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Surgical simulation training models for orthopaedic fracture surgery.

机译：骨科骨折手术的手术模拟训练模型。

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摘要

Articular fracture reduction is a complex surgical task that requires surgeons to be competent at multiple surgical skills to successfully complete. The list of skills needed includes the ability to use fluoroscopic images to build a 3D mental model of the fracture during reconstruction, the proper handling and use of surgical instruments, how to manipulate the fracture fragment into a reduced configuration with minimal hand motion, proper k-wire placement, and the preservation of surrounding soft tissues. Current training methodology is based on an apprenticeship model. The resident learns by watching a senior surgeon, and then preforms the procedure on live patients under the guidance of the senior surgeon to gain competence. This endangers the patient and does not provide the best outcome for either patient or resident.;The work presented in this thesis is the early development of an articular fracture reduction simulator, the subsequent use of the simulator in the training of orthopaedic residents, and assessment of the improvement of residents after practice on the simulator. To date, the simulator has been tested on four different groups of residents,3 different groups from the University of Iowa and one group from the University of Minnesota. Considerable effort has been made to validate the improvement seen in resident performance through objective means. The Objective Structured Assessment of Technical Skills (OSATS) is a global rating score and procedural checklist that has been previously validated to objectively measure surgical skill. Other assessment metrics include hand motion capture to count the number of discrete actions and measure distance traveled during the surgical procedure, fluoroscopic usage and radiation exposure, articular 'step-off', the surface deviation from an intact or ideal reconstruction, and contact stress exposure.;The results indicate that the goals for the simulator have been met, that the simulator provides a means of training orthopaedic residents, assessing improvement, decreased the cost of training, and improved patient safety. The simulator is not without limitations including sample size, and radiation exposure. The task being trained is complex and can be broken down into basic subtasks that could be trained individually. Even with flaws, the simulator is an improvement over current training methods and is an excellent first step toward creating a surgical skills curriculum to comply with new mandates from orthopaedic surgery's governing bodies.
机译：减少关节骨折是一项复杂的手术任务，需要外科医生具备胜任多种手术技能的能力才能成功完成。所需技能列表包括在重建过程中使用透视图像建立骨折的3D心理模型的能力，正确处理和使用外科器械的方法，如何以最小的手部动作将骨折碎片操纵成减小的构型，适当的k线放置，以及周围软组织的保存。当前的培训方法基于学徒模式。住院医师通过看望高级外科医师来学习，然后在高级外科医师的指导下对活着的患者进行操作，以提高能力。这危害了患者，并且无法为患者或住院患者提供最佳的治疗效果。；本文的工作是早期开发关节骨折复位模拟器，随后在模拟器中对患者进行整形训练以及评估。在模拟器上练习后居民的改善情况。迄今为止，该模拟器已在四个不同的居民群体，爱荷华大学的三个不同群体和明尼苏达大学的一个群体上进行了测试。为了通过客观手段验证居民绩效的改善，已经做出了相当大的努力。技术技能的客观结构评估（OSATS）是一项全球评估评分和程序检查表，之前已通过验证，可以客观地衡量手术技能。其他评估指标包括手部动作捕捉，以计算离散动作的数量并测量手术过程中行进的距离，荧光检查的使用和辐射暴露，关节的“偏离”，完整或理想重建的表面偏差以及接触应力暴露结果表明，已经达到了模拟器的目标，模拟器提供了一种训练骨科住院医师，评估改善情况，降低训练成本并提高患者安全性的手段。模拟器并非没有限制，包括样本量和辐射暴露。被训练的任务很复杂，可以分解为可以单独训练的基本子任务。即使存在缺陷，模拟器还是对当前培训方法的改进，并且是迈向创建外科技能课程以符合骨科手术管理机构的新要求的第一步。

著录项

  • 作者

    Ohrt, Gary Thomas.;

  • 作者单位

    The University of Iowa.;

  • 授予单位 The University of Iowa.;
  • 学科 Biophysics Biomechanics.;Engineering Biomedical.
  • 学位 M.S.
  • 年度 2013
  • 页码 117 p.
  • 总页数 117
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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