Delgado Byron, Campos Mauricio, Lobos Daniel, Cuéllar Jorge, Ruz Cristian, Besa Pablo, Castro Javier, Vidal Catalina
From the Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
J Am Acad Orthop Surg. 2024 Dec 12;33(18):1048-1053. doi: 10.5435/JAAOS-D-24-00699.
Lumbar pedicle screw placement in spinal surgery is complex and prone to errors, with notable risks to patients. Standard training methods, such as mentorship in operating rooms, pose safety concerns, prompting the need for alternative training tools. This study aimed to validate and use a three-dimensional (3D)-printed simulation model for lumbar pedicle screw insertion training and assess its effectiveness compared with standard methods. The study proceeded through four phases: model design and validation, construct validation, learning curve assessment, and transfer to a cadaver model. A 3D-printed lumbar spine model was created and refined based on expert feedback. Construct validation demonstrated the model's ability to differentiate between experts and novices. Training sessions with residents showed a notable improvement in performance over multiple attempts, but performance still lagged that of experts. However, skills learned on the simulation model were effectively transferred to a cadaver model, with no notable difference in performance observed. The trained group outperformed a control group trained using standard methods in the cadaver test. The study concludes that the 3D-printed simulation model is a valid training tool for lumbar pedicle screw insertion, effectively transferring skills to a cadaver setting and improving resident performance compared with standard training methods. Additional research is warranted to explore the sustainability of acquired skills and optimize training protocols.
腰椎椎弓根螺钉置入术在脊柱外科手术中较为复杂且容易出错,对患者存在显著风险。标准的培训方法,如在手术室进行导师指导,存在安全隐患,因此需要替代性的培训工具。本研究旨在验证并使用三维(3D)打印模拟模型进行腰椎椎弓根螺钉置入培训,并评估其与标准方法相比的有效性。该研究分四个阶段进行:模型设计与验证、结构验证、学习曲线评估以及向尸体模型的转移。基于专家反馈创建并完善了一个3D打印的腰椎模型。结构验证证明了该模型能够区分专家和新手。对住院医师进行的培训课程显示,经过多次尝试后,其操作表现有显著提高,但仍落后于专家。然而,在模拟模型上所学的技能有效地转移到了尸体模型上,观察到操作表现没有显著差异。在尸体测试中,接受训练的组比使用标准方法训练的对照组表现更好。该研究得出结论,3D打印模拟模型是一种有效的腰椎椎弓根螺钉置入培训工具,能有效地将技能转移到尸体操作环境中,并与标准培训方法相比提高住院医师的操作表现。有必要进行进一步研究以探索所获技能的可持续性并优化培训方案。