Mamodheru emhando nhatu akadhindwa (3DPAMs) anoita seakakodzera nekuda kwekukosha kwawo pakudzidza uye kugona kwawo kuita basa. Chinangwa cheongororo iyi ndechekutsanangura nekuongorora nzira dzinoshandiswa kugadzira 3DPAM yekudzidzisa hunhu hwevanhu uye kuongorora mupiro wayo mukudzidzisa.
Kutsvaga kwemagetsi kwakaitwa muPubMed uchishandisa mazwi anotevera: dzidzo, chikoro, kudzidza, kudzidzisa, kudzidzisa, kudzidzisa, dzidzo, mativi matatu, 3D, mativi matatu, kudhinda, kudhinda, kudhinda, anatomy, anatomy, anatomy, uye anatomy. . Zvakawanikwa zvaisanganisira hunhu hwekudzidza, dhizaini yemuenzaniso, kuongorora chimiro, mashandiro edzidzo, simba uye kushaya simba.
Pakati pezvinyorwa makumi matanhatu nemasere zvakasarudzwa, huwandu hukuru hwezvidzidzo zvakatarisa kunzvimbo yemusoro (zvinyorwa makumi matatu nematatu); zvinyorwa makumi mashanu nerimwe zvinotaura nezvekudhindwa kwemapfupa. Muzvinyorwa makumi mana nemanomwe, 3DPAM yakagadzirwa zvichibva pa computed tomography. Maitiro mashanu ekudhinda akanyorwa. Mapurasitiki nezvinobuda maari zvakashandiswa muzvidzidzo makumi mana nemasere. Dhizaini yega yega inotangira pamadhora zana nemakumi maviri nemashanu kusvika pamadhora zviuru zviviri nemakumi masere ($1.25) kusvika pamadhora zviuru zviviri nemakumi masere ($2,800). Zvidzidzo makumi matatu nemanomwe zvakaenzanisa 3DPAM nemamodheru ekutarisa. Zvinyorwa makumi matatu nematatu zvakaongorora mabasa edzidzo. Mabhenefiti makuru imhando yekuona uye yekubata, kugona kudzidza, kudzokororwa, kugadzirisa uye kugona, kuchengetedza nguva, kubatanidzwa kwemabasa emuviri, kugona kutenderera kwepfungwa kuri nani, kuchengetedza ruzivo uye kugutsikana kwemudzidzisi/mudzidzi. Zvikanganiso zvikuru zvine chekuita nedhizaini: kuenderana, kushaya ruzivo kana kujeka, mavara akajeka zvakanyanya, nguva refu yekudhinda uye mutengo wakakwira.
Ongororo iyi yakarongeka inoratidza kuti 3DPAM inodhura zvishoma uye inoshanda pakudzidzisa maumbirwo emuviri. Mamodheru ane chokwadi anoda kushandiswa kwetekinoroji yekudhinda ye3D inodhura uye nguva yakareba yekugadzira, izvo zvichawedzera zvakanyanya mutengo wezvose. Chinokosha kusarudza nzira yakakodzera yekufungidzira. Kubva pamaonero ekudzidzisa, 3DPAM chishandiso chinoshanda pakudzidzisa maumbirwo emuviri, chine simba rakanaka pamhedzisiro yekudzidza uye kugutsikana. Mhedzisiro yekudzidzisa ye3DPAM inonyanya kunaka kana ichiburitsa nzvimbo dzakaoma dzemaumbirwo emuviri uye vadzidzi vanoishandisa pakutanga kwekudzidziswa kwavo kwekurapa.
Kuchekwa kwezvitunha zvemhuka kwave kuchiitwa kubvira kuGreece yekare uye ndeimwe yenzira huru dzekudzidzisa anatomy. Kuchekwa kwezvitunha kunoitwa panguva yekudzidziswa kunoshandiswa muzvidzidzo zvedzidziso zvevadzidzi vezvokurapa veyunivhesiti uye parizvino kunoonekwa sechiyero chegoridhe chekudzidza anatomy [1,2,3,4,5]. Zvisinei, kune zvipingamupinyi zvakawanda pakushandiswa kwezvitunha zvevanhu, zvichikonzera kutsvaga maturusi matsva ekudzidzisa [6, 7]. Zvimwe zvezvishandiso zvitsva izvi zvinosanganisira augmented reality, maturusi edhijitari, uye 3D printing. Sekureva kweongororo yemabhuku yakaitwa naSantos et al. [8] Panyaya yekukosha kwetekinoroji itsva idzi dzekudzidzisa anatomy, 3D printing inoita seimwe yezvishandiso zvakakosha, zvese maererano nekukosha kwedzidzo kuvadzidzi uye maererano nekukwanisika kwekushandisa [4,9,10].
Kudhinda kwe3D hakusi kutsva. Mapatenti ekutanga ane chekuita netekinoroji iyi anotangira muna 1984: A Le Méhauté, O De Witte naJC André muFrance, uye mavhiki matatu gare gare C Hull muUSA. Kubva ipapo, tekinoroji iyi yakaramba ichichinja uye kushandiswa kwayo kwakawedzera munzvimbo dzakawanda. Semuenzaniso, NASA yakadhinda chinhu chekutanga kunze kwePasi muna 2014 [11]. Nyanzvi dzezvekurapa dzakashandisawo chishandiso ichi chitsva, nokudaro dzichiwedzera chishuwo chekugadzira mushonga wemunhu [12].
Vanyori vazhinji vakaratidza mabhenefiti ekushandisa mamodheru e3D akadhindwa (3DPAM) mudzidzo yezvekurapa [10, 13, 14, 15, 16, 17, 18, 19]. Pakudzidzisa hunhu hwevanhu, mamodheru asiri ezvirwere uye emuviri akajairika anodiwa. Mamwe maongororo akaongorora mamodheru ekudzidzisa pathological kana ekurapa/kuvhiya [8, 20, 21]. Kuti tigadzire modheru yakasanganiswa yekudzidzisa hunhu hwevanhu inosanganisira maturusi matsva akadai se3D printing, takaita ongororo yakarongeka yekutsanangura nekuongorora kuti zvinhu zvakadhindwa zve3D zvinogadzirwa sei kudzidzisa hunhu hwevanhu uye kuti vadzidzi vanoongorora sei kushanda kwekudzidza vachishandisa zvinhu izvi zve3D.
