Traditional cadaver dissection iri kuderera, nepo plastination uye 3D yakadhindwa (3DP) modhi dziri kuwana mukurumbira seimwe nzira yetsika dzekudzidzisa anatomy.Hazvisi pachena kuti kusimba uye kusasimba kwezvishandiso zvitsva izvi ndezvipi uye kuti zvingakanganisa sei ruzivo rwevanatomy yevadzidzi, izvo zvinosanganisira hunhu hwevanhu sekuremekedza, hanya, uye tsitsi.
Pakarepo mushure mekudzidza kwakasarudzika, vadzidzi ve96 vakakokwa.Dhizaini yepragmatic yakashandiswa kuongorora zviitiko zvekudzidza uchishandisa anatomically plasticized uye 3D mhando dzemoyo (Danho 1, n = 63) uye mutsipa (Danho 2, n = 33).An inductive thematic analysis yakaitwa yakavakirwa pa278 free text wongororo (zvichireva kusimba, kusasimba, nzvimbo dzekuvandudza) uye verbatim zvinyorwa zvemapoka anotarisisa (n = 8) nezvekudzidza anatomi uchishandisa aya maturusi.
Madingindira mana akaonekwa: chokwadi chinonzwisiswa, kunzwisisa kwakakosha uye kuomarara, maitiro ekuremekedza nekutarisira, kuwanda, uye hutungamiriri.
Kazhinji, vadzidzi vaifunga kuti zvienzaniso zvakanamirwa zvaive zvechokwadi uye saka vainzwa kuremekedzwa uye kutarisirwa zvakanyanya kupfuura mhando dze3DP, dzaive nyore kushandisa uye dzakakodzera zvirinani pakudzidza basic anatomy.
Kuongorora kwemunhu kwave kuri nzira yekudzidzisa yakajairwa yakashandiswa mune zvekurapa kubva muzana ramakore rechi17 [1, 2].Nekudaro, nekuda kwekuwana kushoma, kudhura kwakanyanya kwekuchengetedza cadaver [3, 4], kuderera kukuru munguva yekudzidziswa kweanatomy [1, 5], uye kufambira mberi kwetekinoroji [3, 6], zvidzidzo zveanatomy zvinodzidziswa uchishandisa nzira dzechinyakare dissection dziri kuderera. .Izvi zvinovhura mikana mitsva yekutsvaga nzira itsva dzekudzidzisa uye maturusi, akadai seakaitwa mapuranga emhando dzevanhu uye 3D yakadhindwa (3DP) modhi [6,7,8].
Imwe neimwe yezvishandiso izvi ine zvayakanakira nezvayakaipira.Mienzaniso yakapfekwa yakaoma, hainhuhwi, ichokwadi uye haina ngozi [9,10,11], zvichiita kuti ive yakakodzera pakudzidzisa nekuita vadzidzi mukudzidza nekunzwisisa kweanatomi.Zvisinei, dzakaomesesa uye hadzina kuchinjika [10, 12], saka dzinofungidzirwa kuti dzakanyanya kuoma kubata uye kusvika kune dzakadzika zvimiro [9].Panyaya yemutengo, masampuli epurasitiki anowanzo kudhura kutenga nekuchengetedza kupfuura 3DP modhi [6,7,8].Kune rumwe rutivi, 3DP modhi inobvumira maumbirwo akasiyana [7, 13] uye mavara [6, 14] uye anogona kugoverwa kune chaiwo zvikamu, izvo zvinobatsira vadzidzi kuti vaone zviri nyore, kusiyanisa uye kuyeuka zvakakosha zvimiro, kunyangwe izvi zvichiita sezvisina chokwadi pane zvepurasitiki. samples.
Tsvakurudzo dzinoverengeka dzakaongorora mhedzisiro yekudzidza / kuita kwemhando dzakasiyana dzezviridzwa zveanatomical senge plasticized specimens, mifananidzo ye2D, zvikamu zvakanyorova, Anatomage tables (Anatomage Inc., San Jose, CA) uye 3DP modhi [11, 15, 16, 17, 18, 19, 20, 21].Zvisinei, zvigumisiro zvakasiyana zvichienderana nekusarudzwa kwechimbo chekudzidzira chinoshandiswa mukutonga uye mapoka ekupindira, pamwe chete zvichienderana nematunhu akasiyana-siyana [14, 22].Semuenzaniso, kana yakashandiswa pamwe chete nekunyorova dissection [11, 15] uye autopsy matafura [20], vadzidzi vakashuma kugutsikana kwekudzidza kwepamusoro uye maitiro kune zvienzaniso zvepurasitiki.Saizvozvo, kushandiswa kweplastination mapatani kunoratidza mhedzisiro yeruzivo rwechinangwa chevadzidzi [23, 24].
