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关节镜手术代表着骨科微创技术的发展潮流,其中膝关节镜为其发展最成熟的,也是从事关节镜手术的年轻医生入门必备技术,良好的膝关节镜技术为开展和发展各项关节镜手术提供了坚实的技术保障。但关节镜技术要求医生有很好的手眼配合和腔镜操作技术,传统的学习方式一般在病人身上、尸体、动物标本及假骨模型上学习,存在成本高、风险大、可重复性差及训练内容与病人真实病情相差较大等缺点[1]。我科运用3D打印技术再现病人的膝关节等比例模型,将3D模型应用到关节镜教学中可实现可视化、个性化、精准化,提高关节镜教学的趣味性、效率性和满意度[2-3]。现作报道。
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客观评价指标中,观察组读片测试评分和关节镜操作评价均高于对照组(P<0.01);专业理论考试2组得分差异无统计学意义(P>0.05)(见表 1)。
分组 n 专业理论考试 读片测试评分 关节镜操作评价 观察组 28 90.04±3.86 38.62±1.82 55.68±2.56 对照组 28 88.54±2.51 36.73±2.02 46.87±3.29 t — 1.72* 3.68 11.19 P — >0.05 <0.01 <0.01 *示t′值 表 1 2组学生客观评价指标比较分析(x±s;分)
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主观指标中,观察组教学的趣味性、教学参与度、学习的有效性、对教学理解、学习注意力、关节镜接受性及关节镜技能提升得分均高于对照组(P<0.05~P<0.01)(见表 2)。
分组 n 教学的趣味性 教学参与度 学习的有效性 对教学理解 学习注意力 关节镜接受性 关节镜技能提升 观察组 28 9.23±1.43 8.96±1.15 8.93±0.79 9.17±0.85 8.83±1.08 9.54±0.89 8.95±1.17 对照组 28 7.51±0.86 8.12±1.26 7.50±0.82 7.79±1.41 7.51±1.14 7.11±1.38 7.29±1.21 t — 5.45* 2.60 6.65 4.44* 4.45 7.83* 5.22 P — <0.01 <0.05 <0.01 <0.01 <0.01 <0.01 <0.01 *示t′值 表 2 2组学生主观评价指标比较(x±s;分)
3D打印技术在膝关节镜临床教学中的应用研究
Application value of 3D printing technology in clinical teaching of knee arthroscopic surgery
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摘要:
目的通过3D打印膝关节疾病的等比例实体模型,加深年轻医生对解剖结构的理解,增加关节镜手术操作的兴趣。 方法选取本科临床医学专业实习学员56人,随机分为观察组和对照组,各28人。观察组采用3D打印等比例膝关节实体模型,运用模型进行临床教学,对照组采用传统教学模式。按教学要求完成培训任务后,根据学员理论考核和问卷探查结果,进行2组教学模式的效果评价。 结果客观评价指标中,观察组读片测试评分和关节镜操作评价均高于对照组(P<0.01);主观评价指标中,观察组教学的趣味性、教学参与度、学习的有效性、对教学理解、学习注意力、关节镜接受性及关节镜技能提升得分均高于对照组(P<0.05~P<0.01)。 结论3D打印的膝关节模型可显著提高膝关节镜的临床教学效果,相比于传统教学模式具有较大优势,在关节镜手术教学中具有良好的实用性和临床教学应用价值。 Abstract:ObjectiveTo deepen the young doctors' understanding of anatomical structures and increase their interest in arthroscopic surgery through 3D printing of full-scale physical models of knee diseases. MethodsFifty-six medical undergraduate clinical internship students were randomly divided into the observation group and control group(28 cases in each group).The observation group was taught using the 3D printing of full-scale physical models of knee joint, and the control group was taught using the traditional teaching model.After completing the training tasks according to the teaching requirements, the teaching effectiveness in two groups were evaluated according to the results of students' theoretical assessment and questionnaire investigation. ResultsAmong the objective evaluation indexes, the scores of reading film test and arthroscopic operation evaluation in observation group were higher than those in control group(P < 0.01).Among the subjective evaluation indexes, the scores of the teaching interesting, teaching participation, learning effectiveness, understanding of teaching, learning attention, arthroscopic acceptability and arthroscopic skill improvement in observation group were higher than those in control group(P < 0.05 to P < 0.01). ConclusionsThe 3D printed model of knee joint can significantly improve the clinical teaching effects of arthroscopy, and has a great advantage compared with the traditional teaching mode.The 3D printed model of knee joint has good practicability and clinical value in the teaching of arthroscopic surgery. -
Key words:
- medical education /
- 3D printing /
- knee joint /
- arthroscopy
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表 1 2组学生客观评价指标比较分析(x±s;分)
