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逼真的髌骨骨折模拟:对手术训练机制及潜在益处的研究

Simulation of realistic patella fractures: an investigation into the mechanism and potential benefit for surgical training.

作者信息

Wegmann Sebastian, Leyendecker Jannik, Leschinger Tim, Weber Maximilian, Mueller Lars-Peter, Harbrecht Andreas

机构信息

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

出版信息

Knee Surg Relat Res. 2025 Jul 14;37(1):29. doi: 10.1186/s43019-025-00281-6.

Abstract

INTRODUCTION

Patella fractures account for about 1% of all bone fractures, predominantly affecting males at a 2:1 ratio and exhibiting distinctive age-related patterns. In younger individuals, these injuries typically result from high-velocity impacts, while in the elderly, they usually arise from lower-energy impacts. Consequently, the types of fractures differ; horizontal fractures are more common in younger individuals, whereas comminuted fractures are more prevalent in older adults. Owing to the knee's biomechanics, surgical intervention is often necessary. Preserving the articular surface is crucial to prevent retropatellar osteoarthritis, making thorough planning of surgical treatment essential. How can the osteosynthesis of this fracture entity be simulated as realistically as possible?

MATERIALS AND METHODS

This study focused on the feasibility of inducing realistic patella fractures with an intact soft tissue envelope on human cadaveric specimens for surgical training purposes. A total of seven fresh-frozen human cadaveric knee joints were used, and fractures were created using a custom-designed drop-test bench. The induced fractures were then classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Speck and Regazzoni classifications using radiographic and computed tomography (CT) evaluations. In addition, intra-rater and inter-rater reliability were further examined.

RESULTS

All specimens were successfully fractured. The results demonstrated high intra-rater and inter-rater reliability in both fracture classification systems, indicating that the method can reliably replicate realistic fractures for training purposes.

CONCLUSIONS

The study highlights the significance of using specimens with realistically induced fracture patterns in surgical education. Given that patella fractures are relatively rare and limit direct clinical exposure, realistic fracture models are invaluable for understanding these conditions. These models enhance surgical training, enabling both novice and experienced surgeons to refine their skills and effectively adapt to new surgical techniques.

摘要

引言

髌骨骨折约占所有骨折的1%,男性受影响的比例为2:1,且呈现出与年龄相关的独特模式。在年轻人中,这些损伤通常由高速撞击导致,而在老年人中,通常由低能量撞击引起。因此,骨折类型有所不同;横行骨折在年轻人中更常见,而粉碎性骨折在老年人中更为普遍。由于膝关节的生物力学特性,手术干预往往是必要的。保留关节面对于预防髌股关节炎至关重要,因此手术治疗的全面规划至关重要。如何尽可能逼真地模拟这种骨折实体的骨固定呢?

材料与方法

本研究聚焦于在人类尸体标本上诱导具有完整软组织包膜的逼真髌骨骨折以用于手术训练目的的可行性。总共使用了七个新鲜冷冻的人类尸体膝关节,并使用定制设计的落锤试验台制造骨折。然后使用X射线和计算机断层扫描(CT)评估,根据骨科学会(AO)以及Speck和Regazzoni分类法对诱导的骨折进行分类。此外,进一步检查了评估者内和评估者间的可靠性。

结果

所有标本均成功骨折。结果表明,在两种骨折分类系统中,评估者内和评估者间的可靠性都很高,这表明该方法能够可靠地复制逼真的骨折用于训练目的。

结论

该研究强调了在外科教育中使用具有逼真诱导骨折模式的标本的重要性。鉴于髌骨骨折相对罕见且限制了直接的临床接触,逼真的骨折模型对于理解这些情况非常宝贵。这些模型增强了手术训练,使新手和经验丰富的外科医生都能够提高他们的技能并有效地适应新的手术技术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b9a/12257690/a5181a255105/43019_2025_281_Fig1_HTML.jpg

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