Mienzaniso ye3DP inowanzoshandiswa kuwedzera nzira dzekudzidzisa dzechinyakare [14,17,21].Loke et al.(2017) yakashuma pamusoro pekushandiswa kwemuenzaniso we3DP kuti unzwisise congenital heart disease mune chiremba wevana [18].Ichi chidzidzo chakaratidza kuti boka re3DP raive nekugutsikana kwekudzidza kwepamusoro, kunzwisisa zviri nani kweFallot's tetrad, nekuvandudza kugona kubata varwere (kuzvimiririra) zvichienzaniswa neboka rekufungidzira re2D.Kudzidza anatomy yemuti wevascular uye anatomy yedehenya uchishandisa 3DP modhi inopa kugutsikana kwekudzidza kwakafanana semifananidzo ye2D [16, 17].Zvidzidzo izvi zvakaratidza kuti mamodheru e3DP ari pamusoro pemifananidzo ye2D maererano nekugutsikana kunoonekwa nemudzidzi.Nekudaro, zvidzidzo zvinonyatso kuenzanisa akawanda-material 3DP modhi nemasamples epurasitiki ane mashoma.Mogali et al.(2021) yakashandisa iyo plastination modhi neiyo 3DP yemoyo uye mitsipa mhando uye yakashuma kuwedzera kwakafanana kwezivo pakati pekutonga uye mapoka ekuyedza [21].
Zvisinei, humwe uchapupu hunodiwa kuti uwane kunzwisisa kwakadzama kwechikonzero nei ruzivo rwekudzidza kwemudzidzi runoenderana nekusarudzwa kwezviridzwa zveanatomical uye zvikamu zvakasiyana zvemuviri uye nhengo [14, 22].Humanist tsika chinhu chinonakidza chinogona kukanganisa maonero aya.Izvi zvinoreva ruremekedzo, kutarisira, tsitsi uye tsitsi zvinotarisirwa kubva kuvadzidzi vanova vanachiremba [25, 26].Hunhu hwehunhu hwagara huchitsvakwa muzvitunha, sezvo vadzidzi vanodzidziswa kunzwira tsitsi uye kutarisira zvitunha zvakapihwa, uye nekudaro kudzidza kweanatomy kwagara kuine nzvimbo yakakosha [27, 28].Nekudaro, izvi hazviwanzo kuyerwa muplasticizing uye 3DP zvishandiso.Kusiyana nemibvunzo yakavharwa yeongororo yeLikert, nzira dzekuunganidza dhata dzemhando yepamusoro dzakadai sehurukuro dzeboka rekutarisa uye mibvunzo yeongororo yakavhurika inopa muono mumhinduro dzevatori vechikamu dzakanyorwa zvisina tsarukano kutsanangura mabatiro emidziyo mitsva yekudzidza paruzivo rwavo rwekudzidza.
Saka tsvakiridzo iyi ine chinangwa chekupindura kuti vadzidzi vanoona sei anatomy zvakasiyana kana vachipihwa maturusi ekuisa (plastination) maringe nemifananidzo yakadhindwa ye3D kuti vadzidze anatomy?
Kupindura mibvunzo iri pamusoro, vadzidzi vane mukana wekuwana, kuunganidza uye kugovera ruzivo rweanatomical kuburikidza nekudyidzana kwechikwata uye kubatana.Iyi pfungwa inobvumirana zvakanaka nedzidziso ye constructivist, maererano nevanhu kana mapoka evanhu vanoshingaira kugadzira uye kugovera ruzivo rwavo [29].Kudyidzana kwakadaro (somuenzaniso, pakati pevezera, pakati pevadzidzi nevadzidzisi) kunokanganisa kugutsikana kwekudzidza [30, 31].Panguva imwecheteyo, ruzivo rwekudzidza rwevadzidzi ruchakanganiswawo nezvinhu zvakaita sekufunda zviri nyore, zvakatipoteredza, nzira dzekudzidzisa, uye zvemukati zvekosi [32].Zvadaro, hunhu uhwu hunogona kukanganisa kudzidza kwemudzidzi uye kugona kwemisoro yavanoda [33, 34].Izvi zvingave zvakabatana nemaonero edzidziso yepragmatic epistemology, apo kukohwa kwekutanga kana kuumbwa kwechiitiko chega, njere, uye zvitendero zvinogona kusarudza nzira inotevera yekuita [35].Nzira yepragmatic yakanyatsorongwa kuti ione misoro yakaoma uye kutevedzana kwayo kuburikidza nekubvunzurudza uye tsvakurudzo, inoteverwa nekuongorora kwepamusoro [36].
