Hafez Mahmoud A, Nasser Eltayeb, Nabeel Ahmed
Orthopaedic Department, Faculty of Medicine, October 6 University, Giza.
Orthopaedic Department, Faculty of Medicine, Helwan University.
Ann Med Surg (Lond). 2023 Apr 19;85(6):2635-2639. doi: 10.1097/MS9.0000000000000644. eCollection 2023 Jun.
The instrumentation system for total knee replacement (TKR) has been there since the 1970s. The many steps and instruments are the main features despite several modifications over the last 50 years. This may lead to the accumulation of errors as certain steps are dependent on others. This study aimed to identify the errors while performing TKR by three trainees at different levels of training.
Three trainees with different expertise performed the steps of TKR on bone models. One senior supervisor recorded the outcomes, including operative time and errors made during the experiment. Errors were further categorized into correctable and uncorrectable ones.
Most of the errors were made by the trainee with the least experience during the stages of femoral cutting, sizing, and rotation. The first-year resident has taken 1.25 times longer than the fellow in preparing the femur and 1.11 times in preparing the tibia. The recorded mistakes were 28, 8, and 3 for the first-year resident, the second-year resident, and the fellow surgeon, respectively. Fifteen of the mistakes were uncorrectable, and none of them were from the senior surgeon.
The results of this study highlight the type of errors made by different trainees. This shows the steep learning curve of conventional instrumentation systems for trainees. Increasing cognitive skills and applying computer-assisted technologies may help trainees overcome this steep learning curve.
全膝关节置换术（TKR）的手术器械系统自20世纪70年代就已存在。尽管在过去50年里有过几次改进，但众多的步骤和器械仍是其主要特点。这可能会导致误差累积，因为某些步骤依赖于其他步骤。本研究旨在识别三名处于不同培训水平的学员在进行全膝关节置换术时所犯的错误。
三名具有不同专业水平的学员在骨模型上进行全膝关节置换术的步骤。一名高级主管记录结果，包括手术时间和实验过程中出现的错误。错误进一步分为可纠正和不可纠正的。
大部分错误是由经验最少的学员在股骨截骨、尺寸测量和旋转阶段犯下的。第一年住院医师在准备股骨时花费的时间比专科住院医生长1.25倍，在准备胫骨时花费的时间长1.11倍。第一年住院医师、第二年住院医师和专科医生记录的错误分别为28处、8处和3处。其中15处错误不可纠正，且均非资深外科医生所犯。
本研究结果突出了不同学员所犯错误的类型。这显示了传统手术器械系统对学员来说陡峭的学习曲线。提高认知技能并应用计算机辅助技术可能有助于学员克服这一陡峭的学习曲线。