Ongororo iyi yemabhuku yakarongeka yakaitwa muna Chikumi 2022 pasina zvirambidzo zvenguva uchishandisa gwara rePRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [22].
Zvinodiwa zvekubatanidzwa zvaive mapepa ekutsvagisa ese achishandisa 3DPAM mukudzidzisa/kudzidza nezvemuviri. Ongororo dzemabhuku, tsamba, kana zvinyorwa zvinotarisa pamhando dzezvirwere, mhando dzemhuka, mhando dzezvakacherwa mumatongo, uye mhando dzekudzidziswa kwekurapa/kuvhiya hazvina kusarudzwa. Zvinyorwa zvakaburitswa muChirungu chete ndizvo zvakasarudzwa. Zvinyorwa zvisina pfupiso dziripo online hazvina kubudiswa. Zvinyorwa zvaisanganisira mhando dzakawanda, imwe yacho yaive yakajairika mumuviri kana kuti yaive nechirwere chidiki chisingakanganisi kukosha kwekudzidzisa, zvakabatanidzwa.
Kutsvaga mabhuku kwakaitwa mudhatabhesi remagetsi rePubMed (National Library of Medicine, NCBI) kuti vaone zvidzidzo zvakakodzera zvakaburitswa kusvika muna Chikumi 2022. Shandisa mazwi ekutsvaga anotevera: dzidzo, chikoro, kudzidzisa, kudzidzisa, kudzidza, kudzidzisa, dzidzo, mativi matatu, 3D, 3D, kudhinda, kudhinda, kudhinda, anatomy, anatomy, anatomy uye anatomy. Mubvunzo mumwe chete wakaitwa: (((dzidzo[Musoro/Chidimbu] KANA chikoro[Musoro/Chidimbu] KANA kudzidza[Musoro/Chidimbu] KANA kudzidzisa[Musoro/Chidimbu] KANA kudzidziswa[Musoro/Chidimbu] KANA Pamwe chete[Musoro/Chidimbu] ] KANA Dzidzo [Musoro/Chidimbu]) UYE (Zviyero Zvitatu [Musoro] KANA 3D [Musoro] KANA 3D [Musoro])) UYE (Prinda [Musoro] KANA Prinda [Musoro] KANA Prinda [Musoro])) UYE (Anatomy) [Musoro] ]/Chidimbu] kana anatomy [Musoro/Chidimbu] kana anatomy [Musoro/Chidimbu] kana anatomy [Musoro/Chidimbu]). Zvimwe zvinyorwa zvakaonekwa nekutsvaga nemaoko muPubMed database uye kuongorora mareferensi ezvimwe zvinyorwa zvesainzi. Hapana zvirambidzo zvemazuva zvakashandiswa, asi sefa ye "Munhu" yakashandiswa.
Mabhuku ese akatorwa uye zvidimbu zvakaongororwa zvichienderana nezvinodiwa zvekubatanidzwa uye zvekuregererwa nevanyori vaviri (EBR neAL), uye chero chidzidzo chisina kuzadzisa zvinodiwa zvese zvekukodzera chakabviswa. Zvinyorwa zvizere zvezvidzidzo zvasara zvakatorwa uye zvakaongororwa nevanyori vatatu (EBR, EBE neAL). Pazvaidikanwa, kusawirirana pakusarudzwa kwezvinyorwa kwakagadziriswa nemunhu wechina (LT). Zvinyorwa zvakasangana nezvinodiwa zvese zvekubatanidzwa zvakaverengerwa muongororo iyi.
Kuburitswa kwedata kwakaitwa nevanyori vaviri (EBR neAL) vachitungamirirwa nemunyori wechitatu (LT).
- Ruzivo rwekugadzira modhi: nzvimbo dzemuviri, zvikamu zvemuviri zvakananga, modhi yekutanga yekudhinda kwe3D, nzira yekuwana, software yekuparadzanisa uye yekuenzanisa, rudzi rweprinta ye3D, rudzi rwezvinhu nehuwandu, chiyero chekudhinda, ruvara, mutengo wekudhinda.
- Kuongororwa kwechimiro chemuenzaniso: mienzaniso inoshandiswa pakuenzanisa, kuongororwa kwechiremba kwenyanzvi/vadzidzisi, huwandu hwevaongorori, rudzi rwekuongorora.
- Kudzidzisa modhi ye3D: kuongorora ruzivo rwevadzidzi, nzira yekuongorora, huwandu hwevadzidzi, huwandu hwemapoka ekuenzanisa, kusarongeka kwevadzidzi, dzidzo/rudzi rwemudzidzi.
Zvidzidzo 418 zvakawanikwa muMEDLINE, uye zvinyorwa 139 zvakabviswa ne "sefa yevanhu". Mushure mekuongorora misoro nezvidimbu, zvidzidzo 103 zvakasarudzwa kuti zviverengerwe zvizere. Zvinyorwa 34 zvakabviswa nekuti zvaive mienzaniso yezvirwere (zvinyorwa 9), mienzaniso yekudzidziswa kwekurapa/kuvhiya (zvinyorwa 4), mienzaniso yemhuka (zvinyorwa 4), mienzaniso ye3D radiological (chinyorwa 1) kana kuti zvaive zvisiri zvinyorwa zvesainzi zvepakutanga (zvitsauko 16). ). Zvinyorwa zvese 68 zvakaverengerwa muongororo. Mufananidzo 1 unoratidza maitiro ekusarudza sechati yekuyerera.
Chati yekuyerera inopfupikisa kuzivikanwa, kuongororwa, uye kuiswa kwezvinyorwa muongororo iyi yakarongeka
Zvidzidzo zvese zvakaburitswa pakati pa2014 na2022, neavhareji yegore rekuburitswa ra2019. Pakati pezvinyorwa makumi matanhatu nesere zvakabatanidzwa, zvidzidzo makumi matatu nematatu (49%) zvaive zvinotsanangura uye zvekuedza, gumi nenomwe (25%) zvaive zvekuedza chete, uye gumi nemasere (26%) zvaive zvekuedza chete. Zvinotsanangura chete. Pazvidzidzo makumi mashanu (73%) zvekuedza, makumi maviri nerimwe (31%) zvakashandisa randomization. Zvidzidzo makumi matatu nemana chete (50%) zvaisanganisira ongororo dzehuwandu. Tafura 1 inopfupikisa hunhu hwechidzidzo chimwe nechimwe.
