规培教学中椎弓根置钉的学习曲线研究

Learning Curves in Spine Surgery Resident Clinical Training for Pedicle Screw Fixation

目的研究骨科专科规培医师腰椎椎弓根置钉技术的学习曲线,为临床技能教学提供学习强度依据。方法2016年7月-2018年10月在脊柱外科参加骨科专陪的医生共9名,脊柱外科专科培训时间最少个12月。所有专陪医师实际操作前先接受腰椎椎弓根置钉理论培训,担任10台手术二助后开始进行实际置钉操作,绘制每位医生完成60次椎弓根置钉的操作时间、透视次数曲线。结果学员完成的置钉数量为63-74次,单个置钉时间及透视次数的学习曲线显示经过约30例操作后到达平台期,手术时间稳定在6min、透视次数稳定在3次左右。将总的操作过程分次研究后发现后30次的平均置钉时间及透视次数无统计学差异(P>0.05)。结论脊柱外科专科培训医师学习腰椎椎弓根置钉的例数为30例左右达到技术平台。该结果对于制定脊柱外科专科培训的学习强度,提高培训效果有着积极的指导意义。

Objective This study aim to investigate the application of learning curves in spine surgery resident clinical training for pedicle screw fixation.Methods 9 residents who trained in spine surgery department for at least 12 months were involved in this study.All the residents received training of basic knowledge of fixation of pedicle screw.After 10 times as first assistant in spine surgeries,the residents were allowed to fix pedicle screws alone.Study the learning curves of the operation times and X-rayed times of each screws.Results Each resident fixed 63-74 screws during the learning period, learning curves of operation times and X-rayed times indicated the curve arrived at a plateau after 30 times of fixed screws. The fixation times were about 6 min and X-rayed times were about 3 times.Each period of learning stages showed no statistic difference in the last 30 times (P>0.05).Conclusion This study suggested that about 30 times of practices required for master this technical.This study shows a promising methods for standardized training of residents.