基于力反馈的虚拟手术训练系统在骨科住院医师临床教学中的应用

Application of virtual surgical training system based on force feedback in clinical teaching for orthopaedic residents

目的评价脊柱虚拟手术训练系统(VSTS)对骨科医师椎弓根螺钉置钉技术培训的有效性。方法 10名无椎弓根置钉经验的住院医师随机平均分为虚拟手术训练组(A组)和传统教学组(B组)。其中A组于置钉前在VSTS上练习置入腰椎椎弓根螺钉,B组于置钉前接受技术讲解和视频演示的传统教学。将8具新鲜成人尸体标本随机分配给2组。2组受试者培训后分别于尸体标本上进行双侧腰椎(L1～5)椎弓根螺钉置入操作。采用CT评价椎弓根螺钉置入准确率,分析比较2组间螺钉穿破率、螺钉可接受率以及平均螺钉穿破距离的差异。结果螺钉穿破率A组(12.5%)显著低于B组(37.5%),差异有统计学意义(P <0.05);螺钉可接受率A组为100%,B组为85%,差异有统计学意义(P <0.05);螺钉穿破距离A组为(1.37±0.62)mm,B组为(2.42±0.51)mm,差异有统计学意义(P <0.05)。结论VSTS较传统教学能有效提高椎弓根螺钉的置钉准确率,具有理想的应用前景。

Objective To assess the validity of virtual surgical training system（VSTS） on lumbar pedicle screw placement for orthopaedic surgeons. Methods Ten inexperienced residents were randomly assigned to the simulation training group（group A） and control group（group B）. Group A received the lumbar pedicle screw placement on VSTS, and group B was given an introductory teaching session before cadaver test. A total of 8 adult fresh cadavers were collected and randomly allocated to the 2 groups. Each group received the bilateral L1-5 pedicle screw instrumentation in the cadaver specimens after training. Accuracy was assessed by CT after instrumentation. The screw penetration rates,acceptable rates and average screw penetration distance were compared between the 2 groups using statistical analysis. Results The screw penetration rate of group A（12.5%） was significantly lower than that of group B（37.5%）,and the difference was statistically significant（P〈0.05）. The screw acceptable rates were 100% in group A and 85% in group B,and the difference was statistically significant（P〈0.05）. The screw penetration distance was （1.37±0.62）mm in group A and（2.42±0.51）mm in group B,and the difference was statistically significant（P〈0.05）. Conclusion The VSTS can effectively enhance the accuracy of the pedicle screw placement in comparison to the traditional teaching method,and possesses very ideal application prospect.