序贯教学法在颈椎超声临床教学中的应用

doi:10.3877/cma.j.issn.1672-6448.2022.06.010

目的

探讨序贯教学法在颈椎超声临床教学中的应用价值。

方法

解放军总医院第一医学中心超声科于2021年8月采用以颈椎重要结构的解剖知识、CT影像特征、超声声像图为教学内容的序贯教学法，对47名年轻超声科医师进行培训与讲解。所有学员既往均无脊柱超声检查经验。逐一对每一个重要结构进行解剖知识、CT影像特征、超声声像图的序贯讲解，讲解时间为60 min。讲解结束后，即刻对学员进行测试，测试的内容为颈椎5个重要结构超声声像图的识别。采用Likert 5级评分法调查学员对该课程的满意程度，以评估该教学方法的有效性。

结果

47名年轻医师对颈椎5个重要结构超声声像图识别的正确率分别为：第7颈椎横突后结节93.62%；第6颈椎横突前、后结节87.23%；颈神经后内侧支87.23%；颈椎关节突关节纵切面85.11%；颈椎椎间孔82.98%。74.47%（35/47）的年轻医师对序贯教学法表示非常满意，21.28%（10/47）的年轻医师表示满意，仅4.26%（2/47）表示不确定。

结论

以颈椎解剖知识、CT影像特征、超声声像图为教学内容的序贯教学法在年轻医师颈椎超声教学中具有较好的应用效果，值得进一步推广。

关键词: 颈椎, 脊柱, 超声检查, 体层摄影术，X线计算机, 解剖学, 教学

Objective

To investigate the usefulness of the sequential teaching method in cervical spine ultrasound training among young sonographers.

Methods

The sequential teaching method which combined the anatomy, CT images, and ultrasound images was used in the cervical spine ultrasound training among 47 young sonographers in August 2021 at the Department of Ultrasound, the First Medical Center of PLA General Hospital. The anatomy and CT and ultrasound features of five important structures of the cervical spine were taught sequentially and the total time was 60 min. After the teaching, the teaching effect was evaluated by the accuracy of the sonographers to identify the important cervical spine structure in the ultrasound images. The sonographers' satisfaction with the course was evaluated with the Likert scale.

Results

The accuracy of the 47 young sonographers to identify the five important cervical structures was 93.62% for the posterior tubercle of the C7 transverse process, 87.23% for both the anterior and posterior tubercles of the C6 transverse process and the medial branch of the cervical nerve, 85.11% for the longitudinal section of the facet joint, and 82.98% for the cervical intervertebral foramina. The majority [74.47% (35/47)] of the young sonographers were strongly satisfied with the teaching method, 21.28% (10/47) were satisfied, and 4.26% (2/47) expressed uncertainty about this teaching method.

Conclusion

The sequential teaching method based on the anatomy, CT images, and ultrasound images of the spine structure is a useful teaching method and could be used in spine ultrasound training for young sonographers.

Key words: Cervical vertebrae, Spine, Ultrasonography, Tomography, X-ray computed, Anatomy, Teaching

图1 颈椎三维CT。图a为颈椎正面观，长箭头为颈椎椎体，短箭头为颈椎横突；图b为颈椎侧面观，长箭头为颈椎椎体，短箭头为颈椎横突，虚线箭头为颈椎关节突关节

图2 颈椎三维CT。图a为颈椎侧面观，虚线箭头为颈椎关节突关节；图b为颈椎后面观，实线箭头为颈椎棘突，虚线箭头为颈椎关节突关节

图3 第7颈椎横突的CT与超声声像图。图a为CT横断面图像显示第7颈椎横突只有后结节（箭头所示）；图b为超声颈外侧横切面图像显示第7颈椎横突的后结节（图中P为后结节），其前方可见第7颈神经根（箭头所示）

图4 第6颈椎横突的CT与超声声像图。图a为CT横断面图像显示第6颈椎横突的后结节（长箭头）与前结节（短箭头）；图b为超声颈外侧横切面图像显示第6颈椎横突的后结节与前结节（图中P为后结节，A为前结节），前后结节之间可见低回声的第6颈神经根（箭头所示）注：CCA为颈总动脉

图5 颈椎关节突关节的CT与超声声像图。图a为矢状位CT图像显示颈椎的关节突关节（箭头所示）；图b为超声颈部后外侧纵切面图像显示关节突关节（长箭头）及颈神经后内侧支（短箭头），图中2、3分别为第2颈椎的下关节突、第3颈椎的关节柱

图6 第5~6颈椎椎间孔的CT与超声声像图。图a为CT横切面图像显示第5~6颈椎椎间孔（箭头所示）；图b为超声颈部外侧横切面图像显示第5~6颈椎椎间孔，其位于颈椎关节突（长箭头）的前方，椎动脉的后方，第6颈神经根（短箭头）走行其中注：a为椎动脉；v为椎静脉

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Application of sequential teaching method in cervical spine ultrasound training among young sonographers

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Application of sequential teaching method in cervical spine ultrasound training among young sonographers