Sampuli dzeCadaver dzinowanzoonekwa sevadzidzisi vakanyarara, sezvo vachionekwa sezvipo zvakakosha zvekubatsira sainzi nevanhu, zvinokurudzira ruremekedzo nekutenda kubva kuvadzidzi kune vanovapa [37, 38].Zvidzidzo zvekare zvakataura zvibodzwa zvakafanana kana zvepamusoro pakati peboka recadaver/plastination neboka re3DP [21, 39], asi hazvina kujeka kana vadzidzi vachigovana ruzivo rwakafanana rwekudzidza, kusanganisira tsika dzevanhu, pakati pemapoka maviri aya.Kuti uwedzere tsvakiridzo, chidzidzo ichi chinoshandisa musimboti wepragmatism [36] kuongorora ruzivo rwekudzidza uye maitiro emhando dze3DP (ruvara uye magadzirirwo) uye ozvienzanisa nemasamples akaiswa purasita maererano nemhinduro dzevadzidzi.
Maonero evadzidzi anogona kuzopesvedzera sarudzo dzevadzidzisi pamusoro pekusarudza maturusi eanatomi akakodzera zvichibva pane izvo uye zvisingashande pakudzidzisa anatomi.Ruzivo urwu runogonawo kubatsira vadzidzisi kuona zvinodiwa nevadzidzi uye kushandisa maturusi ekuongorora akakodzera kuti vavandudze ruzivo rwavo rwekudzidza.
Ichi chidzidzo chemhando yepamusoro chakanangana nekuongorora izvo vadzidzi vanoona sechiitiko chakakosha chekudzidza vachishandisa masampuli emwoyo nemutsipa epurasitiki zvichienzaniswa nemhando dze3DP.Zvinoenderana nekutanga kudzidza naMogali et al.muna 2018, vadzidzi vaiona zvimisikidzo zveplastic kuti zvive zvechokwadi kupfuura 3DP modhi [7].Saka ngatifungei:
Tichifunga kuti maplastinations akagadzirwa kubva kumacadaver chaiwo, vadzidzi vaitarisirwa kuona plastinations zvakanaka kupfuura 3DP modhi maererano nehuchokwadi uye kukosha kwevanhu.
Ichi chidzidzo chehutano chakabatana nezvidzidzo zviviri zvekare zvehuwandu [21, 40] nokuti data inowanikwa mune zvidzidzo zvitatu zvakaunganidzwa panguva imwe chete kubva kumuenzaniso wakafanana wevadzidzi.Chinyorwa chekutanga chakaratidza zvakafanana chinangwa zviyero (test scores) pakati peplastination ne3DP mapoka [21], uye chinyorwa chechipiri chakashandisa factor analysis kugadzira psychometrically yakasimbiswa chiridzwa (zvinhu zvina, 19 zvinhu) kuyera dzidzo inovaka senge kudzidza kugutsikana, kuzvimiririra, hunhu hwevanhu, uye kudzidza midhiya mipimo [40].Chidzidzo ichi chakaongorora nhaurirano dzemhando yepamusoro dzakavhurika uye dzakatariswa neboka kuti vaone zvinoonekwa nevadzidzi zvakakosha pakudzidza anatomi vachishandisa zvienzaniso zvakanamirwa uye mhando dzakadhindwa dze 3D.Nokudaro, chidzidzo ichi chinosiyana nezvinyorwa zviviri zvakapfuura maererano nezvinangwa zvekutsvakurudza / mibvunzo, data, uye nzira dzekuongorora kuti uwane ruzivo rwemhinduro yevadzidzi yehutano (yehurukuro yemashoko ekusununguka pamwe nekukurukurirana kweboka) pamusoro pekushandiswa kwezvishandiso zve3DP zvichienzaniswa nemasampuli epurasitiki.Izvi zvinoreva kuti chidzidzo chazvino chinogadzirisa mubvunzo wekutsvagisa wakasiyana pane zvinyorwa zviviri zvakapfuura [21, 40].
Pachikoro chemunyori, anatomy inosanganiswa musystemic makosi senge cardiopulmonary, endocrinology, musculoskeletal, nezvimwewo, mumakore maviri ekutanga emakore mashanu eBachelor of Medicine uye Bachelor of Surgery (MBBS) chirongwa.Zvienzaniso zvakanamirwa, mapurasitiki emhando, mifananidzo yezvokurapa, uye chaiwo 3D modhi anowanzo shandiswa panzvimbo ye dissection kana wet dissection specimens kutsigira general anatomy maitiro.Zvidzidzo zveboka zvinotsiva zvidzidzo zvechinyakare zvinodzidziswa zvine chekuita nekushandiswa kweruzivo rwawakawana.Pakupera kwega yega system module, tora online foromative anatomy kudzidzira bvunzo iyo inosanganisira makumi maviri ega ega mhinduro dzakanakisa (SBAs) inovhara general anatomy, imaging, uye histology.Pakazara, miedzo mishanu yekugadzira yakaitwa panguva yekuedza (matatu mugore rekutanga uye maviri mugore rechipiri).Iyo yakasanganiswa yakazara yakanyorwa ongororo yeMakore 1 ne2 inosanganisira mapepa maviri, rimwe nerimwe riine 120 SBAs.Anatomy inova chikamu chezviongorori izvi uye chirongwa chekuongorora chinotarisa huwandu hwemibvunzo yeanatomical kuti ibatanidzwe.
