基于活体猪的单侧双通道内镜技术培训体系的构建与应用

Construction and application of a training system for unilateral biportal endoscopic techniques based on live pigs

摘要

目的 建立标准化的基于活体猪的单侧双通道内镜（UBE）技术培训体系，为 UBE 技术的规范化教学提供高仿真的动物实验平台。方法 选取普通级实验用猪 5 只，体重 20～30 kg，年龄 3～4 个月。采用静脉复合麻醉方案，优化俯卧位固定，术中持续监测心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO₂）及核心体温。30 名无 UBE 操作经验的脊柱外科医师被随机分为 5 组，每组 1 只活体猪，培训期间组内学员实行角色轮换，完成 UBE 仿真训练。培训分三个阶段，完成并通过考核后，方可进入下一阶段。第一阶段为解剖定位、通道建立与椎旁肌造腔；第二阶段为关节突和椎板磨骨与黄韧带切除；第三阶段为硬膜囊探查、神经根松解与椎间隙暴露。统计各阶段相应核心指标，包括操作时间、操作准确性（位置误差与骨移除完整性）及神经损伤发生情况，并采用主观效能问卷对培训前后情况进行评估。结果 培训全程所有实验猪生命体征平稳，无麻醉相关并发症。与首次操作相比，学员末次操作的核心指标均有显著改善：通道建立时间由（28.5±4.1）min 缩短至（17.6±2.8）min，通道位置误差由（6.2±1.5）mm 降至（2.3±0.7）mm，骨移除完整性由（62.4±10.2）% 提升至（89.7±5.3）%，神经根识别时间由（45.6±8.7）s 缩短至（22.3±5.1）s，第二阶段和第三阶段的神经损伤发生率亦明显降低。上述指标差异均有统计学意义（P＜0.05 或P＜0.01）。学习曲线显示，操作时间随操作次数增加呈明显下降趋势，77.8% 的神经损伤发生于前 3 次操作。学员主观效能总分由 （56.7±8.3）分升至 （89.2±4.5）分（P＜0.001）。结论 本研究构建的活体猪 UBE 模型可高度模拟术中动态组织反馈，结合三阶段渐进式教学，能有效提升学员操作熟练度、缩短学习曲线、降低神经损伤发生率，适用于 UBE 标准化培训与评估，具有临床教学推广价值。

Abstract

Objective To establish a standardized training system for unilateral biportal endoscopy (UBE) techniques based on live pigs, providing a high-fidelity animal experimental platform for minimal invasive spine surgery teaching. Methods Five conventional-grade experimental pigs weighing 20-30 kg and aged 3-4 months were selected. Intravenous combined anesthesia and optimized prone position fixation were used, with continuous intraoperative monitoring of heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO₂), and core body temperature. Thirty spine surgeons with no prior experience in UBE operations were randomly divided into 5 groups, with 1 live pig assigned to each group. During the training period, trainees within each group rotated to complete UBE simulation training. The training consisted of three stages and trainees must complete the assessment and meet the standards before advancing to the next stage. Stage Ⅰ involved anatomical localization, channel establishment, and paravertebral muscle cavity creation. Stage Ⅱ involved articular process and lamina bone grinding and ligamentum flavum resection. Stage Ⅲ involved dural sac exploration, nerve root decompression, and intervertebral space exposure. Core indicators for each stage were statistically analyzed, including operation time, operational accuracy (position error and completeness of bone removal), and the occurrence of nerve injuries. Subjective efficacy questionnaires were used for assessment before and after training. Results Throughout the training, all experimental pigs maintained stable vital signs without anesthesia-related complications. Compared with the first operation, the core indicators of the last operation by the trainees were significantly improved: the channel establishment time was shortened from (28.5±4.1) min to (17.6±2.8) min, the channel position error was reduced from (6.2±1.5) mm to (2.3±0.7) mm, the bone removal integrity was increased from (62.4±10.2)% to (89.7±5.3)%, the nerve root identification time was shortened from (45.6±8.7) s to (22.3±5.1) s. The incidence of nerve injury in stages Ⅱ and Ⅲ also decreased significantly. The differences in the above indicators were all statistically significant (P＜0.05 or P＜0.01). The learning curve showed a significant decrease in operative time in association with increasing number of operations, with 77.8% of nerve injuries occurring during the first three operations. The total subjective efficacy score of trainees increased from (56.7±8.3) points to (89.2±4.5) points (P＜0.001). Conclusion The live porcine UBE model constructed in this study can closely simulate intraoperative dynamic tissue feedback. Combined with a three-stage progressive teaching approach, it can effectively improve trainees' operational proficiency, shorten the learning curve, and reduce the incidence of nerve injury. This model is suitable for standardized UBE training and assessment and holds value for broader application in clinical teaching.

关键词

单侧双通道内镜技术 / 活体猪模型 / 微创脊柱外科 / 手术培训 / 动物实验

Key words

unilateral biportal endoscopy / live pig model / minimal invasive spine surgery / surgical training / animal experiment

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基金资助

辽宁省卫生健康适宜技术推广项目(SYJS2024-2025-051)