3D打印模型联合可视化手术模拟在四肢骨缺损专病临床教学中的应用

Application of 3D printed model combined with visual surgical simulation in clinical teaching of extremity bone defects

目的探究以“3D打印模型联合可视化手术模拟”为核心的综合创新教学模式在四肢骨缺损专病临床教学中的应用效果。方法选取2019年3月至2021年12月在北京大学第三医院骨科参与临床管理四肢骨缺损患者的医生为研究对象,分为住培组(52名)与进修组(58名)。针对四肢骨缺损专病进行教学培训,主要包括基础知识教学、感染伤口换药、多学科讨论、数字化手术模拟与手术实操等。教学质量评价指标包括理论知识与临床技能考核、实际管理患者临床能力的客观评价、满意度调查等。采用SPSS 22.0进行t检验和卡方检验。结果两组医生培训后的理论知识[(32.4±6.7)与(42.2±3.8)]与临床实践操作考核得分[(19.6±2.0)、(20.8±2.2),(20.5±2.5)、(21.5±2.3)]都有提高(P<0.05);培训后,住培组的6个客观评价指标得分[(8.3±0.8)vs.(6.9±1.1),(7.4±0.7)vs.(6.3±1.5),(7.2±1.3)vs.(5.0±1.4),(7.9±1.2)vs.(4.0±1.5),(8.4±0.8)vs.(6.4±1.6),(40.3±2.6)vs.(28.6±2.4)]均有提高(P<0.01),而进修组在四肢骨缺损专病的理解程度[(8.1±0.9)vs.(7.2±1.1)]、面对复杂骨缺损病例的自信心[(8.1±1.2)vs.(6.6±0.9)]、骨缺损修复手术的空间思维能力[(8.6±0.8)vs.(7.3±0.9)]、实际管理骨缺损患者的总体临床表现[(41.4±2.3)vs.(37.3±1.8)]4个方面有提升(P<0.01)。住培组与进修组对这种综合创新教学模式的满意度评分分别为(95.3±3.2)分和(94.8±2.8)分。结论以“3D打印模型联合可视化手术模拟”为核心的综合创新教学模式可在短时间内提高住培医生的专病基础知识和临床技能,同时满足进修医生对学习手术技术及先进诊疗理念的实际需求。

Objective To investigate the application effect of the comprehensive innovative teaching model with"3D printed model combined with visual surgical simulation"as the core in the clinical teaching of extremity bone defects.Methods The physicians who participated in the clinical management of patients with extremity bone defects in Department of Orthopedics,Peking University Third Hospital,from March 2019 to December 2021 were selected as subjects and were divided into standardized training group with 52 physicians and refresher physician group with 58 physicians.Teaching and training was performed for the special disease of extremity bone defects,including basic knowledge teaching,dressing change for infected wounds,multidisciplinary discussion,digital surgical simulation,and practical surgical operation.The assessment indices for teaching quality included the assessment of theoretical knowledge and clinical skills,the objective evaluation of the clinical ability of patient management,and an investigation of the degree of satisfaction.SPSS 22.0 was used for the t-test and the chi-square test.Results After training,both groups had significant increases in the assessment scores of theoretical knowledge[(32.4±6.7)and(42.2±3.8)]and clinical practice skills[(19.6±2.0),(20.8±2.2),(20.5±2.5),(21.5±2.3)](P<0.05).After training,the standardized training group had significant increases in the scores of six objective evaluation indicators[(8.3±0.8)vs.(6.9±1.1),(7.4±0.7)vs.(6.3±1.5),(7.2±1.3)vs.(5.0±1.4),(7.9±1.2)vs.(4.0±1.5),(8.4±0.8)vs.(6.4±1.6),(40.3±2.6)vs.(28.6±2.4)](P<0.01),while the refresher physician group had significant improvements in four aspects,i.e.,the understanding of extremity bone defects[(8.1±0.9)vs.(7.2±1.1)],the self-confidence in facing complex extremity bone defects[(8.1±1.2)vs.(6.6±0.9)],spatial thinking ability in repair surgery for bone defects[(8.6±0.8)vs.(7.3±0.9)],and overall clinical performance in actual management of patients with bone defects[(41.4±2.3)vs.(37.3±1.8)](P<0.01).The satisfaction score for this comprehensive innovative teaching model was(95.3±3.2)points in the standardized training group and(94.8±2.8)points in the refresher physician group.Conclusions The comprehensive innovative teaching model with"3D printed model combined with visual surgical simulation"as the core can significantly improve the basic knowledge and clinical skills of physicians in a short period of time and meet the needs for learning surgical techniques and advanced diagnosis and treatment concepts among refresher physicians.