Kuti uvandudze reshiyo yemudzidzi-kune-sample, mhando dzemukati dze3DP dzakavakirwa pamienzaniso yeplastinated dzakadzidzwa pakudzidzisa nekudzidza anatomi.Izvi zvinopa mukana wekumisikidza kukosha kwedzidzo yemhando nyowani dze3DP zvichienzaniswa neakapfatwa emhando dzisati dzabatanidzwa zviri pamutemo mudzidzo yeanatomy.
Muchidzidzo ichi, computed tomography (CT) (64-slice Somatom Tsanangudzo Flash CT scanner, Siemens Healthcare, Erlangen, Germany) yakaitwa pamapurasitiki emoyo (moyo mumwe chete nemoyo mumwe mumuchinjikwa) uye musoro nemutsipa ( imwe yose uye imwe midsagittal ndege musoro-mutsipa) (Fig. 1).Digital Imaging and Communications in Medicine (DICOM) mifananidzo yakawanikwa uye yakaiswa mu3D Slicer (shanduro 4.8.1 uye 4.10.2, Harvard Medical School, Boston, Massachusetts) yezvikamu zvezvimiro nemhando dzakadai semhasuru, tsinga, tsinga, uye mapfupa. .Iwo akakamurwa mafaera akaiswa muMaterialize Magics (Version 22, Materialize NV, Leuven, Belgium) kubvisa magomba eruzha, uye mhando dzekudhinda dzakachengetwa muSTL fomati, dzakazoendeswa kune Objet 500 Connex3 Polyjet printer (Stratasys, Edheni. Prairie, MN) kugadzira 3D anatomical modhi.Photopolymerizable resins uye transparent elastomers (VeroYellow, VeroMagenta uye TangoPlus) inoomesa dhizaini pasi pekuita kweiyo UV mwaranzi, ichipa yega yega anatomical chimiro chayo uye ruvara.
Zvishandiso zvekuongorora anatomi zvakashandiswa muchidzidzo ichi.Kuruboshwe: Mutsipa;kurudyi: plated uye 3D yakadhindwa mwoyo.
Mukuwedzera, iyo inokwira aorta uye coronary system yakasarudzwa kubva mumuenzaniso wemwoyo wose, uye zvigadziko zvepasi zvakavakwa kuti zvibatanidze kumuenzaniso (version 22, Materialize NV, Leuven, Belgium).Iyo modhi yakadhindwa paRaise3D Pro2 printer (Raise3D Technologies, Irvine, CA) uchishandisa thermoplastic polyurethane (TPU) filament.Kuratidza tsinga dzemuenzaniso, iyo yakadhindwa TPU yekutsigira yaifanira kubviswa uye tsinga dzeropa dzakapendwa ne red acrylic.
Vadzidzi vekutanga veBachelor of Medicine paLee Kong Chiang Faculty of Medicine mugore rezvidzidzo ra2020-2021 (n = 163, varume makumi mapfumbamwe nemana nevakadzi makumi matanhatu nevapfumbamwe) vakagamuchira email yekukoka kutora chikamu muchidzidzo ichi sechiito chekuzvidira.Kuedza kusingatarisirwi kwakaitwa mumatanho maviri, kutanga nekuchekwa kwemoyo uyezve nekuchekwa kwemutsipa.Pane mavhiki matanhatu ekugeza nguva pakati pematanho maviri kuti kuderedze zvakasara.Mumatanho ese ari maviri, vadzidzi vaive vasingaoni misoro yekudzidza uye mabasa eboka.Vanhu vasingadarike vatanhatu muboka.Vadzidzi vakagamuchira plastinated samples mudanho rekutanga vakagamuchira 3DP modhi mudanho rechipiri.Padanho rega rega, mapoka ese ari maviri anogashira hurukuro yenhanganyaya (maminitsi makumi matatu) kubva kune wechitatu (mudzidzisi mukuru) inoteverwa nekuzvidzidza wega (50 maminetsi) vachishandisa maturusi ekuzviverengera akapihwa uye zvinyorwa.
Rondedzero yeCOREQ (Comprehensive Criteria for Qualitative Research Reporting) inoshandiswa kutungamira tsvakurudzo yemhando.
