旋提手法模拟操作考核系统的应用研究

【作者】 陈明；

【导师】 朱立国；

【作者基本信息】 北京中医药大学 ， 中医学， 2015， 硕士

【摘要】 1研究背景：随着时代发展,颈椎病已成为脊柱疾患的常见病、多发病。当今社会的不良生活习惯和工作方式使其发病率呈上升趋势,严重影响人们的工作及生活质量。目前,该病主要以保守方法进行治疗,其中旋提手法治疗具有操作简便、快捷、见效快等特点,是中医治疗该病的重要手段,日益受到国内外医学的高度重视。并且该手法已经过国家十五、十一五攻关课题及国家自然基金立项研究,证明了其有效性及安全性,被列为国家中医药管理局百项中医临床实用技术推广项目在全国推广应用。然而,旋提手法的传承多采用口传心授的方法进行教学,如《医宗金鉴》所述：“一旦临证,机触于外,巧生于内,手随心转,法从手出”。需要初学者有较高的领悟力,并在临床的学习工作中投入大量的精力去摸索,因此学习效率低,推广难度大,可操作机会少,这些问题成为影响旋提手法治疗颈椎病临床推广的主要因素。本项研究的立意在于经培训的初学者可通过旋提手法模拟操作考核系统的考核而发现自己的不足,从而进行有针对性的练习,并可以在考核系统上进行多次的实际操作,有助于更好领悟旋提手法的精髓,对于积极推广旋提手法有更大的帮助。2应用研究：2.1目的：1、客观评价旋提手法模拟操作考核系统实际应用中的稳定性；2、通过比较旋提手法模拟操作考核系统辅助手法培训与传统手法培训的区别,评价旋提手法模拟操作考核系统作为教学培训工具的作用及优点。2.2方法：试验一由旋提手法模拟操作考核系统对临床应用旋提手法达五年以上的十位医师进行数据采集,每名医师在正常体重指数模拟状态下依次进行五次旋提手法操作,分别记录为G1、 G2、G3、G4、G5,对操作过程中核心指标进行记录(预牵引力、提扳力、最大作用力、提扳时间、旋转幅度、俯仰幅度)。比较分析每名医师五次操作中各项指标指标的差异,以评价旋提手法模拟操作考核系统作为教学考核工具在实际应用中的稳定性。试验二通过招募海报,招募未学习旋提手法的男性研究生60名,将这60名初学者按照随机数字表随机分成A、B两组,每组各30名。A组接受传统培训,由施教者对神经根型颈椎病患者进行旋提手法操作,并予以讲解。教学时间3周,共6课时,每课时45分钟,课前进行培训登记。具体课时安排：前2课时施教者进行操作演示,初学者以学习基本动作为主,中间2课时初学者相互之间进行动作演练,施教者予以技术指导,最后2课时初学者对操作过程中遇到的问题提出疑问,施教者予以解答。B组在视频及PPT教学下了解旋提手法操作方法,随后在模拟操作考核系统上进行训练,训练分为3次,每周一次,每次2课时,每课时45分钟,课前进行培训登记。两组培训结束后,建立初学者考核登记簿并进行登记,并由旋提手法模拟操作考核系统进行操作考核。考核之前,给予A组初学者20分钟实际操作演练,以熟悉该考核系统,避免因对系统生疏而产生的操作误差。考核过程中,对旋提手法操作的核心指标进行记录(预牵引力、提扳力、最大作用力、提扳时间、旋转幅度、俯仰幅度),每人考核三次,A、B两组最终均取三次考核合格率平均值。比较分析两组初学者考核指标的差异,以评价旋提手法模拟操作考核系统作为教学考核工具的作用及优点。2.3结果：试验一十名医师每人进行五次旋提手法操作后,通过旋提手法模拟操作考核系统进行数据记录。经单因素方差分析得出,一名熟练掌握旋提手法的操作者,第三次在模拟操作考核系统上进行手法操作时,即可与操作系统达到较好的磨合度,不会因首次接触该操作系统而引起手法操作的失误。第四次操作开始,机进入到稳定阶段。从操作的合格率出发,其中,G1操作过程中,提扳力的合格率为30%,最大作用力的合格率为70%,旋转幅度的合格率为80%；G2操作过程中,提扳力的合格率为70%,最大作用力的合格率为90%,旋转幅度合格率为90%。十名医师在可能在首次接触旋提手法模拟操作考核系统时,出现操作的不适应。故在G1和G2的操作过程中存在提扳力、最大作用力、旋转幅度等指标的操作误差,但从第三次操作开始,十名医师便未再出现操作失误,各项指标均为合格状态。对十位操作者的五次操作数据中的提扳力、最大作用力、旋转幅度进行单因素方差分析比较。提扳力方面,G4、G5与G1相比较,P值分别为0.015、0.006,均小于0.05,差异具有统计学意义；最大作用力方面,G4、G5与G1相比较,P值分别为0.021、0.012,均小于0.05,差异具有统计学意义；其余各项指标两两比较,P值均大于0.05,差异无统计学意义。由此可得出,熟练掌握旋提手法的操作者在初次操作时,会因为对该旋提手法模拟操作考核系统不熟悉而出现操作误差,但经过三次操作后,基本熟悉该系统的操作方式。在第四次操作以后,即可避免因对系统生疏而产生的操作误差,从而达到稳定的状态。试验二经过两组不同方式培训后,对考核结果进行分析得出,B组初学者各项力学指标合格率较A组均有明显提高,包括预牵引力、扳动力、最大作用力、提扳时间、旋转幅度和俯仰幅度。在A组培训方式中,三种不同体重指数模拟状态下,预牵引力,提扳力,最大作用力的合格率均低于40%,提扳时间、旋转幅度、俯仰幅度的合格率均大于70%。在B组培训方式中,三种不同体重指数模拟状态下,三个力学核心指标中多数超过50%,仍有个别指标合格率未超过40%,提扳时间、旋转幅度、俯仰幅度的合格率均大于90%,甚至接近100%。A、B两组培训中,预牵引力的合格率均伴随着体重指数的增加而降低。经过B组培训后的初学者在各项关键力学指标较A组均有显著提高。正常体重指数模拟状态下的预牵引力、提扳时间的P值均小于0.05,差异具有统计学意义；扳动力、最大作用力、旋转幅度和俯仰幅度的P值均大于0.05,差异无统计学意义。超重体重指数模拟状态下,预牵引力、提扳力、提扳时间的P值均小于0.05,差异具有统计学意义；最大作用力、旋转幅度和俯仰幅度的P值均大于0.05,差异无统计学意义。肥胖体重指数模拟状态下,预牵引力、提扳时间、旋转幅度的P值均小于0.05,差异具有统计学意义；提扳力、最大作用力和俯仰幅度的P值均大于0.05,差异无统计学意义。2.4结论：通过以上数据分析得出：1旋提手法模拟操作考核系统作为考核工具能稳定有效地评价术者施行旋提手法操作的优劣；2经过旋提手法模拟操作考核系统培训后的初学者能够较好掌握旋提手法的操作技巧,提高了手法培训质量,培训效果明显优于传统培训方式。3旋提手法模拟操作考核系统为初学者提供了可重复操作的培训平台。通过本实验研究,证实了旋提手法模拟操作考核系统的科学价值,验证了旋提手法模拟操作考核系统的临床效用。为手法教学、考核提供了客观依据,并为旋提手法的进一步推广奠定基础。更多还原

