From R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical School, Baltimore, MD.
J Am Acad Orthop Surg Glob Res Rev. 2023 May 16;7(5). doi: 10.5435/JAAOSGlobal-D-22-00056. eCollection 2023 May 1.
This cadaveric study seeks to determine whether skills acquired on the simulator translate to improved performance of the clinical task. We hypothesized that completion of simulator training modules would improve performance of percutaneous hip pinning.
Eighteen right-handed medical students from two academic institutions were randomized: trained (n = 9) and untrained (n = 9). The trained group completed nine simulator-based modules of increasing difficulty, designed to teach techniques of placing wires in an inverted triangle construct in a valgus-impacted femoral neck fracture. The untrained group had a brief simulator introduction but did not complete the modules. Both groups received a hip fracture lecture, an explanation and pictorial reference of an inverted triangle construct, and instruction on using the wire driver. Participants then placed three 3.2 mm guidewires in cadaveric hips in an inverted triangle construct under fluoroscopy. Wire placement was evaluated with CT at 0.5 mm sections.
The trained group significantly outperformed the untrained group in most parameters (P ≤ 0.05).
The results suggest that a force feedback simulation platform with simulated fluoroscopic imaging using an established, increasingly difficult series of motor skills training modules has potential to improve clinical performance and might offer an important adjunct to traditional orthopaedic training.
本尸体研究旨在确定在模拟器上获得的技能是否能转化为临床任务表现的改善。我们假设完成模拟器培训模块将提高经皮髋钉钉操作的性能。
来自两个学术机构的 18 名右利手医学生被随机分为训练组（n=9）和未训练组（n=9）。训练组完成了九个基于模拟器的模块，难度逐渐增加，旨在教授在外翻型股骨颈骨折中以倒三角结构放置导丝的技术。未训练组仅进行了简短的模拟器介绍，并未完成模块。两组均接受髋关节骨折讲座、倒三角结构的说明和图片参考以及导丝驱动器使用说明。然后，参与者在尸体髋部的透视下以倒三角结构放置三根 3.2mm 导丝。使用 CT 在 0.5mm 切片处评估导丝放置情况。
训练组在大多数参数上明显优于未训练组（P≤0.05）。
结果表明，具有模拟透视成像的力反馈模拟平台，结合一系列经过验证的、难度逐渐增加的运动技能培训模块，具有提高临床表现的潜力，并可能成为传统骨科培训的重要辅助手段。