Vadzidzi vakapa mhinduro pazvidzidzo zvekutsvaga kuburikidza neongororo yaisanganisira mibvunzo mitatu yakavhurika pamusoro pesimba ravo, kusasimba, uye mikana yebudiriro.Vese makumi mapfumbamwe nevatanhatu vakapindura vakapa mhinduro dzemahara.Ipapo vasere vevadzidzi vanozvipira (n = 8) vakatora chikamu muboka rekutarisa.Hurukuro dzakaitwa paAnatomy Training Center (pakaitwa zviedzo) uye dzakaitwa naMuongorori 4 (Ph.D.), mudzidzisi wechirume asiri weanatomi ane makore anopfuura gumi eruzivo rwekufambisa rweTBL, asi asina kubatanidzwa muchikwata chekudzidza. kudzidzisa.Vadzidzi vanga vasingazive hunhu hwevaongorori (kana boka retsvakurudzo) chidzidzo chisati chatanga, asi fomu remvumo rakavazivisa nezvechinangwa chechidzidzo.Chete muongorori 4 uye vadzidzi vakapinda muboka rekutarisa.Muongorori akatsanangura boka rekutarisa kuvadzidzi uye akavabvunza kana vangada kutora chikamu.Vakagovana ruzivo rwavo rwekudzidza 3D kudhinda uye plastination uye vaifarira zvikuru.Mufambisi akabvunza mibvunzo mitanhatu inotungamira kukurudzira vadzidzi kuti vashande kuburikidza (Supplementary Material 1).Mienzaniso inosanganisira nhaurirano yezvikamu zvezviridzwa zveanatomical zvinokurudzira kudzidza nekudzidza, uye basa rekunzwira tsitsi mukushanda nemienzaniso yakadaro."Ungatsanangura sei ruzivo rwako rwekudzidza anatomy uchishandisa plastinated samples uye 3D akadhindwa makopi?"waive mubvunzo wekutanga mubvunzurudzo.Mibvunzo yese yakavhurika, ichibvumira vashandisi kupindura mibvunzo vakasununguka pasina nzvimbo dzakarerekera, zvichiita kuti data idzva riwanikwe uye matambudziko akundwe nemidziyo yekudzidza.Vatori vechikamu havana kugamuchira kurekodha kwekutaura kana kuongororwa kwemhedzisiro.Kuzvipira kwechidzidzo kwakadzivirira data saturation.Hurukuro yese yakatepwa kuti iongororwe.
Kurekodha kweboka rekutarisa (35 maminetsi) akanyoreswa verbatim uye depersonalized (pseudonyms akashandiswa).Mukuwedzera, mibvunzo yemibvunzo yakazaruka yakaunganidzwa.Zvinyorwa zveboka rekutarisa uye mibvunzo yeongororo yakaunzwa muMicrosoft Excel spreadsheet (Microsoft Corporation, Redmond, WA) yedata triangulation uye aggregation kutarisa kuenzanisa kana kuenderana mhedzisiro kana mitsva mitsva [41].Izvi zvinoitwa kuburikidza ne theoretical thematic analysis [41, 42].Mhinduro dzechinyorwa chemudzidzi wega wega dzinowedzerwa kuhuwandu hwemhinduro.Izvi zvinoreva kuti mazwi ane mitsara yakawanda achatorwa semumwe.Mhinduro ne nil, hapana kana hapana kana ma tag ekutaura anozofuratirwa.Vatsvakurudzi vatatu (mutsvakurudzi wechikadzi ane Ph.D., muongorori wechikadzi ane dhigirii remasters, uye mubatsiri wechirume ane dhigirii reBachelor muinjiniya uye makore 1–3 eruzivo rwekutsvagisa mudzidzo yezvokurapa) akazvimiririra inductively encoded data isina kurongeka.Vatatu vanogadzira mapurogiramu vanoshandisa mapedhi ekudhirowa chaiwo kurongedza post-iyo manotsi zvichienderana nekufanana uye kusiyana.Zvikamu zvinoverengeka zvakaitwa kurongeka uye makodhi emapoka kuburikidza nekurongeka uye iterative maitiro ekuzivikanwa, uko macode akaiswa mumapoka kuti aone subtopics (chaiyo kana hunhu hwakadai sehunhu hwakanaka uye husina kunaka hwezvishandiso zvekudzidza) izvo zvakabva zvaumba madingindira akakura [41].Kuti uwane kubvumirana, muongorori wechirume wechitanhatu (Ph.D.) ane makore gumi nemashanu eruzivo mukudzidzisa anatomy akabvumidza zvidzidzo zvekupedzisira.
Zvinoenderana neChiziviso cheHelsinki, iyo Institutional Ongororo Board yeNanyang Technological University (IRB) (2019-09-024) yakaongorora chirongwa chekudzidza ikawana mvumo inodiwa.Vatori vechikamu vakapa mvumo yekuziva uye vakaziviswa nezvekodzero yavo yekubuda mukutora chikamu chero nguva.
