RESUMEN
Objective:To investigate the effect of application of problem-based learning (PBL) combined with evidence-based medicine (EBM) in clinical practice teaching of an orthopedic department.Methods:A total of 48 interns who entered Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China from June 2017 to June 2018 were randomly divided into experimental group (the PBL combined with EBM concept teaching group, n = 24) and control group (the traditional teaching group, n = 24). In the experimental group, teachers selected typical cases, designed questions with certain flexibility and complexity, and organized the students to consult the literature, discuss in groups, and report and summarize around the practical problems. In the control group, traditional indoctrination teaching was adopted according to the clinical experience of the teachers. The teaching effect was assessed by a questionnaire survey, a theoretical examination, and a clinical skill examination. The results were analyzed by t-test and Chi-square test using SPSS 16.0 software. Results:The questionnaire survey showed that compared with the control group, the experimental group gave a significantly better evaluation of the teaching methods they received in terms of improving their theoretical knowledge comprehension ability, comprehensive analysis ability, team collaboration awareness, document retrieval and language expression ability, stimulating their learning motivation, and enhancing their scientific thinking and innovation ability ( P < 0.05). Furthermore, compared with the control group, the experimental group had significantly higher mean scores for both the theoretical test (92.42±2.55 vs. 86.17±3.36, P < 0.05) and the clinical skill test (85.79±3.15 vs. 78.88±3.41, P < 0.05). Conclusion:The application of PBL teaching in orthopedic practice, with the concept of EBM throughout the teaching process, has obtained a good effect. It can improve the clinical teaching quality in orthopedics, improve the comprehensive quality of clinical medical students, inspire their active learning enthusiasm, and cultivate their creative thinking, problem construction, comprehensive analysis, literature retrieval, and communication ability.
RESUMEN
Oblique lateral interbody fusion (OLIF) is a new technique in spine surgery,through oblique lateral retroperitoneal approach,it can establish a work corridor direct access to the intervertebral space between the psoas muscles and the abdominal vessels sheath.Through the retroperitoneal work corridor,OLIF can complete intervertebral fusion of anterior and middle column,restore the height of intervertebral space and foramen,and make the spinal canal or nerve root indirect-decompression.OLIF is applicable to degenerative lumbar spine diseases,spinal tuberculosis,tumor,kyphosis,postoperative renovation,trauma,etc.OLIF conforms to the current trend of minimally invasive spinal surgery,which has many advantages like less surgical trauma,less surgical bleeding loss,shorter hospital stay,faster recovery,less damage to the abdominal organs,no stimulation of the spinal nerve,and less damage to the psoas and lumbosacral plexus.Although OLIF has theoretically great advantages,the postoperative hip flexion weakness,the groin and thigh area pain and numbness,contralateral nerve injury and other complications are often reported,notwithstanding the complications are considered to be related to long time psoas compression which results in the psoas and lumbosacral plexus injury,large fusion device implantation which leads to contralateral nerve root injury and so on.The primary cause is that the surgeon blindly pursues new technology with lack of knowledge about the new technology,as well as indications and contraindications,the anatomy of the working area,the details of the surgical operation,etc,causing complications associated with technology or access.Further understanding of the OLIF operation process,including mastering the local anatomy and grasping the surgical indications and contraindications is essential for successful application of OLIF technology to treat various lumbar disorders.