【Abstract】 Research Background:With the develepment of era, cervical spondylosis has become a common discase. frcquently- occurring disease discase disorders Bad living habits and ,wav of working in today’s socicty to make its incidence on the rise. serioisly affecting people work anf life quality. At present, the disease is mainly treated with conservative methods. includingf screw lift technique treatmem has the charactics of somble operation. quick cffeet. is an inportant ,cans of traditional Chinesc medicine teeatmem of the disease, by domestic and forcign medicinc attaches great importance to increasingly. And the technique have been national 11th five-year fifteen-year research project and mational naturat tired project research, proved the effectiveness and safely, is listed as the state administration of traditional Chinese medicine the TCM clinical practical technology promotion projects in the popularization and application.However.the tradition of rotary lift technique is used more KouCanXinShou approach to teaching, such as the YiZong Jin Jian "slated:" once the clinical, touch machine at outside. was bom in opperanely. hand do lure. law out of the hand ".Need begioners have higher undcrstanding, and in the clinical work of learning into a lot of energy to fumble,learning efficiency is low,therefore, difficult to promote, less chalice operational. these problems become influence lifi technique main factor for the treatment of cervical spondvlosis clinical promotion. The conception of this study is to be the training beghinners can lift technique hy simulation operation svstem of examination and found own shortcomings, and thus for the targeted practice, and can be conducted on the evaleation system for many times the acual operation, better comprehension of the quintessence of spn of the technique. to actively promote rotary technique have greater help.Application research on:Objective:1 objective evaluation of spinning technique simulation operation assessment system in the practical application of stability;2 by comparing the spinning tcchnque auxiliary tactics training simulation opcration assessment system and the traditional techniqur training, the difference between evabaation screw lift echnique simulation operation effect and advantage of the assessment system as a teaching tool.Methods:Test one:By spinning technique sirmulation operation assessment system for clinical application of spin technique over tive years of ten dictors foe data acquisition, cach physician in normal body mass index (bm) simulation condition, in turn. for five spin manipulation, were recorded as G1 G2 and G3. G4 and G5. core mdexes in the proses of operating records (pre traction, pull foree and maximum force and the time. rotating,pitch range), Comparative analysis of five times per physician. operaling the difference of cach index in thr index, to evaluata screw lift technique simalarion operation asscssment sxstem as the stability of teaching assessment tools in praetical applieation.TEST two:By recruiting poster, recruitment learning technique of 60 male graduate student, will this 60 beginners according to random number table is divided into A, B two groups at random, each group 30.A group received traditional training, conducted by the instructors in patients with cervical spondylosis of nerve root type rotary manipulation, and to explain in delail.Teaching time for three weeks, a total of 6 classes, each class hour 45 minutes, training before class registration. Specific scheduling:2 hours before the instructors operate demo, for beginners to learn basic, intermediate between 2 class beginners, movement exercise instructors give technical guidance, the last 2 hours beginners problems raised questions in the operation process, the instructors to answer.Group B under the video and PPT teaching understanding spin technique operation method, then the simulation operation assessment system on training, the training is divided into three times, once a week, every time 2 hours and 45 minutes per period, training before class registration. The two groups after the training, establish a beginner examination register and register, and by spinning lechniquc simulation operation of the system to operate.Examination before and give the group A beginner practical exercises,20 minutes to get familiar with the evaluation system, avoid the error to the operation of the system is rusty and produce. The assessment process, to spin manipulation of core indicators for recording (pre traction, pull pull force and maximum force and the time, relaxing, pitch range), each inspection three times, finally A, B two group were average examination pass rate three times.Differences of assessment index, and comparative analysis of two groups of beginners to evaluate spin technique simulation operation assessment system in teaching effect and advantages of assessment tools.Results;Test one:Ten doctors for five times per rotation technique after after operation, lift