Makumi mapfumbamwe nematanhatu ekutanga-gore rekutanga undergraduate vadzidzi vezvokurapa vakapa mvumo izere neruzivo, huwandu hwevanhu hwakadai semurume kana zera, uye vakazivisa kuti havana kudzidziswa kwekutanga mune anatomy.Phase I (moyo) uye Phase II (neck dissection) yakabatanidza vatori vechikamu 63 (33 varume nevakadzi 30) uye vatori vechikamu 33 (18 varume ne15 vakadzi), maererano.Zera ravo raibva pamakore gumi nemasere kusvika pamakore makumi maviri nerimwe (zvinoreva ± chiyero chakatsauka: 19.3 ± 0.9) makore.Vadzidzi vese makumi mapfumbamwe nevatanhatu vakapindura mibvunzo (hapana vakasiira chikoro panzira), uye vadzidzi 8 vakatora chikamu mumapoka akatarisisa.Paive ne278 yakavhurika tsinhiro pamusoro pezvakanakira, zvakaipa, uye zvinodiwa zvekuvandudzwa.Pakanga pasina kusawirirana pakati pe data yakaongororwa uye mushumo wezvakawanikwa.
Mukati menhaurirano dzeboka rekutarisa uye mhinduro dzeongororo, madingindira mana akabuda: kunzwisiswa kwechokwadi, kunzwisisa kwakakosha uye kuomarara, maitiro ekuremekedza uye nehanya, kuwanda, uye hutungamiriri (Mufananidzo 2).Musoro wega wega unotsanangurwa zvakadzama pazasi.
Madingindira mana—echokwadi anonzwisiswa, kunzwisisa kwakakosha uye kuoma kunzwisisa, ruremekedzo nehanya, uye kufarira pakudzidza midhiya—anobva pakuongorora dingindira remibvunzo yakavhurika yeongororo uye nhaurirano dzeboka.Zvinhu zviri mumabhokisi ebhuruu neeyero zvinomiririra zvimiro zvesample yakapfava uye iyo 3DP modhi, zvichiteerana.3DP = 3D kudhinda
Vadzidzi vakanzwa kuti zvienzaniso zvakanamirwa zvaive zvechokwadi, zvaive nemavara echisikigo anomiririra macadaver chaiwo, uye aive neruzivo rwakanaka rweanatomical kupfuura mhando dze3DP.Semuyenzaniso, tsandanyama faibha orientation inonyanya kuoneka mumaplasticized samples zvichienzaniswa ne3DP modhi.Kusiyana uku kunoratidzwa muchirevo chiri pasi apa.
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Vadzidzi vakacherekedza kuti maturusi e3DP aibatsira pakudzidza zvakakosha anatomy uye kuongorora macroscopic maficha makuru, nepo zvienzaniso zvepurasitiki zvaive zvakanakira kuwedzera ruzivo rwavo nekunzwisisa kwezvakaoma anatomical zvimiro nematunhu.Vadzidzi vakafunga kuti kunyangwe zviridzwa zvese zviri zviviri zvakafanana zveumwe neumwe, ivo vaive vachishaya ruzivo rwakakosha pakushanda nemhando dze3DP zvichienzaniswa nemasamples epurasitiki.Izvi zvinotsanangurwa muchirevo chiri pasi apa.
“…paive nezvimwe zvinonetsa se… zvidiki zvakaita se fossa ovale… kazhinji modhi ye 3D yemoyo inogona kushandiswa… kumutsipa, pamwe ndichadzidza modhi yekunakisa zvine chivimbo (mutori wechikamu PA1; 3DP, hurukuro yeboka”) .
"Zvakakura zvimiro zvinogona kuoneka ... zvakadzama, zvienzaniso zve3DP zvinobatsira pakudzidza, semuenzaniso, zvimiro zvakakomba (uye) zvinhu zvakakura, zvinoonekwa zviri nyore semhasuru uye nhengo ... PA3 mutori wechikamu 3DP, hurukuro yeboka)”.
Vadzidzi vacho vakaratidza ruremekedzo uye kunetseka kune zvienzaniso zveplastic, asi vainetsekawo nezvekuparadzwa kwechimiro nekuda kwekusasimba kwayo uye kushayikwa kwekushanduka.Kusiyana neizvi, vadzidzi vakawedzera kune yavo inoshanda nekuziva kuti mhando dze3DP dzinogona kudhindwa kana dzakanganiswa.
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“…kumienzaniso yeplastination, zvakaita…chimwe chinhu chakachengetedzwa kwenguva yakareba.Kana ndakaikuvadza… ndinofunga isu tinoziva inoita senge kukuvadzwa kwakanyanya nekuti ine nhoroondo (PA3 anotora chikamu; plastination, yekutarisa boka nhaurirano).
