虚拟现实技术应用于住院医师肩膝关节镜手术教学的系统评价及Meta分析

Implementation of simulated education based on virtual reality of shoulder and knee arthroscopic skills in residency training:a systematic review and meta-analysis

目的探讨虚拟现实(virtual reality,VR)技术在住院医师肩膝关节镜手术教学中的应用效果。方法检索PubMed、Cochrane、维普中文全文数据库、中国知网及万方数据库关于VR技术应用于关节镜手术培训的教学研究。检索时间为2010年1月至2022年12月。按纳入及排除标准筛选文献,综合文献内容并采用RevMan 5.3进行Meta分析。结果共纳入英文文献8篇、中文文献2篇。系统评价提示住院医师经过VR模拟培训后操作主观考核评分优于常规教学,但低于大体标本操作培训。住院医师经过VR模拟培训后关节镜下镜头运动轨迹长度、软骨致伤情况均优于常规教学组。Meta分析结果提示住院医师经过VR模拟培训后,完成肩关节镜[加权均数差=70.26,95%置信区间(7.81,132.71),P<0.05]和膝关节镜[加权均数差=187.90,95%置信区间(162.96,212.85),P<0.05]诊断性探查的耗时均短于常规教学组。结论VR模拟培训有助于住院医师掌握肩膝关节镜手术技术,值得推广并整合于住院医师培训课程中。

Objective To investigate the efficacy of simulated education based on virtual reality(VR) of shoulder and knee arthroscopic skills in residency training.Methods The medical educational articles dated from January 2010 to December 2022 were searched from Pubmed,Cochrane,VIP,CNKI and Wanfang database.Meta-analysis was performed by RevMan 5.3.Results 8 articles published in English and 2 articles published in Chinese were included.After VR simulated training,residents scored higher than those who received non-VR training.Meanwhile,residents in VR group had shorter camera path length and less cartilage injury than control group.The meta-analysis revealed that residents shortened time in the performance of diagnostic shoulder[WMD=70.26,95%CI(7.81,132.71),P<0.05]and knee[WMD=187.90,95%CI(162.96,212.85),P<0.05]arthroscopy compared with those without VR training.Conclusion The present analysis provides considerable evidence of the validity of VR simulated training,which helps residents manage basic arthroscopic skills.Therefore,VR training could be integrated in the curricula of residency training.