- 作者：Elisabeth Zetlitz ; MbChB ; MRCS(Glasg)鈦?/sup> ; &dagger ; ; &Dagger ; ; elisabethz@hotmail.com ; Scott Cameron Wearing ; PhD§ ; ; Alexander Nicol ; PhD鈦?/sup> ; Andrew Mackay Hart ; BSc(Hons) ; MBChB ; MRCSG ; AFRCSEd ; MD(Hons) ; PhD ; FRCSEd(Plast)&Dagger ; ; 鈭?/sup>
- 关键词：tendon ; reconstructive surgical procedures ; education ; clinical competence
- 刊名：Journal of Surgical Education
- 出版年：2012
- 期刊代码：199_19317204
- 类别：med
- 出版时间：July-August, 2012
- 卷：69
- 期：4
- 页码：504-510
- 文件大小：452 K
Objectives
This study evaluated the utility of a porcine flexor tendon model and standard biomechanical testing procedures to quantify the acquisition of surgical skills associated with Zone II flexor tendon repair in a trainee by benchmarking task performance outcomes relative to evidence-based standards.Study Design
Single-subject repeated measures research design. Bench-top set-up of apparatus undertaken in a University Research laboratory. After initial directed learning, a trainee repaired 70 fresh flexor digitorum profundus tendons within the flexor sheath using either a Pennington or ventral-locking-loop modification of a two-strand Kessler core repair. Tendon repairs were then preconditioned and distracted to failure. Key biomechanical parameters of the repair, including the ultimate tensile strength (UTS), yield strength, 3 mm gap force and stiffness, were calculated. Repairs were divided into 3 categories, early (first 10 days), intermediate (ensuing 10 days), and late repairs (final 10 days), and potential changes in repair properties over the training period were evaluated using a general linear modeling approach.
Results
There was a significant change in the mechanical characteristics of the repairs over the training period, evidencing a clear learning effect (p < 0.05). Irrespective of the repair technique employed, early and intermediate repairs were characterized by a significantly lower UTS (29%and 20%, respectively), 3 mm gap (21%and 16%, respectively), and yield force (18%and 23%, respectively), but had a higher stiffness (33%and 38%, respectively) than late repairs (p < 0.05). The UTS of late repairs (47-48 N) were comparable to those published within the literature (45-51 N), suggesting surgical competence of the trainee.
Conclusions
This simple, low-cost porcine model appears to be useful for providing preclinical training in flexor tendon repair techniques and has the potential to provide a quantitative index to evaluate the competency of surgical trainees. Further research is now required to identify optimal training parameters for flexor tendon repair and to develop procedure-specific standards for adequate benchmarking.