Nyaya makumi matatu nematatu (48%) dzakaongorora nzvimbo yemusoro, nyaya gumi nepfumbamwe (28%) dzakaongorora nzvimbo yechipfuva, nyaya gumi nenomwe (25%) dzakaongorora nzvimbo yedumbu, uye nyaya gumi neshanu (22%) dzakaongorora mativi emuviri. Nyaya makumi mashanu nerimwe (75%) dzakataura nezvemapfupa akadhindwa mu3D semamodheru emuviri kana kuti mamodheru emuviri ane zvidimbu zvakawanda.
Nezve mamodheru kana mafaira akashandiswa kugadzira 3DPAM, zvinyorwa makumi maviri nematatu (34%) zvakataura nezvekushandiswa kwedata revarwere, zvinyorwa makumi maviri (29%) zvakataura nezvekushandiswa kwedata remufi, uye zvinyorwa gumi nenomwe (25%) zvakataura nezvekushandiswa kwedatabases. zvakashandiswa, uye zvidzidzo zvinomwe (10%) hazvina kuburitsa pachena kwakabva magwaro akashandiswa.
Zvidzidzo makumi mana nemanomwe (69%) zvakagadzira 3DPAM zvichibva pa computed tomography, uye zvidzidzo zvitatu (4%) zvakashuma kushandiswa kwe microCT. Zvinyorwa zvinomwe (10%) zvakaratidza zvinhu zve3D zvichishandisa optical scanners, zvinyorwa zvina (6%) zvichishandisa MRI, uye chinyorwa chimwe (1%) zvichishandisa makamera nema microscopes. Zvinyorwa gumi nemana (21%) hazvina kutaura kwakabva mafaira e3D model design source. Mafaira e3D akagadzirwa neavhareji yespatial resolution iri pasi pe0.5 mm. Resolution yepamusoro i30 μm [80] uye resolution yepamusoro i1.5 mm [32].
Mapurogiramu makumi matanhatu akasiyana esoftware (kupatsanura, kutevedzera, kugadzira kana kudhinda) akashandiswa. Mimics (Materialise, Leuven, Belgium) ndiyo yainyanya kushandiswa (zvidzidzo gumi nemana, 21%), ichiteverwa neMeshMixer (Autodesk, San Rafael, CA) (zvidzidzo gumi netatu, 19%), Geomagic (3D System, MO, NC, Leesville). (zvidzidzo gumi, 15%), 3D Slicer (Slicer Developer Training, Boston, MA) (zvidzidzo zvipfumbamwe, 13%), Blender (Blender Foundation, Amsterdam, Netherlands) (zvidzidzo zvisere, 12%) uye CURA (Geldemarsen, Netherlands) (zvidzidzo zvinomwe, 10%).
Makumi matanhatu nemanomwe akasiyana eprinta uye maitiro mashanu ekudhinda anotaurwa. Tekinoroji yeFDM (Fused Deposition Modeling) yakashandiswa muzvigadzirwa makumi maviri nematanhatu (38%), kuputira zvinhu muzvigadzirwa gumi nematatu (19%) uye pakupedzisira kuputira binder (zvigadzirwa gumi nerimwe, 16%). Matekinoroji asinganyanyi kushandiswa ndeaya stereolithography (SLA) (zvinyorwa zvishanu, 7%) uye selective laser sintering (SLS) (zvinyorwa zvina, 6%). Printer inonyanya kushandiswa (zvinyorwa zvinomwe, 10%) iConnex 500 (Stratasys, Rehovot, Israel) [27, 30, 32, 36, 45, 62, 65].
Pakutsanangura zvinhu zvakashandiswa kugadzira 3DPAM (zvinhu 51, 75%), zvidzidzo 48 (71%) zvakashandisa mapurasitiki nezvimwe zvinobva mazviri. Zvinhu zvikuru zvakashandiswa zvaive PLA (polylactic acid) (n = 20, 29%), resin (n = 9, 13%) uye ABS (acrylonitrile butadiene styrene) (mhando 7, 10%). Zvinhu 23 (34%) zvakaongorora 3DPAM yakagadzirwa nezvinhu zvakasiyana-siyana, zvinhu 36 (53%) zvakaratidza 3DPAM yakagadzirwa nezvinhu chimwe chete, uye zvinhu 9 (13%) hazvina kutaura chinhu.
Zvinyorwa makumi maviri nemapfumbamwe (43%) zvakashuma huwandu hwezvinyorwa zvinodhindwa kubva pa0.25:1 kusvika 2:1, neavhareji ye1:1. Zvinyorwa makumi maviri nemashanu (37%) zvakashandisa chiyero che1:1. Ma3DPAM makumi maviri nemasere (41%) aive nemavara akasiyana-siyana, uye mapfumbamwe (13%) akadhayiwa mushure mekudhinda [43, 46, 49, 54, 58, 59, 65, 69, 75].
Zvinhu makumi matatu nemana (50%) zvakataura nezvemitengo. Zvinhu zvipfumbamwe (13%) zvakataura nezvemutengo wemaprinta e3D nezvinhu zvakagadziriswa. Mutengo wemaprinta unobva pamadhora mazana matatu nemakumi maviri nemaviri kusvika pamadhora zviuru makumi matanhatu nemashanu. Kana zvataurwa, mitengo yemamodeli inotangira pamadhora zana nemakumi maviri nemashanu kusvika pamadhora mazana maviri nemakumi masere nemazana masere (1.25) kusvika pamadhora zviuru zviviri nemakumi masere (2,800); izvi zvakanyanyisa zvinoenderana neskeletal sampuli [47] uye high-fidelity retroperitoneal models [48]. Tafura 2 inopfupikisa data remuenzaniso wekudzidza kwega kwega kwakabatanidzwa.