"Mamodheru akadhindwa e3D anogona kugadzirwa nekukasira uye zviri nyore…kuita kuti mamodheru e3D awanikwe nevanhu vakawanda uye kufambisa kudzidza pasina kugovana masampuli (I38 mubatsiri; 3DP, ongororo yemahara)."
Nemamodheru e3D tinogona kutamba tichitenderera tisinganetseke zvakanyanya nezvekuvakuvadza, senge kukuvadza samples… (PA2 mutori wechikamu; 3DP, hurukuro yeboka rekutarisa)."
Sekureva kwevadzidzi, nhamba yezvimiro zveplastic ishoma, uye kuwana zvivakwa zvakadzika kwakaoma nekuda kwekuoma kwavo.Kune iyo 3DP modhi, ivo vanotarisira kuenderera mberi nekunatsiridza iyo anatomical ruzivo nekugadzirisa modhi kune nzvimbo dzekufarira pakudzidza kwemunhu.Vadzidzi vakabvuma kuti ese mapurasitiki emhando ye3DP anogona kushandiswa pamwe chete nemamwe marudzi emidziyo yekudzidzisa senge Anatomage tafura yekusimudzira kudzidza.
"Zvimwe zvakadzika zvemukati zvimiro hazvionekwe zvakanaka (mutori wechikamu C14; plastination, free-form comment)."
"Zvichida matafura eautopsy nedzimwe nzira angave anobatsira zvakanyanya (nhengo C14; plastination, mahara manyoro wongororo)."
"Nekuita chokwadi chekuti mhando dze3D dzakanyatsotsanangurwa, unogona kuve nemhando dzakasiyana dzinotarisa munzvimbo dzakasiyana uye dzakasiyana zvinhu, senge tsinga nemidziyo yeropa (mutori wechikamu I26; 3DP, yemahara mameseji wongororo)."
Vadzidzi vakakurudzirawo kusanganisira kuratidzira kuti mudzidzisi atsanangure mashandisirwo emuenzaniso nemazvo, kana nhungamiro yekuwedzera pamifananidzo yakatsanangurwa yemuenzaniso kufambisa kudzidza nekunzwisisa mumanotsi ehurukuro, kunyangwe vakabvuma kuti chidzidzo ichi chakanyatsogadzirirwa kuzvidzidzira.
"Ndinokoshesa maitiro akazvimirira ekutsvaga ... pamwe nhungamiro yakawanda inogona kupihwa nenzira yemasiraidhi akadhindwa kana mamwe manotsi ... (mutori wechikamu C02; zvinyorwa zvemahara zvakajairika)."
"Nyanzvi dzezvemukati kana kuva nemamwe maturusi ekuona akadai seanopopota kana vhidhiyo zvinogona kutibatsira kunzwisisa zvirinani chimiro chemhando dze3D (nhengo C38; wongororo yemavara emahara)."
Vadzidzi vegore rekutanga zvekurapa vakabvunzwa nezve ruzivo rwavo rwekudzidza uye kunaka kweiyo 3D yakadhindwa uye yemasamples epurasitiki.Sezvaitarisirwa, vadzidzi vakawana masampuli epurasitiki ari echokwadi uye akarurama kupfuura akadhindwa e3D.Iyi mhedzisiro inosimbiswa nekutanga kudzidza [7].Sezvo zvinyorwa zvichiitwa kubva pazvitunha zvakapiwa, ndezvechokwadi.Kunyangwe yaive 1: 1 replica yemufananidzo wakanamirwa une morphological maitiro akafanana [8], iyo polymer-based 3D yakadhindwa modhi yaionekwa seyasiri yechokwadi uye isiri yechokwadi, kunyanya muvadzidzi maive neruzivo rwakadai semicheto yeoval fossa. isingaonekwi mumuenzaniso we3DP wemoyo kana uchienzaniswa nemuenzaniso weplastic.Izvi zvinogona kunge zvakakonzerwa nehutano hwemufananidzo weCT, iyo isingabvumiri kutsanangurwa kwakajeka kwemiganhu.Naizvozvo, zvakaoma kugovera zvimiro zvakadaro muzvikamu zvesoftware, izvo zvinokanganisa maitiro ekudhinda e3D.Izvi zvinogona kumutsa kusava nechokwadi nezvekushandiswa kwemidziyo ye3DP sezvo vachitya kuti ruzivo rwakakosha rucharasika kana maturusi akajairwa akadai semasamples epurasitiki akasashandiswa.Vadzidzi vanofarira kudzidziswa kwekuvhiya vangawana zvakakosha kushandisa mienzaniso inoshanda [43].Mhedzisiro yemazuva ano yakafanana nezvidzidzo zvekare zvakawana kuti mapurasitiki emhando [44] uye 3DP samples haana kurongeka kwemasampuli chaiwo [45].
