藤原 美子¹, 山本 周一¹, 菊田 健太¹, 加藤 由美¹, 倉田 慎平⁴, 水掫 貴満², 仲川 喜之², 井上 隆³, 田中 康仁⁴

Yoshiko FUJIWARA¹, Syuichi YAMAMOTO¹, Kenta KIKUTA¹, Yumi KATOU¹, Shimpei KURATA⁴, Takamitsu MONDORI², Yoshiyuki NAKAGAWA², Takashi INOUE³, Yasuhito TANAKA⁴

¹宇陀市立病院臨床検査科, ²宇陀市立病院整形外科, ³奈良県立医科大学付属病院臨床研究センター生物統計部門, ⁴奈良県立医科大学付属病院整形外科

¹Department of Clinical Laboratory, Uda City Hospital, ²Department of Orthopaedic Surgery, Uda City Hospital, ³Department of Evidence-Based Medicine Institute for Clinical and Translational Science, Nara Medical University Hospital, ⁴Department of Orthopaedic Surgery, Nara Medical University Hospital

キーワード : shoulder ultrasound, educational program, rotator cuff tear

目的：検査室の肩超音波検査（shoulder ultrasound：SUS）人材育成のためにSUS習得のための研修プログラムを作成し有効性を検証する．対象と方法：SUS未経験技師3名（超音波未経験者1名・他領域超音波経験者2名）を1年間教育した．腱板断裂診断に関し，研修中と研修終了後で肩腱板断裂患者に対し検査を施行した各20症例を対象として，術中所見と比較して，感度・特異度・正診率を調査した．また，研修終了後，指導技師と研修技師3名の技師間診断精度差についても比較検討した．検定にはFisher検定を用いた．結果：研修初期時の上腕二頭筋長頭腱の正診率は，技師1：70％，技師2：72％，技師3：65％肩甲下筋腱は，技師1：50％，技師2：50％，技師3：60％と低値であった．プログラム終了後の上腕二頭筋長頭腱の正診率は，技師1：85％，技師2：80％，技師3：75％，肩甲下筋腱は，技師1：65％，技師2：65％，技師3：85％と改善がみられた．上腕二頭筋長頭腱，肩甲下筋腱，棘上筋腱，棘下筋腱の所見に関して指導を受けた技師によるSUSの術前所見と術中所見を比較し技師間での有意差は認めなかった．考察：今回，我々の開発したSUS研修プログラムは，SUS未経験技師においても，技師間差なく超音波技術を習得できる有用なプログラムであると考えられた．結語：SUS研修プログラムは技師への技術指導に有効である．

Purpose: The aim of this study was to verify the validity of a shoulder ultrasonic training program in the clinical laboratory for human resource development. Methods: Three technicians were trained under this program for 1 year. We evaluated the sensitivity, specificity, and accuracy of shoulder ultrasound (SUS) findings in comparison with the intraoperative findings in 20 cases. SUS was performed in pairs during training, and SUS was performed by the technician alone at 1 year. At the end of the program, the diagnostic accuracy was of the instructor and the three technicians was evaluated using Fisher's test. Results: There was no significant difference between the instructor and three technicians in terms of evaluation of the long head of biceps tendon (LHBT), subscapularis tendon, supraspinatus tendon, and infraspinatus tendon before surgery. At the start of this program, the accuracy of SUS findings for the LHBT was 69% (technicians 1: 70%, 2: 72%, and 3: 65%) and that for the subscapularis tendon was 53% (technicians 1: 50%, 2: 50%, and 3: 60%). After completion of the program, the accuracy of SUS findings for the LHBT improved to 80% (technicians 1: 85%, 2: 80%, and 3: 75%) and that for the subscapularis tendon improved to 71% (technicians 1: 65%, 2: 65%, and 3: 85%). Discussion: The education we provided using the shoulder ultrasonic training program was useful for learning SUS techniques regardless of whether or not the technician had experience with ultrasound examinations. Conclusion: It is conceivable that the shoulder ultrasonic training program is effective for technical guidance.