Zvidzidzo makumi matatu nenomwe (54%) zvakaenzanisa 3DAPM nemuenzaniso wekutarisa. Pakati pezvidzidzo izvi, muenzanisiro wakajairika waiva muenzaniso wekutarisa anatomical, wakashandiswa muzvinyorwa gumi nemana (38%), kugadzirira kwakaiswa purasitiki muzvinyorwa zvitanhatu (16%), kugadzirira kwakaiswa purasitiki muzvinyorwa zvitanhatu (16%). Kushandiswa kwe virtual reality, computed tomography imaging imwe 3DPAM muzvinyorwa zvishanu (14%), imwe 3DPAM muzvinyorwa zvitatu (8%), mitambo yakakomba muchinyorwa chimwe (3%), radiographs muchinyorwa chimwe (3%), mabhizinesi emhando muchinyorwa chimwe (3%) uye augmented reality muchinyorwa chimwe (3%). Zvidzidzo makumi matatu nemana (50%) zvakaongorora 3DPAM. Zvidzidzo gumi neshanu (48%) zvakatsanangura ruzivo rwevaongorori zvakadzama (Tafura 3). 3DPAM yakaitwa nevarapi kana vanachiremba vaipinda muzvidzidzo zvinomwe (47%), nyanzvi dzemuviri muzvidzidzo zvitanhatu (40%), vadzidzi muzvidzidzo zvitatu (20%), vadzidzisi (chidzidzo hachina kutaurwa) muzvidzidzo zvitatu (20%) zvekuongorora uye mumwe muongorori muchinyorwa (7%). Avhareji yehuwandu hwevaongorori i14 (vashoma 2, vasingasviki 30). Zvidzidzo makumi matatu nenhatu (49%) zvakaongorora chimiro che3DPAM maererano nehunhu, uye zvidzidzo gumi (15%) zvakaongorora chimiro che3DPAM zvichienderana nehuwandu. Pazvidzidzo makumi matatu nenhatu zvakashandisa ongororo dzehunhu, gumi nenhanhatu dzakashandisa ongororo dzinotsanangura chete (48%), zvipfumbamwe zvakashandisa bvunzo/ratings/ongororo (27%), uye zvisere zvakashandisa Likert scales (24%). Tafura 3 inopfupikisa ongororo dzehunhu dzemamodheru muongororo yega yega yakabatanidzwa.
Nyaya makumi matatu nenhatu (48%) dzakaongorora nekuenzanisa kushanda kwekudzidzisa vadzidzi 3DPAM. Pazvidzidzo izvi, nyaya makumi maviri nenhatu (70%) dzakaongorora kugutsikana kwevadzidzi, gumi nembiri (51%) dzakashandisa zviyero zveLikert, uye 6 (18%) dzakashandisa dzimwe nzira. Nyaya makumi maviri nembiri (67%) dzakaongorora kudzidza kwevadzidzi kuburikidza nekuyedzwa kweruzivo, apo gumi (30%) dzakashandisa bvunzo dzepamberi uye/kana bvunzo dzepashure. Zvidzidzo gumi nerimwe (33%) zvakashandisa mibvunzo yekusarudza mhinduro yakawanda uye bvunzo kuti zviongorore ruzivo rwevadzidzi, uye zvidzidzo zvishanu (15%) zvakashandisa kunyora mifananidzo/kuzivikanwa kwemuviri. Avhareji yevadzidzi makumi manomwe nevatanhatu vakapinda muchidzidzo chega chega (zvishoma 8, zvisingasviki 319). Zvidzidzo makumi maviri nemana (72%) zvaive neboka rekudzora, izvo makumi maviri (60%) zvakashandisa randomization. Kusiyana neizvi, chidzidzo chimwe (3%) chakapa mamodheru emuviri kuvadzidzi gumi vakasiyana. Paavhareji, mapoka maviri nehafu akaenzaniswa (zvishoma 2, zvisingasviki 10). Zvidzidzo makumi maviri nezvitatu (70%) zvaisanganisira vadzidzi vekurapa, izvo gumi nemana (42%) zvaive vadzidzi vekurapa vegore rekutanga. Zvidzidzo zvitanhatu (18%) zvaisanganisira vagari vemo, vana (12%) vadzidzi vemazino, uye vatatu (9%) vadzidzi vesainzi. Zvidzidzo zvitanhatu (18%) zvakashandisa uye zvakaongorora kudzidza kwega uchishandisa 3DPAM. Tafura 4 inopfupikisa mhedzisiro ye3DPAM yekuongorora kushanda zvakanaka kwekudzidzisa kwega kwega kwakabatanidzwa.
Zvakanakira zvikuru zvakataurwa nevanyori pakushandisa 3DPAM sechishandiso chekudzidzisa maitiro evanhu akajairwa maitiro avo ekuona uye ekubata, kusanganisira realism [55, 67], kururama [44, 50, 72, 85], uye kusiyana kwemaonero [34, 45]. , 48, 64], ruvara uye kujeka [28, 45], kugara kwenguva refu [24, 56, 73], mhedzisiro yedzidzo [16, 32, 35, 39, 52, 57, 63, 69, 79], mutengo [27, 41, 44, 45, 48, 51, 60, 64, 80, 81, 83], kugona kudzokororwa [80], mukana wekuvandudza kana kugadzirisa munhu [28, 30, 36, 45, 48, 51, 53, 59, 61, 67, 80], kugona kushandisa vadzidzi [30, 49], kuchengetedza nguva yekudzidzisa [61, 80], nyore kuchengetedza [61], kugona kubatanidza mashandiro emuviri kana kugadzira maumbirwo chaiwo [51, 53], 67], nekukurumidza kugadzira mapfupa mamodheru [81], kugona kugadzira mamodheru pamwe chete nekuenda nawo kumba [49, 60, 71], kuvandudza kugona kwekuchinjana pfungwa [23] uye kuchengetedza ruzivo [32], pamwe nemudzidzisi [25, 63] uye kugutsikana kwevadzidzi [25, 45, 46, 52, 52, 57, 63, 66, 69, 84].
