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To cover the aspects of multimodal knowledge such as perceptual-gestural knowledge, various devices are required. Traces produced by these devices provide rich information and often accurate on learners’ activity. However, those traces are multi-source and heterogeneous and, thus, difficult to process automatically. To foster their treatment, a formal representation that reflects consistent multimodal activity, to which they are linked, is needed. This paper describes our proposal to formalize this type of traces recorded from TELEOS, an Intelligent Tutoring System dedicated to percutaneous orthopedic surgery., Pour couvrir toutes les facettes des connaissances multimodales telles que les connaissances perceptivo-gestuelles, divers périphériques sont exploités. Les traces produites par ces derniers fournissent des informations pertinentes sur l’activité de l’apprenant. Cependant elles sont multi-sources et hétérogènes et, de ce fait, difficiles à traiter automatiquement. Pour faciliter leur traitement, il convient de leur fournir une représentation formelle qui reflète l’activité multimodale à laquelle elles sont liées. Cet article décrit notre proposition de formalisation de ce type de traces enregistrées à partir d’un Système Tutoriel Intelligent dédié à la chirurgie orthopédique percutanée, TELEOS., Toussaint Ben-Manson, Luengo Vanda, Jambon Francis. Analyse de connaissances perceptivo-gestuelles dans un Système Tutoriel Intelligent. In: Sciences et Technologies de l'Information et de la Communication pour l'Éducation et la Formation, volume 24 n°1, 2017. Sélection de la conférence EIAH 2015, sous la direction de Gaëlle Molinari et Lahcen Oubahssi. pp. 231-264.

Six patients with lumbar herniated discs were treated using the Nucleotome Flex II system under computed tomography (CT) guidance. Excellent results were obtained in patients whose intraoperative CT showed that the tip of the nucleotome was located at the posterior part of the disc. The nucleotome flexed within the area where the dye had spread during the preoperative computed tomographic discography (CTD). On the other hand, in both good and poor cases, the tip of the nucleotome could not flex posteriorly because of strong resistance. In these cases, preoperative CTD showed disc protrusion with a narrow dye base. The findings following open discectomies of poor cases showed that the dye lacking area consisted of a relatively intact annulus fibrosus. A relatively intact annulus fibrosus may obstruct the flexion of the nucleotome, resulting in a poor outcome in such cases., 6例の腰椎椎間板へルニアの症例に対して, CTガイドのもとで Nucleotome Flex II による経皮的椎間板摘出術を施行した. 優の成績が得られた症例においては, 術中のCT所見において, nucleotome の先端が椎間板の後方部分（へルニアに近い部分）に到達していた. これらの症例では術前のCT椎間板造影像において, 造影剤の充満されている部分の中で nucleotome が屈曲していた. 他方, 良と不可の症例においては, nucleotome は強い抵抗のため後方へ屈曲できなかった. これらの症例の術前のCT椎間板造影像では, Castro のいう narrow dye base とし、う所見であった. 不可の症例では, 引き続き open discectomy が行われたが, narrow dye base において認められた造影剤が入りこまない部分は比較的健常な線維輪であった. 比較的健常な線維輪が nucleotome の屈曲を妨げ, その結果としてヘルニアに近い椎間板の後方部分が切除されなかったため, 成績が不良となったと考えられた.