Matatu-dimensional akadhindwa eanatomical modhi (3DPAMs) anoita sechishandiso chakakodzera nekuda kwekukosha kwedzidzo uye kugona.Chinangwa chekuongorora uku ndechekutsanangura uye kuongorora nzira dzinoshandiswa kugadzira 3DPAM yekudzidzisa hunhu hwevanhu uye kuongorora kudzidzisa kwayo.
Tsvagiridzo yemagetsi yakaitwa muPubMed pachishandiswa mazwi anotevera: dzidzo, chikoro, kudzidza, kudzidzisa, kudzidzisa, kudzidzisa, dzidzo, mativi matatu, 3D, 3-dimensional, kudhinda, kudhinda, kudhinda, anatomy, anatomy, uye anatomy. ..Zvakawanikwa zvaisanganisira maitiro ekudzidza, dhizaini yemhando, morphological assessment, kuita kwedzidzo, kusimba uye kusasimba.
Pakati pezvinyorwa zve68 zvakasarudzwa, nhamba huru yezvidzidzo yakatarisana nenharaunda yecranial (33 zvinyorwa);51 zvinyorwa zvinotaura kudhindwa kwemapfupa.Muzvinyorwa makumi mana nenomwe, 3DPAM yakagadzirwa zvichibva pacomputer tomography.Matanho mashanu okudhinda akanyorwa.Plastics uye zvinobva kwavari zvakashandiswa muzvidzidzo makumi mana nemasere.Imwe neimwe dhizaini inosiyana mumutengo kubva pamadhora 1.25 kusvika kumadhora mazana maviri nemakumi masere.Zvidzidzo makumi matatu nenomwe zvakaenzanisa 3DPAM nemareferensi modhi.Zvinyorwa makumi matatu nenhatu zvakaongorora zviitiko zvedzidzo.Mabhenefiti makuru ndeemhando yekuona uye inobatika, kugona kudzidza, kudzokorora, kugadzirisa uye kugona, kuchengetedza nguva, kubatanidzwa kweatomy inoshanda, kugona kutenderera kwepfungwa, kuchengetedza ruzivo uye kugutsikana kwemudzidzisi/mudzidzi.Izvo zvipingamupinyi zvikuru zvine chekuita nekugadzira: kuenderana, kushaikwa kweruzivo kana kujeka, mavara akanyanya kupenya, nguva refu yekudhinda uye mutengo wakakwira.
Ongororo iyi yakarongeka inoratidza kuti 3DPAM inodhura-inoshanda uye inoshanda pakudzidzisa anatomy.Mamwe mamodheru echokwadi anoda kushandiswa kweanodhura matekinoroji e3D uye nguva refu yekugadzira, izvo zvichawedzera zvakanyanya mutengo wese.Chinokosha ndechokusarudza nzira yakakodzera yekufungidzira.Kubva pamaonero edzidziso, 3DPAM chishandiso chinoshanda chekudzidzisa anatomi, chine simba rakanaka pane zvinobuda pakudzidza uye kugutsikana.Mhedzisiro yekudzidzisa ye3DPAM ndiyo yakanyanya kunaka kana ichiburitsa matunhu akaomarara eanatomical uye vadzidzi vanoishandisa pakutanga mukudzidziswa kwavo kwekurapa.
Kubviswa kwezvitunha zvemhuka kwave kuchiitwa kubva kuGreece yekare uye ndiyo imwe yenzira huru dzekudzidzisa anatomy.Cadaveric dissections inoitwa panguva yekudzidzira inoshanda inoshandiswa mune theoretical curriculum yevadzidzi vezvokurapa vekuyunivhesiti uye parizvino inoonekwa seyegoridhe mwero wekudzidza anatomy [1,2,3,4,5].Zvisinei, pane zvipingamupinyi zvakawanda pakushandiswa kwezviyero zvevanhu zvecadaveric, zvichiita kuti kutsvaga zvishandiso zvitsva zvekudzidzisa [6, 7].Zvimwe zvezvishandiso zvitsva izvi zvinosanganisira augmented reality, maturusi edhijitari, uye 3D kudhinda.Zvinoenderana neazvino ongororo yemabhuku naSantos et al.[8] Panyaya yekukosha kwehunyanzvi hutsva uhu hwekudzidzisa anatomi, kudhinda kwe3D kunoratidzika sechimwe chezvishandiso zvakakosha, zvese maererano nekukosha kwedzidzo kuvadzidzi uye maererano nekugoneka kwekuita [4,9,10] .
3D kudhinda hakusi kutsva.Matende ekutanga ane chekuita neiyi tekinoroji akadzokera ku1984: A Le Méhauté, O De Witte naJC André muFrance, uye mavhiki matatu gare gare C Hull muUSA.Kubva ipapo, tekinoroji yakaramba ichishanduka uye kushandiswa kwayo kwakawedzera munzvimbo dzakawanda.Semuenzaniso, NASA yakadhinda chinhu chekutanga kunze kwePasi muna 2014 [11].Nharaunda yezvekurapa yakatorawo chishandiso chitsva ichi, nekudaro ichiwedzera chishuwo chekuvandudza mushonga wemunhu [12].
Vanyori vazhinji vakaratidza mabhenefiti ekushandisa 3D yakadhindwa anatomical modhi (3DPAM) mudzidzo yekurapa [10, 13, 14, 15, 16, 17, 18, 19].Kana uchidzidzisa anatomy yemunhu, kwete-pathological uye anatomically yakajairika mhando inodiwa.Dzimwe wongororo dzakaongorora maitiro ekurapa kana ekurapa / ekuvhiya ekudzidzira [8, 20, 21].Kuti tigadzire modhi yakasanganiswa yekudzidzisa anatomy yemunhu inosanganisira maturusi matsva senge 3D kudhinda, takaita wongororo yakarongeka kutsanangura nekuongorora kuti zvinhu zvakadhindwa zve 3D zvinogadzirwa sei kudzidzisa anatomy yemunhu uye kuti vadzidzi vanoongorora sei kushanda kwekudzidza vachishandisa izvi zvinhu zve3D.
