Pastor Tatjana, Buschbaum Jan, von Laue Mathilde, Link Björn-Christian, Beeres Frank J P, Fletcher James, Ganse Bergita, Richards R Geoff, Gueorguiev Boyko, Pastor Torsten
AO Research Institute Davos, Davos, Switzerland.
Department of Traumatology and Orthopaedics, Bürgerspital Solothurn, Solothurn, Switzerland.
Eur J Trauma Emerg Surg. 2025 Jan 11;51(1):7. doi: 10.1007/s00068-024-02686-6.
Digitally Enhanced Hands-on Surgical Training (DEHST) platform was introduced to overcome the lack of training capabilities for the challenging task of freehand distal interlocking of intramedullary nails. It demonstrates high perceived realism for surgeons, and novices perform significantly better after DEHST training. However, characterization of how performance improves remained unexplored. The aim of this study was to evaluate the training progression of novices in freehand distal interlocking during five training rounds with DEHST and to compare their performance in a simulated operation against experienced surgeons.
Ten novices (Group 1) underwent five DEHST training sessions (approximately one hour in total) and their performance data was acquired and evaluated. The surgical performance of Group 1 was compared with ten surgical experts (Group 2) by performing distal interlocking of a real tibia nail in an artificial bone model in a simulated operation. Time taken, number of X-rays, accuracy of nail hole roundness, and success rates were compared between the groups.
Group 1 achieved comparable performance to Group 2 in number of X-rays 26.0 (range 15-40) versus 22.5 (range 16-34), p = 0.281, and accuracy of hole roundness 95.0% (range 91.1-98.0%) versus 93.3% (range 90.7-95.9%), p = 0.087. However, Group 1 needed significantly longer time compared with Group 2, p = 0.001, and furthermore, one participant in Group 1 (10%) failed to hit the nail hole with the drill bit, while 100% of the participants in Group 2 were successful.
DEHST appears to be a useful tool to gradually improve the proficiency level of novices and to train relevant practical surgical skills needed for distal interlocking of intramedullary nails. However, further investigations are needed to demonstrate the performance under the conditions of a real operation.
数字增强型实操手术训练（DEHST）平台的引入是为了克服在徒手进行髓内钉远端交锁这项具有挑战性的任务中训练能力的不足。它对外科医生而言具有较高的真实感，新手在接受DEHST训练后表现有显著提升。然而，关于性能如何提高的特征尚未得到探索。本研究的目的是评估新手在使用DEHST进行五轮训练过程中徒手远端交锁的训练进展，并将他们在模拟手术中的表现与经验丰富的外科医生进行比较。
十名新手（第一组）接受了五次DEHST训练课程（总共约一小时），并获取和评估了他们的表现数据。通过在模拟手术中对人工骨模型中的真实胫骨钉进行远端交锁，将第一组的手术表现与十名外科专家（第二组）进行比较。比较两组之间的用时、X射线使用次数、钉孔圆度的准确性和成功率。
第一组在X射线使用次数方面与第二组相当，分别为26.0次（范围15 - 40次）和22.5次（范围16 - 34次），p = 0.281；钉孔圆度准确性分别为95.0%（范围91.1 - 98.0%）和93.3%（范围90.7 - 95.9%），p = 0.087。然而，与第二组相比，第一组需要的时间明显更长，p = 0.001，此外，第一组中有一名参与者（10%）未能用钻头命中钉孔，而第二组的所有参与者（100%）均成功。
DEHST似乎是一种有用的工具，可以逐步提高新手的熟练程度，并训练髓内钉远端交锁所需的相关实际手术技能。然而，需要进一步研究以证明在实际手术条件下的表现。