Zvikanganiso zvikuru zvine chekuita nekugadzirwa: kuomarara [80], kugara kwenguva refu [28, 62], kushaya ruzivo rwakadzama kana kujeka [28, 30, 34, 45, 48, 62, 64, 81], mavara akajeka zvakanyanya [45]. uye kusasimba kwepasi [71]. Zvimwe zvikanganiso zvinosanganisira kurasikirwa neruzivo [30, 76], nguva yakareba inodiwa pakupatsanura mifananidzo [36, 52, 57, 58, 74], nguva yekudhinda [57, 63, 66, 67], kushaya kusiyana kwemaumbirwo [25], uye mutengo . Yakakwira [48].
Ongororo iyi yakarongeka inopfupisa zvinyorwa makumi matanhatu nemasere zvakaburitswa kwemakore mapfumbamwe uye inoratidza kufarira kwevesainzi mu3DPAM sechishandiso chekudzidzisa hunhu hwevanhu hwakajairwa. Dunhu rega rega rehunhu rakadzidzwa uye rakadhindwa mu3D. Pazvinyorwa izvi, zvinyorwa makumi matatu nenomwe zvakaenzanisa 3DPAM nedzimwe modhi, uye zvinyorwa makumi matatu netatu zvakaongorora kukosha kwe3DPAM pakudzidzisa vadzidzi.
Tichifunga nezvekusiyana kwekugadzirwa kwezvidzidzo zvekudhinda zve3D, hatina kuona zvakakodzera kuita meta-analysis. Meta-analysis yakaburitswa muna 2020 yainyanya kutarisa pamiedzo yeruzivo rweanatomy mushure mekudzidziswa pasina kuongorora hunyanzvi uye tekinoroji yekugadzirwa nekugadzirwa kwe3DPAM [10].
Nzvimbo yemusoro ndiyo inonyanya kudzidzwa, pamwe nekuti kuoma kwemuviri wayo kunoita kuti zviomere vadzidzi kuratidza nzvimbo iyi yemuviri munzvimbo ine mativi matatu zvichienzaniswa nemakumbo kana torso. CT ndiyo nzira inonyanya kushandiswa yekufungidzira mifananidzo. Iyi nzira inoshandiswa zvakanyanya, kunyanya munzvimbo dzekurapa, asi ine resolution shoma yenzvimbo uye low soft tissue contrast. Izvi zvinoita kuti CT scans isakodzere kupatsanurwa uye kuumbwa kwetsinga dzetsinga. Kune rumwe rutivi, computed tomography yakakodzera zvirinani kupatsanurwa/kuumbwa kwemapfupa; mapfupa/soft tissue contrast inobatsira kupedzisa matanho aya pamberi pe3D printing anatomical models. Kune rumwe rutivi, microCT inoonekwa se tekinoroji yekutarisa maererano nereference resolution mubone imaging [70]. Optical scanners kana MRI inogonawo kushandiswa kuwana mifananidzo. Resolution yepamusoro inodzivirira kutsvedzerera kwemapfupa uye inochengetedza hunyoro hwemaumbirwo emuviri [59]. Sarudzo yemuenzaniso inokanganisawo resolution yenzvimbo: semuenzaniso, mamodheru epurasitiki ane resolution yakaderera [45]. Vagadziri vemifananidzo vanofanirwa kugadzira mamodheru e3D akasarudzika, izvo zvinowedzera mitengo ($25 kusvika $150 paawa) [43]. Kuwana mafaira emhando yepamusoro e.STL hakuna kukwana kugadzira mamodheru emhando yepamusoro emuviri. Zvakakosha kuona maparamita ekudhinda, akadai sekutarisa kwemodheru yemuviri paplate yekudhinda [29]. Vamwe vanyori vanoti matekinoroji epamusoro ekudhinda akadai seSLS anofanira kushandiswa pese pazvinogoneka kuvandudza kururama kwe3DPAM [38]. Kugadzirwa kwe3DPAM kunoda rubatsiro rwehunyanzvi; nyanzvi dzinonyanya kutsvagwa ndidzo mainjiniya [72], ma radiologist, [75], vagadziri vemifananidzo [43] uye ma anatomists [25, 28, 51, 57, 76, 77].
Kupatsanura uye kugadzira mapurogiramu ekugadzira mapurogiramu zvinhu zvakakosha pakuwana mamodheru akarurama emuviri, asi mutengo wemapurogiramu aya uye kuoma kwawo kunodzivisa kushandiswa kwawo. Zvidzidzo zvakati wandei zvakaenzanisa kushandiswa kwemapurogiramu akasiyana ekugadzira mapurogiramu uye matekinoroji ekudhinda, zvichiratidza zvakanakira nekuipira kwetekinoroji yega yega [68]. Kuwedzera kune software yekugadzira mapurogiramu, software yekudhinda inoenderana neprinta yakasarudzwa inodiwawo; vamwe vanyori vanosarudza kushandisa online 3D printing [75]. Kana zvinhu zve3D zvakakwana zvikadhindwa, mari inodyarwa inogona kutungamira mukuwana mari [72].
Plastiki ndiyo inonyanya kushandiswa. Mhando dzakasiyana-siyana dzemagadzirirwo ayo nemavara zvinoita kuti ive chinhu chinosarudzwa pa3DPAM. Vamwe vanyori vakarumbidza simba rayo guru zvichienzaniswa nemidziyo yechinyakare yekufa kana plastinated [24, 56, 73]. Mamwe mapurasitiki ane hunhu hwekukotama kana kutambanudza. Semuenzaniso, Filaflex ine tekinoroji yeFDM inogona kutambanuka kusvika 700%. Vamwe vanyori vanoona sechinhu chinosarudzwa pakugadzira tsandanyama, tendon uye ligament [63]. Kune rumwe rutivi, zvidzidzo zviviri zvakamutsa mibvunzo nezve fiber orientation panguva yekudhinda. Kutaura zvazviri, tsandanyama orientation, insertion, innervation, uye mashandiro azvo zvakakosha mukugadzira tsandanyama [33].