Iyi yakarongeka yekuongorora mabhuku yakaitwa muna Chikumi 2022 pasina zvirambidzo zvenguva uchishandisa PRISMA (Inodiwa Kushuma Zvinhu zveSystem Ongororo uye Meta-Analyses) nhungamiro [22].
Maitiro ekusanganisa aive ese mapepa ekutsvagisa achishandisa 3DPAM mukudzidzisa kweanatomy / kudzidza.Ongororo yezvinyorwa, tsamba, kana zvinyorwa zvinotarisa pamienzaniso yezvirwere, mhando dzemhuka, mhando dzekuchera matongo, uye mhando dzekudzidzisa dzekurapa / dzekuvhiya dzakabviswa.Zvinyorwa zvakabudiswa muChirungu chete ndizvo zvakasarudzwa.Zvinyorwa zvisina zvinyorwa zvepamhepo zviripo zvakaiswa kunze.Zvinyorwa zvaisanganisira mamodheru akawanda, ingangoita imwe chete yaive yakajairika kana yaive nediki pathology isingakanganise kukosha kwekudzidzisa, zvakasanganisirwa.
Kutsvaga kwemabhuku kwakaitwa mudura remagetsi rePubMed (National Library yeMishonga, NCBI) kuti ione zvidzidzo zvakakosha zvakaburitswa kusvika munaJune 2022. Shandisai mazwi ekutsvaga anotevera: dzidzo, chikoro, kudzidzisa, kudzidzisa, kudzidza, kudzidzisa, dzidzo, zvitatu- dimensional, 3D, 3D, kudhinda, kudhinda, kudhinda, anatomy, anatomy, anatomy uye anatomy.Mubvunzo mumwechete wakaitwa: (((Dzidzo[Chinyorwa/Zvinyorwa] KANA chikoro[Chinyorwa/Chinyorwa] ORKudzidza[Chinyorwa/Chinyorwa] KANA kudzidzisa[Chinyorwa/Chinyorwa] KANA kudzidziswa[Chinyorwa/Chinyorwa] OReach[Chinyorwa/Zvinyorwa] ] KANA Dzidzo [Zita/Zvinyorwa]) UYE (Zviyero Zvitatu [Zita] KANA 3D [Chinyorwa] KANA 3D [Chinyorwa])) UYE (Dhinda [Chinyorwa] KANA Dhinda [Chinyorwa] KANA Dhinda [Chinyorwa])) UYE (Anatomy) [Chinyorwa ] ]/abstract] kana anatomy [zita/abstract] kana anatomy [zita/abstract] kana anatomy [zita/abstract]).Zvimwe zvinyorwa zvakaonekwa nekutsvaga nemaoko PubMed dhatabhesi uye nekuongorora mareferensi ezvimwe zvinyorwa zvesainzi.Hapana zvirambidzo zvezuva zvakaiswa, asi "Munhu" sefa yakashandiswa.
Mazita ese akadzoserwa uye abstracts akaongororwa achipokana nekubatanidzwa uye kusabatanidzwa maitiro nevanyori vaviri (EBR neAL), uye chero chidzidzo chisina kusangana nemaitiro ekukodzera chakabviswa.Zvinyorwa zvizere-zvinyorwa zvezvidzidzo zvakasara zvakadzorerwa uye zvakaongororwa nevanyori vatatu (EBR, EBE uye AL).Kana zvichidiwa, kusawirirana mukusarudzwa kwezvinyorwa kwakagadziriswa nemunhu wechina (LT).Zvinyorwa zvakasangana nemaitiro ese ekubatanidza zvakaverengerwa muongororo iyi.
Kutorwa kwedata kwakaitwa kwakazvimiririra nevanyori vaviri (EBR uye AL) pasi pekutariswa kwemunyori wechitatu (LT).
- Model dhizaini data: anatomical matunhu, chaiwo anatomical zvikamu, yekutanga modhi ye3D kudhinda, nzira yekutora, segmentation uye modelling software, 3D printer mhando, mhando yezvinhu uye huwandu, chiyero chekudhinda, ruvara, mutengo wekudhinda.
- Morphological assessment yemhando: mienzaniso inoshandiswa pakuenzanisa, kuongororwa kwechiremba kwenyanzvi / vadzidzisi, nhamba yevaongorori, rudzi rwekuongorora.
- Kudzidzisa 3D modhi: kuongororwa kweruzivo rwemudzidzi, nzira yekuongorora, nhamba yevadzidzi, nhamba yemapoka ekuenzanisa, randomisation yevadzidzi, dzidzo / rudzi rwemudzidzi.
Zvidzidzo zve418 zvakaonekwa muMEDLINE, uye zvinyorwa zve139 zvakabviswa ne "munhu" filter.Mushure mekuongorora mazita uye zvinyorwa, zvidzidzo zve103 zvakasarudzwa kuti zviverengere zvizere.Zvinyorwa zve34 hazvina kubatanidzwa nekuti angave ari emhando dzepathological (9 zvinyorwa), zvekurapa/kuvhiya mamodheru ekudzidzisa (4 zvinyorwa), mhando dzemhuka (4 zvinyorwa), 3D radiological modhi (1 chinyorwa) kana zvisiri zvepakutanga zvinyorwa zvesainzi (16 zvitsauko).).Zvose zvezvinyorwa zve68 zvakabatanidzwa mukuongorora.Mufananidzo 1 unopa nzira yekusarudza sechati inoyerera.
Inoyerera chati inopfupikisa kuzivikanwa, kuongorora, uye kuisirwa zvinyorwa muongororo iyi yakarongeka
Zvidzidzo zvese zvakaburitswa pakati pa2014 na2022, paine avhareji gore rekuburitswa ra2019. Pakati pemakumi matanhatu nemasere zvinosanganisira zvinyorwa, makumi matatu nenhatu (49%) zvidzidzo zvaitsanangura uye kuyedza, 17 (25%) zvaive zvekuedza chete, uye gumi nemasere (26%) vaive. experimental.Kunyatsotsanangura.Pakati pe50 (73%) zvidzidzo zvekuedza, 21 (31%) yakashandisa randomization.Zvidzidzo zve34 chete (50%) zvaisanganisira ongororo yenhamba.Tafura 1 inopfupisa maitiro echidzidzo chega chega.
