Klingebiel Felix Karl-Ludwig, Sawauchi Kenichi, Mittlmeier Anne, Kalbas Yannik, Berk Till, Halvachizadeh Sascha, Teuben Michel, Neuhaus Valentin, Mauffrey Cyril, Pape Hans-Christoph, Pfeifer Roman
Department of Trauma Surgery, University Hospital Zurich, Raemistr. 100, Zurich, 8091, Switzerland.
Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Raemistr. 100, Zurich, 8091, Switzerland.
Patient Saf Surg. 2024 Sep 27;18(1):28. doi: 10.1186/s13037-024-00412-0.
The management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement. Given the infrequent performance of these procedures, regular training is imperative to ensure readiness for emergencies. Our pre- post simulation study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries, facilitating participants' knowledge retention and procedural confidence enhancement.
A standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint was developed. Trauma surgeons of a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated as secondary outcome measures.
Fifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The mean total operation time was 20.34 ± 6.06 min, without significant differences between consultants and residents (p = 0.604). The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before = 3.8 ± 3.08 vs. After = 5.67 ± 2.35; p = 0.002) as well as after external fixation (10-LS: Before = 3.93 ± 2.79 vs. After = 6.07 ± 2.52; p = 0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before = 4.60 ± 3.0 vs. After = 6.53 ± 2.39; p = 0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS = 7.87 ± 1.13).
Our unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging. Further studies are required to validate the objective benefits and improvements that participants undergo through frequent training.
对血流动力学不稳定的骨盆环损伤进行处理需要手术干预，通常涉及外固定和经皮螺钉置入等操作。鉴于这些操作并不经常进行，定期培训对于确保做好应对紧急情况的准备至关重要。我们的模拟前后研究旨在调整并验证一种用于稳定不稳定骨盆环损伤的逼真模拟模型，以促进参与者知识的保留并增强其操作信心。
利用合成骨盆骨开发了一种不稳定骨盆环的标准化模拟器，其耻骨联合和骶髂关节完全断裂。邀请一家一级学术医院的创伤外科医生在C形臂引导下进行外固定和紧急骶髂螺钉置入。在模拟课程之前和之后，参与者完成一份主观问卷，以10分制李克特量表（10-LS）评估他们对紧急干预的信心。还评估了术中成像质量、复位准确性以及螺钉、钢丝和外固定器的定位等客观参数作为次要结果指标。
15名创伤外科医生（10名住院医生，5名顾问医生）在一天内参与了模拟。平均总手术时间为20.34±6.06分钟，顾问医生和住院医生之间无显著差异（p = 0.604）。模拟器训练后，紧急骶髂螺钉置入的信心显著增加（10-LS：训练前=3.8±3.08 vs.训练后=5.67±2.35；p = 0.002），外固定训练后也是如此（10-LS：训练前=3.93±2.79 vs.训练后=6.07±2.52；p = 0.002）。此外，对（术中）骨盆成像的信心显著增加（10-LS：训练前=4.60±3.0 vs.训练后=6.53±2.39；p = 0.011）。总体而言，该模型被评为对临床实践的逼真模拟（10-LS = 7.87±1.13）。
我们的不稳定骨盆骨折模型是一种用于练习外固定和经皮技术等紧急干预的工具。参与者在技术操作和术中成像方面从中受益。需要进一步研究来验证参与者通过频繁训练所获得的客观益处和改善情况。