Zvinoshamisa kuti zvidzidzo zvishoma zvinotaura nezvehukuru hwekudhinda. Sezvo vanhu vazhinji vachiona chiyero che1:1 sechinowanzo shandiswa, munyori angangodaro akasarudza kusataura nezvazvo. Kunyangwe kuwedzera kwaizobatsira pakudzidza kwakanangana mumapoka makuru, kugona kwekuwedzera hakusati kwaongororwa, kunyanya nekukura kwehukuru hwekirasi uye saizi yemuviri yemuenzaniso iri chinhu chakakosha. Ehe, zviyero zvehukuru hwakazara zvinoita kuti zvive nyore kuwana nekutaurirana zvinhu zvakasiyana-siyana zvemuviri kumurwere, izvo zvinogona kutsanangura kuti nei zvichiwanzo shandiswa.
Pamaprinta akawanda aripo pamusika, ayo anoshandisa tekinoroji yePolyJet (yezvinhu kana yebinder inkjet) kupa mavara uye multi-layer (uye nekudaro multi-texture) kudhinda kwepamusoro kunodhura pakati peUS$20,000 neUS$250,000 (https: //www.aniwaa.com/). Mutengo uyu wepamusoro unogona kuderedza kusimudzirwa kwe3DPAM muzvikoro zvekurapa. Pamusoro pemutengo weprinta, mutengo wezvinhu zvinodiwa pakudhinda inkjet wakakwira kupfuura weSLA kana FDM printers [68]. Mitengo yemaprinta eSLA kana FDM inokwanisikawo, kubva pa€576 kusvika €4,999 muzvinyorwa zvakanyorwa muongororo iyi. Sekureva kwaTripodi nevamwe vake, chikamu chimwe nechimwe chemapfupa chinogona kudhindwa neUS$1.25 [47]. Zvidzidzo gumi nerimwe zvakagumisa kuti kudhinda kwe3D kwakachipa pane plasticization kana mamodheru ekutengesa [24, 27, 41, 44, 45, 48, 51, 60, 63, 80, 81, 83]. Uyezve, mamodheru aya ekutengeserana akagadzirirwa kupa ruzivo rwevarwere vasina ruzivo rwakakwana rwekudzidzisa nezvemuviri [80]. Mamodheru aya ekutengeserana anoonekwa seakaderera pane 3DPAM [44]. Zvakakosha kuziva kuti, pamusoro pehunyanzvi hwekudhinda hunoshandiswa, mutengo wekupedzisira unoenderana nechiyero uye nekudaro saizi yekupedzisira ye3DPAM [48]. Nezvikonzero izvi, chiyero chakazara ndicho chinosarudzwa [37].
Chidzidzo chimwe chete chakaenzanisa 3DPAM nemamodheru emuviri anowanikwa mumusika [72]. Samples dzemutumbi ndiwo anonyanya kushandiswa kufananidza 3DPAM. Pasinei nemiganhu yavo, mamodheru emutumbi anoramba ari chishandiso chakakosha chekudzidzisa anatomy. Musiyano unofanira kuitwa pakati pekuongorora muviri, kupatsanurwa kwemapfupa nemapfupa akaoma. Zvichibva pamiedzo yekudzidzira, zvidzidzo zviviri zvakaratidza kuti 3DPAM yaishanda zvakanyanya pane kupatsanurwa kwemapfupa neplastinated [16, 27]. Chidzidzo chimwe chakaenzanisa awa imwe yekudzidziswa uchishandisa 3DPAM (chikamu chezasi) neawa imwe yekupatsanurwa kwenzvimbo imwe chete yemuviri [78]. Pakanga pasina mutsauko wakakosha pakati penzira mbiri dzekudzidzisa. Zvingangodaro kuti hapana tsvakurudzo yakawanda panyaya iyi nekuti kuenzanisa kwakadaro kwakaoma kuita. Kupatsanurwa kwemapfupa kugadzirira kunotora nguva yakawanda kuvadzidzi. Dzimwe nguva maawa akawanda ekugadzirira anodiwa, zvichienderana nezviri kugadzirirwa. Kuenzanisa kwechitatu kunogona kuitwa nemapfupa akaoma. Chidzidzo chakaitwa naTsai naSmith chakawana kuti mamakisi ebvunzo aive nani zvikuru muboka richishandisa 3DPAM [51, 63]. Chen nevamwe vake vakataura kuti vadzidzi vanoshandisa mamodheru e3D vakaita zvirinani pakuziva maumbirwo (madehenya), asi pakanga pasina musiyano mumamakisi eMCQ [69]. Pakupedzisira, Tanner nevamwe vake vakaratidza mhedzisiro iri nani mushure mebvunzo muboka iri vachishandisa 3DPAM yepterygopalatine fossa [46]. Zvimwe zvishandiso zvitsva zvekudzidzisa zvakaonekwa muongororo iyi yemabhuku. Zvinonyanya kuzivikanwa pakati pazvo ichokwadi chakawedzeredzwa, chokwadi chechokwadi uye mitambo yakakomba [43]. Sekureva kwaMahrous nevamwe vake, kusarudzwa kwemamodheru emuviri kunoenderana nehuwandu hwemaawa ayo vadzidzi vanotamba mitambo yemavhidhiyo [31]. Kune rumwe rutivi, dambudziko guru rezvishandiso zvitsva zvekudzidzisa muviri imhinduro yehaptic, kunyanya kune zvishandiso zvepamhepo chete [48].
Zvidzidzo zvakawanda zvakaongorora 3DPAM itsva zvakashandisa bvunzo dzekutanga dzeruzivo. Idzi bvunzo dzekutanga dzinobatsira kudzivirira rusaruro muongororo. Vamwe vanyori, vasati vaita zvidzidzo zvekuedza, vanobvisa vadzidzi vese vakawana mapoinzi ari pamusoro peavhareji pabvunzo yekutanga [40]. Pakati perusaruro rwataurwa naGaras nevamwe vake paive neruvara rwemuenzaniso uye kusarudzwa kwevanozvipira mukirasi yevadzidzi [61]. Kupenda kunoita kuti zvionekwe maumbirwo emuviri. Chen nevamwe vake vakasimbisa mamiriro ekuyedza akaomarara pasina mutsauko wekutanga pakati pemapoka uye chidzidzo chacho chakapofumadzwa kusvika pamwero wakanyanya [69]. Lim nevamwe vake vanokurudzira kuti bvunzo yepashure pebvunzo ipedzwe nemumwe munhu wechitatu kudzivirira rusaruro muongororo [16]. Zvimwe zvidzidzo zvakashandisa zviyero zveLikert kuti zviongorore kugona kwe3DPAM. Chishandiso ichi chakakodzera kuongorora kugutsikana, asi kuchine rusaruro rwakakosha rwekuziva nezvarwo [86].