Zvinyorwa zve33 (48%) zvakaongorora nzvimbo yemusoro, zvinyorwa zve19 (28%) zvakaongorora nzvimbo yechipfuva, zvinyorwa zve17 (25%) zvakaongorora nzvimbo yeabdominopelvic, uye zvinyorwa zve15 (22%) zvakaongorora magumo.Zvinyorwa makumi mashanu nechimwe (75%) zvakataura mapfupa e3D akadhindwa semamodheru eanatomical kana akawanda-slice anatomical modhi.
Nezvemisikirwo yemhando kana mafaira akashandiswa kugadzira 3DPAM, zvinyorwa zve23 (34%) zvakataura nezvekushandiswa kwedata revarwere, zvinyorwa zve20 (29%) zvakataura nezvekushandiswa kwe data cadaveric, uye zvinyorwa zve17 (25%) zvakataura nezvekushandiswa kwedatabase.yakashandiswa, uye zvidzidzo zve 7 (10%) hazvina kuzivisa kwakabva zvinyorwa zvakashandiswa.
Zvidzidzo zve47 (69%) zvakagadzira 3DPAM zvichibva pane computed tomography, uye zvidzidzo zve3 (4%) zvakashuma kushandiswa kwe microCT.7 zvinyorwa (10%) zvakaratidza 3D zvinhu vachishandisa optical scanners, 4 zvinyorwa (6%) vachishandisa MRI, uye 1 chinyorwa (1%) vachishandisa makamera uye maikorosikopu.14 zvinyorwa (21%) hazvina kutaura kwainobva iyo 3D modhi dhizaini sosi mafaera.3D mafaera anogadzirwa ane avhareji yekugadziriswa kwenzvimbo isingasviki 0.5 mm.Iyo yakanyanya kugadziriswa ndeye 30 μm [80] uye iyo yakanyanya kugadziriswa ndeye 1.5 mm [32].
Makumi matanhatu akasiyana esoftware application (segmentation, modelling, design kana kudhinda) yakashandiswa.Mimics (Materialise, Leuven, Belgium) yakashandiswa kazhinji (14 zvidzidzo, 21%), ichiteverwa neMeshMixer (Autodesk, San Rafael, CA) (13 zvidzidzo, 19%), Geomagic (3D System, MO, NC, Leesville) .(10 zvidzidzo, 15%), 3D Slicer (Slicer Developer Training, Boston, MA) (9 zvidzidzo, 13%), Blender (Blender Foundation, Amsterdam, Netherlands) (8 zvidzidzo, 12%) uye CURA (Geldemarsen, Netherlands) (7 zvidzidzo, 10%).
Makumi matanhatu nemanomwe akasiyana printa modhi uye mashanu maitiro ekudhinda anotaurwa.FDM (Fused Deposition Modeling) tekinoroji yakashandiswa muzvigadzirwa makumi maviri nematanhatu (38%), kuputika kwezvinhu muzvigadzirwa gumi nenhatu (19%) uye pakupedzisira binder blasting (11 zvigadzirwa, 16%).Iwo mashoma akashandiswa matekinoroji ndeye stereolithography (SLA) (5 zvinyorwa, 7%) uye yakasarudzika laser sintering (SLS) (4 zvinyorwa, 6%).Inonyanya kushandiswa printer (zvinyorwa zvinomwe, 10%) iConnex 500 (Stratasys, Rehovot, Israel) [27, 30, 32, 36, 45, 62, 65].
Pakutsanangura zvinhu zvakashandiswa kugadzira 3DPAM (51 zvinyorwa, 75%), 48 zvidzidzo (71%) zvakashandisa mapurasitiki uye zvinobva kwavari.Zvinhu zvikuru zvakashandiswa zvaiva PLA (polylactic acid) (n = 20, 29%), resin (n = 9, 13%) uye ABS (acrylonitrile butadiene styrene) (7 marudzi, 10%).Zvinyorwa makumi maviri nenhatu (34%) zvakaongorora 3DPAM yakagadzirwa kubva kune akawanda zvinhu, zvinyorwa makumi matatu nematanhatu (53%) zvakaratidza 3DPAM yakagadzirwa kubva muchinhu chimwe chete, uye zvinyorwa zve9 (13%) hazvina kutsanangura chinhu.
Zvinyorwa makumi maviri nezvipfumbamwe (43%) zvakashuma kudhindwa kwakaenzana kubva pa0.25:1 kusvika pa2:1, neavhareji ye1:1.Zvinyorwa makumi maviri neshanu (37%) zvakashandisa chiyero che1:1.28 3DPAMs (41%) yaive nemavara mazhinji, uye 9 (13%) yakadhayiwa mushure mekudhindwa [43, 46, 49, 54, 58, 59, 65, 69, 75].
Zvinyorwa makumi matatu nezvina (50%) zvakataura nezvemitengo.9 zvinyorwa (13%) zvakataura mutengo wemaprinta e3D uye zvigadzirwa.Madhindi anotangira pamutengo kubva pamadhora mazana matatu kusvika pamakumi matanhatu neshanu.Kana yatsanangurwa, mitengo yemhando inotangira pamadhora 1.25 kusvika ku2,800;izvi zvakanyanyisa zvinoenderana neskeletal specimens [47] uye yakakwirira-kutendeseka retroperitoneal models [48].Tafura 2 inopfupisa iyo data yemuenzaniso kune yega yega inosanganisirwa kudzidza.
