目的 评估超声引导在经皮椎间孔镜手术穿刺置管教学中的应用效果。方法 选取2017年10月~2018年5月在解放军总医院骨科微创脊柱中心培训的40名无椎间孔镜手术基础的进修医师为研究对象。随机将这些医师分为实验组和对照组,实验组20人,采用超声引导教学方法;对照组20人,采用传统教学方法。两组医师教学时数和教学目标均相同。教学结束后,采用问卷调查、考核等主客观评价指标考查教学效果。结果 与对照组相比,实验组医师对解剖关系、手术入路、穿刺及置管部位、手术技巧的掌握及总分高于对照组医师,差异均具有统计学意义(均P<0.05)。问卷调查结果显示,超声引导教学方法更有助于提高学习效率,提高对椎间孔镜穿刺入路和穿刺技巧的理解,提高对椎间孔镜穿刺置管流程的理解和记忆,使医师更有信心自己进行椎间孔镜穿刺置管的手术操作。结论 超声引导有利于提高椎间孔镜手术穿刺置管的教学效果,值得推广。
Objective To evaluate the effect of ultrasound-guided puncture and catheterization in teaching of percutaneous endoscopic lumbar discectomy (PELD). Methods From October 2017 to May 2018, 40 refresher doctors with no experience of PELD who were trained in the minimally invasive spine center in the Department of Orthopedics, General Hospital of Chinese PLA were selected as the research subjects. These doctors were randomly divided into experimental group and control group, each group had 20 doctors. The ultrasound guided teaching method was adopted in experimental group and traditional teaching method was adopted in control group. The teaching hours and teaching objectives of the two groups were the same. After the end of teaching, subjective and Objective evaluation indicators such as questionnaires and examinations were used to investigate the teaching effect. Results The doctors in the experimental group had higher score than the control group in the anatomical relationship, the surgical approach, the puncture and cannulation, the mastery of the surgical skills and total score (all P<0.05). Results of the questionnaire survey showed that the ultrasound guided teaching method was more helpful to improve the learning efficiency, to improve the understanding of the puncture approach and puncture technique of PELD, to improve the understanding and memory of the process of puncture and cannulation, and to make the surgeons more confident to perform PELD by themselves. Conclusions Ultrasound guidance is beneficial to improve the teaching effect of puncture and catheterization for PELD, and is worthy of promotion.
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