Kukosha kwe3DPAM mudzidzo kwakanyanya kuongororwa pakati pevadzidzi vezvekurapa, kusanganisira vadzidzi vezvekurapa vegore rekutanga, muzvidzidzo gumi nemana kubva pa33. Mukudzidza kwavo kwekuyedza, Wilk nevamwe vake vakataura kuti vadzidzi vezvekurapa vaidavira kuti kudhinda kwe3D kunofanira kubatanidzwa mukudzidza kwavo kwemuviri [87]. 87% yevadzidzi vakabvunzurudzwa muchidzidzo cheCercenelli vaidavira kuti gore rechipiri rekudzidza ndiro raive nguva yakanakisa yekushandisa 3DPAM [84]. Zvakabuda kuna Tanner nevamwe vake zvakaratidzawo kuti vadzidzi vaiita zviri nani dai vasina kumbodzidza nezvemunda uyu [46]. Data iri rinoratidza kuti gore rekutanga rechikoro chezvekurapa ndiro nguva yakanakisa yekubatanidza 3DPAM mukudzidzisa kwemuviri. Meta-analysis yaYe yakatsigira pfungwa iyi [18]. Muzvinyorwa makumi maviri nenomwe zvakabatanidzwa muchidzidzo ichi, paive nemusiyano wakakura mumapoinzi ebvunzo pakati pe3DPAM nemamodheru echinyakare evadzidzi vezvekurapa, asi kwete kune vagari vemo.
3DPAM sechishandiso chekudzidza chinovandudza kubudirira kwedzidzo [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]. Mapoka enyanzvi akawanawo mamodheru aya achibatsira [37, 42, 49, 81, 82], uye zvidzidzo zviviri zvakawana kugutsikana kwevadzidzisi ne3DPAM [25, 63]. Pazvinhu zvese, Backhouse nevamwe vake vanoona kudhinda kwe3D senzira yakanakisa yekusarudza mamodheru echinyakare emuviri [49]. Mukuongorora kwavo kwekutanga, Ye nevamwe vake vakasimbisa kuti vadzidzi vakagamuchira mirairo ye3DPAM vaiva nemapoinzi ari nani mushure mebvunzo pane vadzidzi vakagamuchira mirairo ye2D kana yechitunha [10]. Zvisinei, vakasiyanisa 3DPAM kwete nekuomarara, asi nemoyo, tsinga, uye dumbu. Muzvidzidzo zvinomwe, 3DPAM haina kuita zvakanaka kupfuura mamwe mamodheru zvichibva pamiedzo yeruzivo yakapihwa vadzidzi [32, 66, 69, 77, 78, 84]. Mukuongorora kwavo, Salazar nevamwe vake vakagumisa kuti kushandiswa kwe3DPAM kunovandudza kunzwisisa kwemaodheru akaomarara [17]. Pfungwa iyi inoenderana netsamba yaHitas kumupepeti [88]. Dzimwe nzvimbo dzemaodheru dzinoonekwa sedzisina kuomarara hadzidi kushandiswa kwe3DPAM, nepo nzvimbo dzakaomarara dzemaodheru (dzakadai semutsipa kana sisitimu yetsinga) dzaizova sarudzo ine musoro ye3DPAM. Pfungwa iyi inogona kutsanangura kuti nei mamwe ma3DPAM asingaonekwe seakakwirira kupfuura mamodheru echinyakare, kunyanya kana vadzidzi vasina ruzivo munharaunda iyo mashandiro emodheru anowanikwa ari nani. Saka, kupa modheru yakapusa kuvadzidzi vane ruzivo rwakati rwechidzidzo ichi (vadzidzi vekurapa kana vagari vemo) hazvibatsire mukuvandudza mashandiro evadzidzi.
Pamabhenefiti ese edzidzo akanyorwa, zvidzidzo gumi nerimwe zvakasimbisa hunhu hwekuona kana kubata hwemamodheru [27,34,44,45,48,50,55,63,67,72,85], uye zvidzidzo zvitatu zvakavandudza simba nekugara kwenguva refu (33, 50 -52, 63, 79, 85, 86). Zvimwe zvakanakira ndezvekuti vadzidzi vanogona kugadzirisa maumbirwo, vadzidzisi vanogona kuchengetedza nguva, zviri nyore kuchengetedza kupfuura zvitunha, chirongwa ichi chinogona kupedzwa mukati memaawa makumi maviri nemana, chinogona kushandiswa sechishandiso chekudzidzisa kumba, uye chinogona kushandiswa kudzidzisa ruzivo rwakawanda. mapoka [30, 49, 60, 61, 80, 81]. Kudhindwa kwe3D kwakadzokororwa kwekudzidzisa anatomy kwakawanda kunoita kuti mamodheru ekudhinda e3D ave nemutengo wakaderera [26]. Kushandiswa kwe3DPAM kunogona kuvandudza kugona kwekutenderera kwepfungwa [23] uye kuvandudza kududzirwa kwemifananidzo yepakati [23, 32]. Zvidzidzo zviviri zvakawana kuti vadzidzi vakasangana ne3DPAM vaiva nemukana wekuvhiyiwa [40, 74]. Zvisungo zvesimbi zvinogona kuiswa kuti zvigadzire kufamba kunodiwa kuti vadzidze nezve functional anatomy [51, 53], kana kuti mamodheru anogona kudhindwa achishandisa ma trigger designs [67].