Zvidzidzo makumi matatu nenomwe (54%) zvakaenzanisa iyo 3DAPM nemuenzaniso wereferenzi.Pakati pezvidzidzo izvi, muenzanisi wakajairika aive anatomical referensi modhi, yakashandiswa muzvinyorwa zve14 (38%), kugadzirira kwepurasitiki muzvinyorwa zve6 (16%), kugadzirira kwepurasitiki muzvinyorwa zve6 (16%).Kushandiswa kwechokwadi chaicho, computed tomography imaging imwe 3DPAM muzvinyorwa zvishanu (14%), imwe 3DPAM muzvinyorwa zvitatu (8%), mitambo yakakomba muchinyorwa 1 (3%), radiographs muchinyorwa 1 (3%), mhando dzebhizinesi mu 1 chinyorwa (3%) uye yakawedzerwa chokwadi mune 1 chinyorwa (3%).Zvidzidzo makumi matatu neina (50%) zvakaongororwa 3DPAM.Zvidzidzo gumi neshanu (48%) zvakatsanangura zviitiko zvevateresi zvakadzama (Tafura 3).3DPAM yakaitwa nevanovhiya kana kuenda kune vanachiremba muzvidzidzo zve7 (47%), nyanzvi dzeanatomical muzvidzidzo zve6 (40%), vadzidzi muzvidzidzo zve3 (20%), vadzidzisi (chirango chisina kutaurwa) muzvidzidzo zve3 (20%) yekuongorora. uye mumwe muongorori mune chinyorwa (7%).Avhareji yenhamba yevaongorori igumi neina (shoma 2, yepamusoro 30).Zvidzidzo makumi matatu nenhatu (49%) zvakaongorora 3DPAM morphology qualitatively, uye 10 zvidzidzo (15%) zvakaongorora 3DPAM morphology yakawanda.Pazvidzidzo makumi matatu nenhatu zvakashandisa ongororo dzemhando yepamusoro, gumi nematanhatu dzakashandisa ongororo dzinotsanangura (48%), 9 dzakashandisa bvunzo/zviyero/ongororo (27%), uye 8 dzakashandisa zviyero zveLikert (24%).Tafura 3 inopfupisa morphological assessments yemhando mune imwe neimwe inosanganisirwa kudzidza.
Makumi matatu nenhatu (48%) zvinyorwa zvakaongorora uye kuenzanisa kushanda kwekudzidzisa 3DPAM kuvadzidzi.Pazvidzidzo izvi, 23 (70%) zvinyorwa zvakaongorora kugutsikana kwevadzidzi, 17 (51%) vakashandisa zviyero zveLikert, uye 6 (18%) vakashandisa dzimwe nzira.Zvinyorwa makumi maviri nezviviri (67%) zvakaongorora kudzidza kwevadzidzi kuburikidza nekuongorora ruzivo, izvo gumi (30%) zvakashandisa pretess uye / kana posttests.Zvidzidzo gumi nechimwe (33%) zvakashandisa mibvunzo yakawanda-yesarudzo uye bvunzo kuongorora ruzivo rwevadzidzi, uye zvidzidzo zvishanu (15%) zvakashandisa kunyora mifananidzo/kuzivikanwa kweanatomical.Avhareji yevadzidzi makumi manomwe nevatanhatu vakapinda muchidzidzo chega chega (vashoma 8, vanokwana 319).Zvidzidzo makumi maviri nezvina (72%) zvaive neboka rekutonga, iro 20 (60%) rakashandisa randomisation.Kusiyana neizvi, chidzidzo chimwe (3%) chakapihwa mamodhiyo eanatomical kuvadzidzi gumi vakasiyana.Paavhareji, mapoka e2.6 akaenzaniswa (shoma 2, yakawanda 10).Zvidzidzo makumi maviri nenhatu (70%) zvakabatanidza vadzidzi vezvokurapa, avo 14 (42%) vaive vadzidzi vekutanga vekurapa.Zvidzidzo zvitanhatu (18%) zvaisanganisira vagari, 4 (12%) vadzidzi vemazino, uye 3 (9%) vadzidzi vesainzi.Zvidzidzo zvitanhatu (18%) zvakamisikidzwa uye zvakaongorora kuzvimiririra kudzidza vachishandisa 3DPAM.Tafura 4 inopfupisa mhedzisiro ye3DPAM yekudzidzisa inoshanda yekuongorora kune yega yega inosanganisirwa kudzidza.
Mabhenefiti makuru akataurwa nevanyori pakushandisa 3DPAM sechishandiso chekudzidzisa cheyakajairika anatomy yemunhu inoonekwa uye inobatika hunhu, kusanganisira realism [55, 67], kurongeka [44, 50, 72, 85], uye kuenderana kusiyanisa [34, 45]. ]., 48, 64], ruvara uye pachena [28, 45], durability [24, 56, 73], maitiro ekudzidzisa [16, 32, 35, 39, 52, 57, 63, 69, 79], mari [27, 41. 67, 80], kukwanisa kushandisa vadzidzi [30, 49], kuchengetedza nguva yekudzidzisa [61, 80], kusununguka kwekuchengetedza [61], kukwanisa kubatanidza anatomy inoshanda kana kugadzira zvivako zvakananga [51, 53], 67] , kukurumidza kugadzirwa kwemaskeletal models [81], kukwanisa kubatanidzwa-kugadzira mienzaniso uye kuenda navo kumba [49, 60, 71], kuvandudza mano ekutenderera kwepfungwa [23] nekuchengetedza ruzivo [32], pamwe chete nemudzidzisi [ 25, 63] uye kugutsikana kwevadzidzi [25, 45, 46, 52, 52, 57, 63, 66, 69, 84].
Izvo zvakanyanya kukanganisa zvine chekuita nekugadzira: kuomarara [80], kuenderana [28, 62], kushaya ruzivo kana kujeka [28, 30, 34, 45, 48, 62, 64, 81], mavara akajeka kwazvo [45].uye kusasimba kwepasi[71].Zvimwe zvipingamupinyi zvinosanganisira kurasikirwa neruzivo [30, 76], nguva yakareba inodiwa pachikamu chemufananidzo [36, 52, 57, 58, 74], nguva yekudhinda [57, 63, 66, 67], kushaikwa kwekusiyana kweanatomical [25], uye mutengo.Pamusoro[48].
Ongororo iyi yakarongeka inopfupikisa zvinyorwa makumi matanhatu nesere zvakaburitswa mumakore 9 uye inosimbisa kufarira kwesaenzi mu3DPAM sechombo chekudzidzisa akajairwa anatomy yemunhu.Yese dunhu reanatomical rakadzidzwa uye 3D yakadhindwa.Pazvinyorwa izvi, zvinyorwa makumi matatu nenomwe zvakaenzanisa 3DPAM nemamwe mamodheru, uye zvinyorwa makumi matatu nematatu zvakaongorora kukosha kwekudzidzisa kwe3DPAM kuvadzidzi.
