of the 3 double handed positions tested: a soft tissue protection sleeve in the other hand (0.41 mm, 95% confidence interval [CI] 0.80-0.03, p = 0.031), a 2-handed position with the contralateral small finger on bone and the thumb on the drill (0.42 mm, 95% CI 0.06-0.79, p = 0.018), and a 2-handed position with the contralateral elbow braced against the table (0.40 mm, 95% CI 0.02-0.78, p = 0.038). No position afforded a significant accuracy advantage (p = 0.227). Interactions of participant height with plunge depth and accuracy as well between drill hole number and plunge depth were observed.
Orthopaedic surgical educators should discourage trainees from operating a bone drill using only 1 hand to reduce the risk of iatrogenic injury due to drill plunging.
Therapeutic Level II.
骨钻孔是骨科手术教育过程中磨练的一项关键技能。骨钻的握持和操作方式（支撑姿势）可能会影响钻孔性能。
进行了一项随机交叉前瞻性研究，以评估4种支撑姿势对骨科手术实习生在模拟骨钻孔任务中表现的影响。使用考虑参与者培训水平、首选支撑姿势、身高、体重和钻孔数量的线性混合效应模型，来估计每种支撑姿势对钻孔深度和准确性这两个主要结果影响的成对比较和总体比较。
共筛选了42名实习生，19名被随机分组并完成了研究。与测试的3种双手姿势中的任何一种相比，单手钻孔姿势的钻孔切入深度通过成对比较显著更深：另一只手持软组织保护套（0.41毫米，95%置信区间[CI]0.80 - 0.03，p = 0.031）、对侧小手指放在骨上且拇指放在钻上的双手姿势（0.42毫米，95%CI 0.06 - 0.79，p = 0.018）以及对侧肘部靠在桌子上的双手姿势（0.40毫米，95%CI 0.02 - 0.78，p = 0.038）。没有一种姿势具有显著的准确性优势（p = 0.227）。观察到参与者身高与切入深度和准确性之间以及钻孔数量与切入深度之间的相互作用。
骨科手术教育工作者应劝阻实习生仅用一只手操作骨钻，以降低因钻孔切入导致医源性损伤的风险。
治疗性II级。