technique by simulation operation assessment system to record the data.By the single factor analysis of variance, a skilled master the technique of the operator, the third time in a simulated operation assessment system on manipulation, can with the operating system to achieve better grinding-in degrees. not caused by the operating system for the first time contact operation mistakes.Fourth operation, machine into the stable phase. Starting from the percent of pass of operation, among them, the G1 operation process, the pull force of the percent of pass is 30%, the biggest force percent of pass is 70%, the amplitude of the rotating percent of pass is 80%;G2 operation process, the pull force of the percent of pass is 70%, the biggest force percent of pass is 90%, rotating percent of pass is 90%.Ten doctcrs in May at first contact spin tactics simulation operation assessment system, the operation does not adapt.The operation of reason in the G1 and G2) exist in the process of pull force and maximum force, rotaring. such as index of operation error, but since the third operation. 10 doctors not to appear error, the indicators are qualified.In ten data of five operators pull force and maximum force, rotation rate comparing single factor variance analysis.To pull force, G4 and G5 compared with G1, P values were 0.015,0.006. arc less than 0.05, the difference is statistically significant;The biggest force. G4 and G5 compared with G1, P values were 0.021,0.012, are less than 0.05, the difference is statistically significant:The remaining two compare the indicators, P values were greater than 0.05. there was no statistically significant difference. Can be concluded from this. skilled technique of the operator in the operation for the first time, because of the screw lift technique simulation operation assessment system are not familiar with the operation error, but after three operations, familiar with the basic operation of the system. After the fourth operation, to avoid the error to the operation of the system is rusty and produce, so as to achieve stable state.Test two:After two groups of different ways of training, analyzes the results of the appraisal conclusion, group B beginners the mechanics indexes are obviously increase the qualified rate of the group A, including preliminary miction, pull force and maximum force, time. rotating and pitch range.In A set of training methods, three different body mass index (bmi) simulation condition, pull, pull force and maximum force in the pass rate is lower than 40%. to pull time, rotating, the amplitude of the pitch were greater than 70%pass rale,In group B training methods, three different body mass index (bmi) simulation condition, the three core mechanics index in the majority of more than 50%, there are still individual indicators qualified rate of not more than 40%, to pull time, rotating and pitch of the qualified rate of not less than 90%, or even close to 100%.A, B two groups of training, the traction of the lower pass rate along with the increase of body mass index.After group B training beginners in the key mechanical indexes in group A were significantly improved.Normal body mass index (hmi) simulation condition of P values are in the process of the traction and pull the time less than 0.05, the difference is statistically significam;Pull force and maximum force, rotation and the pitch range of P values were greater than 0.05, there was no statistically significant difference.Overweight bmi simulation condition, traction, pull pull force and the time of the P values are less than 0.05, the difference is statistically signiticant;The amplitude of the maximum force, rotating and pitch P values were greater than 0.05, there was no statistically significant difference.Fat body mass index (bmi) simulation condition, the trachon and pull lime, rotating P values are less than 0.05. the difference is statistically significant;Pull force and maximum force and the pitch range of P values were greater than 0.05, there was no statistically significant difference.Conclusion:Through the above data analysis:1 Spinning technique simulation operation assessmem system as stable assessment tool can effectively evaluate the performer of spin manipulation of advantages and disadvantages:2 After spinning technique to simulate operation assessment system after training beginners can better grasp the spin of the technique of operating skills, improve the quality of the techmque training, training effect is superior to traditional training methods.3 Spinning technique simulation operation assessment system for beginners can duplicate an operation provides a platform for the training.Through this experiment, confirmed the rotation technique simulation operation assessment system of scientific value, verity the spin manipulation simulation operation assessment system of clinical utility.Provided a objective basis for teaching and evaluation technique. and laying a foundation for further promotion of the technique.更多还原