Tichifunga nezvekusiyana kwekugadzirwa kweanatomical 3D kudhinda zvidzidzo, isu hatina kuona zvakakodzera kuita meta-analysis.Ongororo yemeta yakaburitswa muna 2020 yakanyanya kutarisisa bvunzo dzeanatomical ruzivo mushure mekudzidziswa pasina kuongorora tekinoroji uye tekinoroji madhizaini e3DPAM dhizaini nekugadzira [10].
Nzvimbo yemusoro ndiyo inonyanya kudzidzwa, pamwe nekuti kuoma kwechimiro chayo kunoita kuti zvinyanye kuomera vadzidzi kuratidza dunhu reanatomical iri munzvimbo ine mativi matatu zvichienzaniswa nemakumbo kana torso.CT ndiyo inonyanya kushandiswa yekufungidzira modhi.Iyi tekinoroji inoshandiswa zvakanyanya, kunyanya mumagadzirirwo ekurapa, asi ine shongedzo yenzvimbo uye yakaderera yakapfava mutsauko.Izvi zvinokanganisa zvinoita kuti CT scans isakodzere kupatsanurwa uye kuenzanisira kwenheyo system.Kune rumwe rutivi, computed tomography inonyatsokodzera pfupa tissue segmentation / modeling;Bone/soft tissue mutsauko unobatsira kupedzisa nhanho idzi pamberi pe 3D yekudhinda anatomical modhi.Kune rimwe divi, microCT inoonekwa seyereferenzi tekinoroji maererano nekugadziriswa kwenzvimbo mukufungidzira kwepfupa [70].Optical scanners kana MRI inogonawo kushandiswa kuwana mifananidzo.Kugadziriswa kwepamusoro kunodzivirira kutsetseka kwemapfupa uye kunochengetedza hunyengeri hwezvimiro zveanatomical [59].Sarudzo yemuenzaniso inokanganisawo kugadzirisa kwenzvimbo: semuenzaniso, mapurasitiki emhando ane yakaderera resolution [45].Vagadziri vemifananidzo vanofanirwa kugadzira mhando dze3D, izvo zvinowedzera mutengo ($25 kusvika $150 paawa) [43].Kuwana mafaera emhando yepamusoro .STL hakuna kukwana kugadzira mhando dzemhando yepamusoro dzeanatomical.Izvo zvinodiwa kuti uone kudhinda paramita, senge kutariswa kweiyo anatomical modhi pane yekudhinda ndiro [29].Vamwe vanyori vanoratidza kuti matekinoroji epamusoro ekudhinda akadai seSLS anofanirwa kushandiswa pese pazvinogoneka kuvandudza kurongeka kwe3DPAM [38].Kugadzirwa kwe3DPAM kunoda rubatsiro rwehunyanzvi;nyanzvi dzinonyanya kutsvakwa mainjiniya [72], radiologists, [75], graphic designers [43] uye anatomist [25, 28, 51, 57, 76, 77].
Segmentation uye modelling software zvinhu zvakakosha mukuwana echokwadi anatomical modhi, asi mutengo wemapakeji esoftware uye kuoma kwawo kunotadzisa kushandiswa kwavo.Ongororo dzinoverengeka dzakaenzanisa kushandiswa kweakasiyana software mapakeji uye matekinoroji ekudhinda, achiratidzira zvakanakira nekuipira kwehunyanzvi hwese [68].Pamusoro pekuenzanisira software, kudhinda software inowirirana neprinta yakasarudzwa inodiwawo;vamwe vanyori vanofarira kushandisa online 3D kudhinda [75].Kana zvinhu zvakakwana zve 3D zvakadhindwa, mari yacho inogona kutungamira mukudzoka kwemari [72].
Plastiki ndiyo inonyanya kushandiswa zvinhu.Hwaro hwakasiyana-siyana hwemavara uye mavara anoita kuti ive chinhu chesarudzo che3DPAM.Vamwe vanyori vakarumbidza simba rayo rakakwirira zvichienzaniswa nemhando dzechinyakare cadaveric kana plastinated [24, 56, 73].Mamwe mapurasitiki anotove nekukotama kana kutambanudza zvinhu.Semuenzaniso, Filaflex ine FDM tekinoroji inogona kutambanudza kusvika ku700%.Vamwe vanyori vanozviona sechinhu chesarudzo chemhasuru, tendon uye ligament replication [63].Kune rimwe divi, zvidzidzo zviviri zvakamutsa mibvunzo nezve faibha orientation panguva yekudhinda.Muchokwadi, tsandanyama fiber orientation, kuisirwa, kusachengeteka, uye basa rakakosha mumhasuru yekuenzanisira [33].
Zvinoshamisa ndezvokuti zvidzidzo zvishomanana zvinotaura ukuru hwekudhinda.Sezvo vanhu vazhinji vachitora reshiyo ye1:1 seyakajairwa, munyori anogona kunge akasarudza kusataura nezvazvo.Kunyangwe kukwidza kungave kunobatsira pakudzidza kwakanangana mumapoka makuru, kugona kwekuyera hakusati kwaongororwa, kunyanya nekukura kwemakirasi uye ukuru hwemuviri wemuenzaniso chinhu chakakosha.Ehe, zviyero zvakakura zvinoita kuti zvive nyore kutsvaga uye kutaurirana zvakasiyana-siyana zveanatomical kumurwere, izvo zvinogona kutsanangura chikonzero nei zvichiwanzo kushandiswa.