Kudhinda kwe3D kunobvumira kugadzirwa kwemamodheru anogadziriswa emuviri nekuvandudza zvimwe zvinhu panguva yekuenzanisira, [48, 80] kugadzira hwaro hwakakodzera, [59] kusanganisa mamodheru akawanda, [36] vachishandisa kujeka, (49) ruvara, [45] kana kuita kuti zvimwe zvimiro zvemukati zvionekwe [30]. Tripodi nevamwe vake vakashandisa ivhu rekuveza kuti vawedzere mamodheru avo emapfupa akadhindwa mu3D, vachisimbisa kukosha kwemamodheru akagadzirwa pamwe chete sezvishandiso zvekudzidzisa [47]. Muzvidzidzo zvipfumbamwe, ruvara rwakashandiswa mushure mekudhinda [43, 46, 49, 54, 58, 59, 65, 69, 75], asi vadzidzi vakarishandisa kamwe chete [49]. Zvinosuwisa kuti chidzidzo ichi hachina kuongorora mhando yekudzidziswa kwemamodheru kana kutevedzana kwekudzidziswa. Izvi zvinofanirwa kufungwa nezvazvo mukudzidza kwemamodheru, sezvo mabhenefiti ekudzidza kwakasanganiswa uye kugadzira pamwe chete akasimbiswa zvakanaka [89]. Kuti vakwanise kugadzirisa kukura kwebasa rekushambadzira, kudzidza wega kwave kuchishandiswa kakawanda kuongorora mamodheru [24, 26, 27, 32, 46, 69, 82].
Imwe ongororo yakagumisa kuti ruvara rwepurasitiki rwaive rwakanyanya kupenya[45], imwe ongororo yakagumisa kuti modhi yacho yaive isina kusimba[71], uye dzimwe ongororo mbiri dzakaratidza kushomeka kwekusiyana kwemaumbirwo emamodheru ega ega[25, 45]. . Zvidzidzo zvinomwe zvakagumisa kuti hunhu hwemaumbirwo e3DPAM hahuna kukwana [28, 34, 45, 48, 62, 63, 81].
Kuti uwane mamwe mamodheru ezvikamu zvakakura uye zvakaoma, zvakaita seretroperitoneum kana cervical spine, nguva yekupatsanura nekutevedzera inoonekwa seyakareba kwazvo uye mutengo wacho wakakwira zvikuru (inenge US$2000) [27, 48]. Hojo nevamwe vake vakataura muchidzidzo chavo kuti zvakatora maawa makumi mana kugadzira modheru yezvikamu zvechiuno [42]. Nguva yakareba yekupatsanura yaive maawa mazana matatu nemakumi masere muchidzidzo chakaitwa naWeatherall nevamwe vake, umo mamodheru akawanda akabatanidzwa kugadzira modheru yakazara yekufema kwevana [36]. Muzvidzidzo zvipfumbamwe, nguva yekupatsanura nekudhinda yakaonekwa seyakaipa [36, 42, 57, 58, 74]. Zvisinei, zvidzidzo gumi nembiri zvakatsoropodza hunhu hwemuviri hwemamodheru avo, kunyanya kugadzikana kwavo, [28, 62] kushaya kujeka, [30] kushata uye monochromaticity, [71] kushaya nyama yakapfava, [66] kana kushaya ruzivo [28, 34]. , 45, 48, 62, 63, 81]. Zvakaipa izvi zvinogona kugadziriswa nekuwedzera nguva yekuparadzanisa kana yekuenzanisa. Kurasikirwa nekuwana ruzivo rwakakosha kwaive dambudziko rakatarisana nemapoka matatu [30, 74, 77]. Sekureva kwevarwere, mishonga yekuenzanisa ine iodine haina kupa kuoneka kwakanaka kwetsinga dzeropa nekuda kwemiganhu yemushonga [74]. Kubaiwa jekiseni remuenzaniso wechitunha kunoita senzira yakanaka inosiya musimboti wekuti "zvishoma sezvinobvira" uye miganho yemushonga wekuenzanisa unoiswa.
Zvinosuwisa kuti zvinyorwa zvakawanda hazvitauri zvimwe zvinhu zvakakosha zve3DPAM. Zvishoma pane hafu yezvinyorwa zvakataura pachena kana 3DPAM yavo yakanga yakafukidzwa nemavara. Kufukidzwa kwehuwandu hwezvinyorwa zvainge zvisingawirirane (43% yezvinyorwa), uye 34% chete vakataura nezvekushandiswa kwemidziyo yakawanda. Aya ma parameter ekudhinda akakosha nekuti anokanganisa hunhu hwekudzidza hwe3DPAM. Zvinyorwa zvakawanda hazvipe ruzivo rwakakwana nezvematambudziko ekuwana 3DPAM (nguva yekugadzira, zvitupa zvevashandi, mari yesoftware, mari yekudhinda, nezvimwewo). Ruzivo urwu rwakakosha uye runofanira kufungwa nezvarwo tisati tafunga nezvekutanga chirongwa chekugadzira 3DPAM itsva.
Ongororo iyi yakarongeka inoratidza kuti kugadzira uye kudhinda 3D mamodheru akajairwa eanatomical kunogoneka pamutengo wakaderera, kunyanya kana uchishandisa maprinta eFDM kana SLA uye zvinhu zvepurasitiki zvisingadhuri zvine ruvara rumwe chete. Zvisinei, magadzirirwo aya ekutanga anogona kuvandudzwa nekuwedzera ruvara kana kuwedzera magadzirirwo muzvinhu zvakasiyana. Mamodheru chaiwo (akadhindwa achishandisa zvinhu zvakawanda zvemavara akasiyana uye magadzirirwo kuti anyatsotevedzera hunhu hwekubata hwemutumbi) anoda matekinoroji ekudhinda e3D anodhura uye nguva yakareba yekugadzira. Izvi zvichawedzera zvakanyanya mutengo wese. Pasinei nekuti ndeipi nzira yekudhinda inosarudzwa, kusarudza nzira yakakodzera yekufungidzira ndiyo kiyi yekubudirira kwe3DPAM. Kana resolution yenzvimbo yakakwira, modheru yacho inova chaiyo uye inogona kushandiswa pakutsvagisa kwepamusoro. Kubva pamaonero ekudzidzisa, 3DPAM chishandiso chinoshanda chekudzidzisa anatomical, sezvinoratidzwa nemiedzo yeruzivo inopihwa vadzidzi uye kugutsikana kwavo. Mhedzisiro yekudzidzisa ye3DPAM inonyanya kunaka kana ichiburitsa nzvimbo dzakaoma dzeanatomical uye vadzidzi vanoishandisa pakutanga kwekudzidziswa kwavo kwekurapa.
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Nguva yekutumira: Kubvumbi-09-2024