Simulation of Anterior Cruciate Ligament Reconstruction in a Dry Model
Simulation of Anterior Cruciate Ligament Reconstruction in a Dry Model
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DOI：
10.1177/0363546515608161
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发表时间：
2015-12-01
影响因子：
4.8
通讯作者：
Ogilvie-Harris, Darrell
中科院分区：
文献类型：
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作者：
Dwyer, Tim;Shantz, Jesse Slade;Ogilvie-Harris, Darrell
背景：随着对证明手术技能能力的需求的增加，对有效评估工具的需求也增加。假设/目的：本研究的目的是验证用于评估前十字韧带重建(ACLR)性能的干燥膝关节模型。研究设计：对照实验室研究。方法：邀请所有住院医生、运动医学工作者和研究员在干燥的前交叉韧带模型上使用前内侧钻孔和按钮内固定，对前交叉韧带的干燥模型进行前内侧钻和内按钮固定。记录以前接受膝关节镜检查和ACLR检查的情况。在研究之前，一份详细的手术手稿和技术视频被发送给所有参与者。住院医师通过使用改进的Delphi程序和关节镜手术技能评估工具(ASSET)创建的特定任务核对表对住院医生进行评估。结果：共有29名住院医师、5名研究员和6名外科医生(共40名参与者)在干模型上进行了ACLR。当使用总资产分数时，测试的内部可靠性(Cronbach Alpha)非常高(>；0.9)。对资产总分和核对表总分的单因素方差分析表明，不同培训年限的参与者之间存在差异(P<；.001)。事后分析显示，初级住院医师(研究生1-3年级)和老年住院医师(研究生4年级和研究生5年级)以及老年住院医师和研究员(P<；0.05)之间的全球评分和检查表得分存在显著差异。研究员和员工之间在全球评级(P<；.05)上存在显著差异，但在核对表分数(P>；.05)上没有显著差异。总资产评分与既往接受膝关节镜检查(0.73分)和ACLR检查(0.65分)有很好的相关性。检验员评分和盲法评估师评分之间的评价者间信度(组内相关系数)非常高(0.8)。结论：本研究的结果提供了证据，ACLR在干燥模型中的表现是评估居民对所需步骤和器械的知识的可靠方法，并且该方法显示了有效性。临床相关性：在住院医生和同事在手术室实施ACLR之前，这些模型可用于确保最低水平的能力。
Background: As the demand increases for demonstration of competence in surgical skill, the need for validated assessment tools also increases.Hypothesis/Purpose: The purpose of this study was to validate a dry knee model for the assessment of performance of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the combination of a checklist and a previously validated global rating scale would be a valid and reliable means of assessing ACLR when performed by residents in a dry model.Study Design: Controlled laboratory study.Methods: All residents, sports medicine staff, and fellows were invited to perform a hamstring ACLR using anteromedial drilling and Endobutton fixation on a dry model of an anterior cruciate ligament. Previous exposure to knee arthroscopy and ACLR was recorded. A detailed surgical manuscript and technique video were sent to all participants before the study. Residents were evaluated by staff surgeons with task-specific checklists created by use of a modified Delphi procedure and the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Each procedure (hand movements and arthroscopic video) was recorded and scored by a fellow blinded to the year of training of each participant.Results: A total of 29 residents, 5 fellows, and 6 staff surgeons (40 participants total) performed an ACLR on the dry model. The internal reliability (Cronbach alpha) of the test when using the total ASSET score was very high (>0.9). One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between participants based on year of training (P < .001). Post hoc analysis demonstrated a significant difference in global ratings and checklist scores between junior residents (postgraduate year [PGY] 1-3) and senior residents (PGY 4 and 5) and senior residents and fellows (P < .05). A significant difference was seen between fellows and staff on the global rating (P < .05) but not on the checklist scores (P > .05). A good correlation was seen between the total ASSET score and prior exposure to knee arthroscopy (0.73) and ACLR (0.65). The interrater reliability (intraclass correlation coefficient) between the examiner ratings and the blinded assessor ratings for the total ASSET score was very high (>0.8).Conclusion: The results of this study provide evidence that the performance of an ACLR in a dry model is a reliable method of assessing a resident's knowledge of the steps and instrumentation required, and the method shows evidence of validity.Clinical Relevance: These models may be used to ensure a minimal level of competence before residents and fellows perform ACLR in the operating room.