Pamadhinda akawanda anowanikwa pamusika, ayo anoshandisa PolyJet (material kana binder inkjet) tekinoroji kupa ruvara uye multi-layer (uye nekudaro multi-texture) high tsanangudzo kudhinda mutengo pakati US$20,000 uye US$250,000 (https: //www .aniwaa.com/).Uyu mutengo wakakwira unogona kudzikisira kusimudzirwa kwe3DPAM muzvikoro zvekurapa.Pamusoro pemutengo weprinta, mutengo wezvinhu zvinodiwa pakudhinda inkjet wakakwira kupfuura weSLA kana FDM printers [68].Mitengo yeSLA kana FDM maprinta zvakare inokwanisika, kubva pa576 kusvika € 4,999 muzvinyorwa zvakanyorwa muongororo iyi.Sekureva kwaTripodi nevamwe vaanoshanda navo, chikamu chimwe nechimwe cheskeletal chinogona kudhindwa neUS $ 1.25 [47].Zvidzidzo gumi nerimwe zvakagumisa kuti 3D kudhinda kwakachipa pane plasticization kana mamodheru ekutengesa [24, 27, 41, 44, 45, 48, 51, 60, 63, 80, 81, 83].Uyezve, aya emhando dzekutengeserana akagadzirirwa kupa ruzivo rwemurwere pasina ruzivo rwakakwana rwekudzidzisa kweanatomy [80].Aya emhando dzekutengesa anoonekwa seakaderera kune 3DPAM [44].Zvakakosha kuziva kuti, kuwedzera kune tekinoroji yekudhinda inoshandiswa, mutengo wekupedzisira wakaenzana nechiyero uye saka saizi yekupedzisira ye3DPAM [48].Nezvikonzero izvi, chiyero chakazara-chiyero chinosarudzwa [37].
Chidzidzo chimwe chete chakaenzanisa 3DPAM nemhando dzekutengesa dzinowanikwa anatomical [72].Cadaveric samples ndiyo inonyanya kushandiswa kuenzanisa ye3DPAM.Pasinei nezvavasingakwanisi, ma cadaveric modhi anoramba ari chishandiso chakakosha chekudzidzisa anatomy.Musiyano unofanirwa kuitwa pakati peautopsy, dissection uye yakaoma bone.Zvichienderana nemiedzo yekudzidziswa, zvidzidzo zviviri zvakaratidza kuti 3DPAM yaive yakanyanya kushanda kupfuura plastinated dissection [16, 27].Chimwe chidzidzo chakaenzanisa awa imwe yekudzidziswa uchishandisa 3DPAM (yakaderera kumucheto) neawa imwe yekuparadzanisa yeatomical dunhu rimwechete [78].Pakanga pasina misiyano inokosha pakati pemitoo miviri yokudzidzisa.Zvingangodaro kuti pane tsvakurudzo shoma pamusoro penyaya iyi nokuti kuenzanisa kwakadaro kwakaoma kuita.Dissection gadziriro inopedza nguva yevadzidzi.Dzimwe nguva maawa akawanda ekugadzirira anodiwa, zvichienderana nezviri kugadzirirwa.Kuenzanisa kwechitatu kunogona kuitwa nemapfupa akaoma.Chidzidzo chakaitwa naTsai naSmith chakawana kuti zvibodzwa zvebvunzo zvaive nani muboka vachishandisa 3DPAM [51, 63].Chen nevamwe vaaishanda navo vakaona kuti vadzidzi vanoshandisa 3D modhi vakaita zvirinani pakuziva zvimiro (madehenya), asi pakanga pasina mutsauko muMCQ zvibodzwa [69].Pakupedzisira, Tanner nevamwe vaaishanda navo vakaratidza zviri nani mushure mebvunzo mhinduro muboka iri vachishandisa 3DPAM yepterygopalatine fossa [46].Zvimwe zvishandiso zvitsva zvekudzidzisa zvakaonekwa muongororo yemabhuku iyi.Zvinonyanya kuzivikanwa pakati pavo ndezvechokwadi chakawedzerwa, chokwadi chaicho uye mitambo yakakomba [43].Sekureva kwaMahrous nevamwe vaanoshanda navo, kusarudzwa kwemamodhiyo eanatomical kunoenderana nehuwandu hwemaawa vadzidzi vanotamba mitambo yemavhidhiyo [31].Kune rimwe divi, dhizaini huru yemidziyo mitsva yekudzidzisa yeanatomy ndeye haptic mhinduro, kunyanya kune chaiwo chaiwo maturusi [48].
Zvidzidzo zvizhinji zvinoongorora iyo itsva 3DPAM yakashandisa pretest yezivo.Aya pretest anobatsira kudzivirira kusarura mukuongorora.Vamwe vanyori, vasati vaita zvidzidzo zvekuedza, vasingabatanidzi vadzidzi vese vakawana pamusoro peavhareji pabvunzo yekutanga [40].Pakati pekusarura Garas nevamwe vaaishanda navo vakataurwa vaive ruvara rwemuenzaniso uye kusarudzwa kwevanozvipira mukirasi yevadzidzi [61].Staining inogonesa kuzivikanwa kweanatomical zvimiro.Chen nevamwe vaaishanda navo vakasimbisa mamiriro ekuedza akasimba pasina misiyano yekutanga pakati pemapoka uye chidzidzo chakapofumadzwa kusvika pakakwirira pazvinogona [69].Lim nevamwe vaanoshanda navo vanokurudzira kuti mushure mebvunzo yekuongorora inopedzwa nemunhu wechitatu kudzivirira kusarura mukuongorora [16].Zvimwe zvidzidzo zvakashandisa zvikero zveLikert kuongorora kugona kwe3DPAM.Ichi chiridzwa chakakodzera kuongorora kugutsikana, asi kuchine zvakakosha kusarura kunofanirwa kuziva [86].