分组 n 专业理论考试 读片测试评分 关节镜操作评价 观察组 28 90.04±3.86 38.62±1.82 55.68±2.56 对照组 28 88.54±2.51 36.73±2.02 46.87±3.29 t — 1.72* 3.68 11.19 P — >0.05 <0.01 <0.01 *示t′值 表 2 2组学生主观评价指标比较(x±s;分)
分组 n 教学的趣味性 教学参与度 学习的有效性 对教学理解 学习注意力 关节镜接受性 关节镜技能提升 观察组 28 9.23±1.43 8.96±1.15 8.93±0.79 9.17±0.85 8.83±1.08 9.54±0.89 8.95±1.17 对照组 28 7.51±0.86 8.12±1.26 7.50±0.82 7.79±1.41 7.51±1.14 7.11±1.38 7.29±1.21 t — 5.45* 2.60 6.65 4.44* 4.45 7.83* 5.22 P — <0.01 <0.05 <0.01 <0.01 <0.01 <0.01 <0.01 *示t′值 -
[1] LEBLANC J, HUTCHISON C, HU Y, et al. A comparison of orthopaedic resident performance on surgical fixation of an ulnar fracture using virtual reality and synthetic models[J]. J Bone Joint Surg Am, 2013, 95(9): 1. [2] 李晓峰. 3D打印技术在骨科临床教学中的应用[J]. 微创医学, 2018, 13(2): 217. [3] PUJOL S, BALDWIN M, NASSIRI J, et al. Using modeling techniques to enhance teaching of difficult anatomical concepts[J]. Acad Radiol, 2016, 23(4): 507. doi: 10.1016/j.acra.2015.12.012 [4] 唐昊, 赵瑞, 沈洪兴, 等. 规范化关节镜微创技术临床教学模式的应用与研究[J]. 中国医学教育技术, 2013, 27(4): 435. doi: 10.3969/j.issn.1004-5287.2013.04.021 [5] 李杨, 田华, 张克. 3D打印技术在骨科膝关节置换术教学中的应用[J]. 中华医学教育杂志, 2018, 38(5): 734. doi: 10.3760/cma.j.issn.1673-677X.2018.05.022 [6] LEE V, SINGH G, TRASATTI JP, et al. Design and fabrication of human shin by three-dimensional bioprinting[J]. Tissue Eng Part C Methods, 2014, 20(6): 473. doi: 10.1089/ten.tec.2013.0335 [7] RENGIER F, MEHNDIRATTA A, VON TENGG-KOBLIGK H, et al. 3d printing based on imaging data: Review of medical applications[J]. Int J Comput Assist Radiol Surg, 2010, 5(4): 335. doi: 10.1007/s11548-010-0476-x [8] JONES DB, SUNG R, WEINBERG C, et al. Three-dimensional modeling may improve surgical education and clinical practice[J]. Surg Innov, 2016, 23(2): 189. doi: 10.1177/1553350615607641 [9] AWAN OA, SHETH M, SULLIVAN I, et al. Efficacy of 3D printed models on resident learning and understanding of common acetabular fracturers[J]. Acad Radiol, 2019, 26(1): 130. doi: 10.1016/j.acra.2018.06.012 [10] KIM MS, HANSGEN AR, WINK O, et al. Rapid prototyping: A new tool in understanding and treating structural heart disease[J]. Circulation, 2008, 117(18): 2388. doi: 10.1161/CIRCULATIONAHA.107.740977 [11] ALLEN LK, EAGLESON R, DE RIBAUPIERRE S. Evaluation of an online three-dimensional interactive resource for undergraduate neuroanatomy education[J]. Anat Sci Educ, 2016, 9(5): 431. doi: 10.1002/ase.1604 [12] SO E, HYER CF, RICHARDSON MP, et al. What is the current role and factors for success of the journal club in podiatric foot and ankle surgery residency training programs?[J]. J Foot Ankle Surg, 2017, 56(5): 1009. doi: 10.1053/j.jfas.2017.04.028 [13] 陈家磊, 方跃. 3D打印技术在复杂创伤骨科病例教学中的应用[J]. 中国继续医学教育, 2019, 11(28): 32. doi: 10.3969/j.issn.1674-9308.2019.28.014 [14] 李潍, 孔元蓉, 黎静, 等. PBL与EBL教学联合3D打印技术在骨科临床教学中的应用[J]. 现代医院, 2017, 17(12): 1743. doi: 10.3969/j.issn.1671-332X.2017.12.008 [15] 高鹏, 杜悠, 边焱焱, 等. 3D打印技术及VR技术在重度下肢畸形矫正临床教学中的应用[J]. 中华骨与关节外科杂志, 2019, 12(9): 712. doi: 10.3969/j.issn.2095-9958.2019.09.14 [16] 刘昌艺, 张逢乐, 杨辉, 等. 3D打印技术在复杂股骨粗隆间骨折的临床PBL教学中的应用[J]. 组织工程与重建外科杂志, 2017, 13(6): 360. doi: 10.3969/j.issn.1673-0364.2017.06.017 [17] 梁晓南, 姚军, 赵劲民. 将3D打印模型引入Sandwich教学中的应用研究——以骨科见习教学为例[J]. 微创医学, 2017, 12(1): 75. [18] LIM PK, STEPHENSON GS, KEOWN TW, et al. Use of 3D printed models in residenteducation for the classification of acetabulum fractures[J]. J Surg Educ, 2018, 75(6): 1679. doi: 10.1016/j.jsurg.2018.04.019