Kukosha kwekudzidzisa kwe3DPAM kwakaongororwa zvakanyanya pakati pevadzidzi vezvokurapa, kusanganisira vadzidzi vekutanga vekurapa, mu14 yezvidzidzo makumi matatu nematatu.Muchidzidzo chavo chekutyaira, Wilk nevamwe vaaishanda navo vakashuma kuti vadzidzi vezvokurapa vanotenda kuti kudhinda kwe3D kunofanirwa kuverengerwa mukudzidza kwavo kweanatomy [87].87% yevadzidzi vakaongororwa muchidzidzo cheCercenelli vakatenda kuti gore rechipiri rekudzidza ndiyo nguva yakanakisa yekushandisa 3DPAM [84].Tanner nevamwe vaaishanda navo zvakaratidzawo kuti vadzidzi vakaita zvirinani dai vasina kumbodzidza ndima [46].Idzi data dzinoratidza kuti gore rekutanga rechikoro chekurapa ndiyo nguva yakakwana yekubatanidza 3DPAM mukudzidzisa kweanatomy.Ye's meta-analysis yakatsigira iyi pfungwa [18].Muzvinyorwa makumi maviri nenomwe zvakasanganisirwa muchidzidzo, pakanga paine misiyano mikuru yebvunzo pakati pe3DPAM nemhando dzechinyakare dzevadzidzi vekurapa, asi kwete kune vagari.
3DPAM sechishandiso chekudzidza inovandudza kubudirira mune zvidzidzo [16, 35, 39, 52, 57, 63, 69, 79], kuchengetedza ruzivo kwenguva refu [32], uye kugutsikana kwevadzidzi [25, 45, 46, 52, 57, 63 , 66]., 69 , 84 ].Mapanel enyanzvi akawanawo mamodheru aya anobatsira [37, 42, 49, 81, 82], uye zvidzidzo zviviri zvakawana kugutsikana kwemudzidzisi ne3DPAM [25, 63].Pane zvese zvinyorwa, Backhouse uye vatinoshanda navo vanofunga kudhinda kwe3D seyakanakisa imwe nzira kune yechinyakare anatomical modhi [49].Mune yavo yekutanga meta-analysis, Ye nevamwe vakasimbisa kuti vadzidzi vakagamuchira 3DPAM mirairo vaive nani post-bvunzo mamaki kupfuura vadzidzi vakagamuchira 2D kana cadaver mirairo [10].Nekudaro, ivo vakasiyanisa 3DPAM kwete nekuoma, asi nekungoita nemoyo, tsinga system, uye dumbu remukati.Muzvidzidzo zvinomwe, 3DPAM haina kupfuura mamwe mamodheru zvichienderana nebvunzo dzeruzivo dzakapihwa vadzidzi [32, 66, 69, 77, 78, 84].Mune meta-analysis yavo, Salazar nevamwe vaaishanda navo vakagumisa kuti kushandiswa kwe3DPAM kunonyatso kunatsiridza kunzwisisa kwakaoma anatomy [17].Pfungwa iyi inoenderana netsamba yaHitas kumupepeti [88].Dzimwe nzvimbo dzeanatomical dzinoonekwa sedzisina kuoma hazvidi kushandiswa kwe3DPAM, nepo nzvimbo dzakaomarara dzeanatomical (senge mutsipa kana tsinga system) ingave sarudzo ine musoro ye3DPAM.Pfungwa iyi inogona kutsanangura kuti sei mamwe ma3DPAM asingatariswe seakakwirira kune echinyakare mamodheru, kunyanya kana vadzidzi vasina ruzivo mudura umo maitiro emuenzaniso anowanikwa ari epamusoro.Nokudaro, kupa muenzaniso wakapfava kuvadzidzi vanotova neruzivo rwechidzidzo chacho (vadzidzi vezvokurapa kana vagari vemo) hakubatsiri mukuvandudza kushanda kwevadzidzi.
Pamusoro pezvidzidzo zvose zvakanyorwa, zvidzidzo zve 11 zvakasimbisa maitiro ekuona kana tactile emhando [27,34,44,45,48,50,55,63,67,72,85], uye zvidzidzo zve3 zvakavandudza simba nekugara kwenguva refu (33). , 50 -52, 63, 79, 85, 86).Zvimwe zvakanakira ndezvekuti vadzidzi vanogona kushandura zvimiro, vadzidzisi vanogona kuchengetedza nguva, zviri nyore kuchengetedza pane macadavers, chirongwa chinogona kupedzwa mukati memaawa makumi maviri nemana, chinogona kushandiswa sechishandiso chekuchikoro chepamba, uye chinogona kushandiswa kudzidzisa zvakawanda. yeruzivo.mapoka [30, 49, 60, 61, 80, 81].Kudzokororwa 3D kudhindwa kwepamusoro-vhoriyamu anatomy kudzidzisa kunoita 3D kudhinda mhando kudhura-inoshanda [26].Kushandiswa kwe3DPAM kunogona kuvandudza kugona kutenderera kwepfungwa [23] uye kuvandudza kududzirwa kwemifananidzo yakayambuka [23, 32].Zvidzidzo zviviri zvakawana kuti vadzidzi vakafumurwa ku3DPAM vainyanya kuvhiyiwa [40, 74].Metal connectors inogona kuiswa mukati kuti igadzire kufamba kunodiwa kudzidza inoshanda anatomy [51, 53], kana modhi inogona kudhindwa uchishandisa trigger dhizaini [67].
3D kudhinda kunobvumira kusikwa kweanogadzirika mamodheru eanatomical nekuvandudza zvimwe zvinhu panguva yekuenzanisira nhanho, [48, 80] kugadzira hwaro hwakakodzera, [59] kubatanidza mhando dzakawanda, [36] kushandisa pachena, (49) ruvara, [45] kana kuita kuti zvimwe zvimiro zvemukati zvionekwe [30].Tripodi nevamwe vaaishanda navo vakashandisa kuveza ivhu kuti vabatsire 3D yavo yakadhindwa mapfupa emhando, vachisimbisa kukosha kwemhando dzakagadzirwa pamwe chete semidziyo yekudzidzisa [47].Muzvidzidzo zve9, ruvara rwakashandiswa mushure mekudhinda [43, 46, 49, 54, 58, 59, 65, 69, 75], asi vadzidzi vakashandisa kamwe chete [49].Zvinosuruvarisa, chidzidzo chacho hachina kuongorora kunaka kwekudzidzira kwemuenzaniso kana kutevedzana kwekudzidziswa.Izvi zvinofanirwa kutariswa muchimiro chedzidzo yeanatomy, sezvo mabhenefiti ekudzidza akasanganiswa uye kugadzira pamwe akasimbiswa [89].Kuti utsungirire nekukura kwebasa rekushambadzira, kuzvidzidzira kwakashandiswa kakawanda kuongorora mhando [24, 26, 27, 32, 46, 69, 82].
Imwe ongororo yakagumisa kuti ruvara rwezvinhu zvepurasitiki rwakanga rwakanyanya kupenya[45], imwe ongororo yakagumisa kuti modhi yacho yakanga isina kusimba [71], uye zvimwe zvidzidzo zviviri zvakaratidza kushaikwa kwekusiyana kweanatomical mumagadzirirwo emhando imwe neimwe [25, 45] ]..Zvidzidzo zvinomwe zvakagumisa kuti iyo anatomical tsanangudzo ye3DPAM haina kukwana [28, 34, 45, 48, 62, 63, 81].
Kuti uwane mamwe akadzama emhando dzeatomical ematunhu makuru uye akaomarara, akadai seretroperitoneum kana cervical spine, iyo segmentation uye yekuenzanisira nguva inoonekwa seyakareba kwazvo uye mutengo wakakwira zvakanyanya (inenge US $ 2000) [27, 48].Hojo nevamwe vaaishanda navo vakataura mukudzidza kwavo kuti zvakatora maawa makumi mana kugadzira iyo anatomical modhi yepelvis [42].Nguva yakareba yekuparadzanisa yaive maawa 380 muchidzidzo chakaitwa naWeatherall uye vaaishanda navo, umo mamodheru akawanda akasanganiswa kuti agadzire yakakwana yevana airway modhi [36].Muzvidzidzo zvipfumbamwe, zvikamu uye nguva yekudhinda zvakaonekwa sezvisina kunaka [36, 42, 57, 58, 74].Zvisinei, zvidzidzo zve 12 zvakatsoropodza maitiro emhando yemhando dzavo, kunyanya kufanana kwavo, [28, 62] kusava pachena, [30] fragility uye monochromaticity, [71] kushaya zvinyoro zvinyoro, [66] kana kushaya ruzivo [28, 34]., 45, 48, 62, 63, 81].Izvi zvisingabatsiri zvinogona kukundwa nekuwedzera chikamu kana nguva yekufananidza.Kurasikirwa nekutora ruzivo rwakakosha raive dambudziko rakatarisana nemapoka matatu [30, 74, 77].Maererano nemishumo yevarwere, maodhini akasiyana-siyana haana kupa zvakakwana kuoneka kwevascular nekuda kwekukanganisa kwedhesi [74].Jekiseni remhando yecadaveric rinoratidzika senzira yakanaka inofamba kubva pamusimboti we "zvishoma sezvinobvira" uye miganhu yedosi yeanosiyanisa ajenti inobaiwa.
Nehurombo, zvinyorwa zvakawanda hazvitaure zvimwe zvakakosha zve3DPAM.Isingasviki hafu yezvinyorwa zvakataura zvakajeka kana 3DPAM yavo yaive yakadhindwa.Kuvharidzirwa kwehuwandu hwekudhinda kwakanga kusingaenderani (43% yezvinyorwa), uye chete 34% yakataura kushandiswa kwezvinyorwa zvakawanda.Aya maparamendi ekudhinda akakosha nekuti anopesvedzera zvimiro zvekudzidza zve3DPAM.Zvizhinji zvinyorwa hazvipi ruzivo rwakakwana nezve kuoma kwekuwana 3DPAM (nguva yekugadzira, zvikwaniriso zvevashandi, mutengo wesoftware, mutengo wekudhinda, nezvimwewo).Ruzivo urwu rwakakosha uye runofanira kutariswa musati mafunga kutanga chirongwa chekugadzira 3DPAM itsva.
Ongororo iyi yakarongeka inoratidza kuti kugadzira uye kudhinda kwe3D kwakajairwa anatomical modhi kunokwanisika nemutengo wakaderera, kunyanya kana uchishandisa FDM kana SLA maprinta uye isingadhure imwe-ruvara mapurasitiki zvinhu.Nekudaro, aya madhizaini ekutanga anogona kukwidziridzwa nekuwedzera ruvara kana kuwedzera madhizaini mune zvakasiyana zvinhu.Mamwe mamodheru echokwadi (akadhindwa achishandiswa akawanda emavara akasiyana uye maumbirwo kuti anyatso dzokorora hunhu hwetactile ye cadaver referensi modhi) inoda inodhura 3D tekinoroji yekudhinda uye nguva refu yekugadzira.Izvi zvichawedzera zvakanyanya mutengo wese.Hazvina mhosva kuti ndeipi nzira yekudhinda inosarudzwa, kusarudza nzira yakakodzera yekufungidzira ndiyo yakakosha pakubudirira kwe3DPAM.Iyo yakakwira kugadzirisa kwenzvimbo, iyo modhi inova yechokwadi uye inogona kushandiswa kutsvagurudzo yepamusoro.Kubva pamaonero edzidziso, 3DPAM chishandiso chinoshanda chekudzidzisa anatomy, sezvinoratidzwa nemiedzo yezivo inopihwa vadzidzi uye kugutsikana kwavo.Mhedzisiro yekudzidzisa ye3DPAM ndiyo yakanyanya kunaka kana ichiburitsa matunhu akaomarara eanatomical uye vadzidzi vanoishandisa pakutanga mukudzidziswa kwavo kwekurapa.
Mazita akagadzirwa uye/kana akaongororwa muchidzidzo chazvino haasi kuwanikwa pachena nekuda kwezvipingamupinyi zvemutauro asi anowanikwa kubva kumunyori anowirirana nechikumbiro chine musoro.
Drake RL, Lowry DJ, Pruitt CM.Ongororo yeyakakura anatomy, microanatomy, neurobiology, uye embryology makosi muUS medical school curricula.Anat Rec.2002;269(2):118-22.
Ghosh SK Cadaveric dissection sechishandiso chekudzidzisa cheanatomical sainzi muzana ramakore rechi21: Dissection sechishandiso chekudzidzisa.Ongororo yedzidzo yesainzi.2017;10(3):286–99.
Nguva yekutumira: Kubvumbi-09-2024