Kuti uvandudze kuwanikwa kwevadzidzi uye nekudaro kugutsikana kwemudzidzi, mutengo uye kuwanikwa kwezvishandiso zvinofanirwa kutariswa.Mhedzisiro yacho inotsigira kushandiswa kwemhando dze3DP yekuwana ruzivo rweanatomical nekuda kwekugadzira kwavo kusingadhure [6, 21].Izvi zvinopindirana nechidzidzo chekare chakaratidza kuenzaniswa kwechinangwa chekuita zvemhando dzepurasitiki uye 3DP modhi [21].Vadzidzi vaifunga kuti mamodheru e3DP ainyanya kubatsira pakudzidza pfungwa dzeanatomical, nhengo, uye maficha, nepo zvienzaniso zvakanamirwa zvaive zvakakodzera kudzidza kuoma kweanatomy.Pamusoro pezvo, vadzidzi vakakurudzira kushandiswa kwemamodheru e3DP pamwe chete nemhando dziripo dzemacadaver uye tekinoroji yemazuva ano kuvandudza kunzwisisa kwevadzidzi kweanatomy.Nzira dzakawanda dzekumiririra chinhu chimwe chete, senge mepu yeanatomy yemoyo uchishandisa macadavers, 3D kudhinda, murwere scans, uye chaiwo 3D modhi.Iyi nzira yakasiyana-siyana inobvumira vadzidzi kuti vaenzanisire anatomy nenzira dzakasiyana, kutaura zvavakadzidza nenzira dzakasiyana, uye kuita vadzidzi nenzira dzakasiyana [44].Tsvagiridzo yakaratidza kuti zvechokwadi zvekudzidza zvakaita sematurusi ecadaver zvinogona kunetsa kune vamwe vadzidzi maererano nemutoro wekuziva wakabatana nekudzidza anatomy [46].Kunzwisisa kukonzeresa kwemutoro wekuziva pakudzidza kwemudzidzi uye kushandisa matekinoroji kudzikisa hunyanzvi hwekuziva kugadzira nzvimbo yekudzidza iri nani kwakakosha [47, 48].Usati wasuma vadzidzi kune cadaveric zvinhu, 3DP modhi inogona kuve nzira inobatsira yekuratidza zvakakosha uye zvakakosha zveanatomy kuitira kudzikisa yekuziva mutoro uye kuwedzera kudzidza.Pamusoro pezvo, vadzidzi vanogona kutora mhando dze3DP kumba kuti dziongororwe pamwe chete nemabhuku uye zvekudzidzisa uye kuwedzera kudzidza kweanatomy kupfuura lab [45].Nekudaro, iyo tsika yekubvisa zvikamu zve3DP haisati yaitwa munzvimbo yemunyori.
Muchidzidzo ichi, masamples epurasitiki airemekedzwa kupfuura 3DP replicas.Mhedziso iyi inoenderana netsvagurudzo yapfuura inoratidza kuti cadaveric specimens se "murwere wekutanga" anoraira ruremekedzo nekunzwira tsitsi, nepo mhando dzekugadzira dzisingaite [49].Realistic plastinated nyama yemunhu ndeyepedyo uye ndeyechokwadi.Kushandiswa kwezvinhu zvecadaveric kunobvumira vadzidzi kukudziridza mafungiro evanhu uye tsika [50].Pamusoro pezvo, maonero evadzidzi epaplastination mapatani anogona kukanganiswa neruzivo rwavo rwunokura rwezvirongwa zvekupa cadaver uye/kana plastination process.Plastination inopiwa cadavers inotevedzera tsitsi, kuyemura uye kutenda uko vadzidzi vanonzwa kune avo vanopa [10, 51].Aya maitiro anosiyanisa vanamukoti vevanhu uye, kana akarimwa, anogona kuvabatsira kufambira mberi nekutenda nekunzwira tsitsi nevarwere [25, 37].Izvi zvinofananidzwa nevadzidzisi vakanyarara vachishandisa mvura yemunhu dissection [37,52,53].Sezvo mienzaniso yokunamira yaipiwa kubva mumadhaka, yaionekwa nevadzidzi sevadzidzisi vakanyarara, izvo zvakaita kuti chiremekedzo chechishandiso chitsva ichi chokudzidzisa.Kunyangwe vachiziva kuti mamodheru e3DP anogadzirwa nemichina, vachiri kunakidzwa nekuashandisa.Boka rega rega rinonzwa kuchengetwa uye modhi yacho inobatwa nekungwarira kuchengetedza kuvimbika kwayo.Vadzidzi vanogona kunge vatoziva kuti 3DP modhi inogadzirwa kubva kuvarwere data nekuda kwezvinangwa zvekudzidzisa.Pachikoro chemunyori, vadzidzi vasati vatanga zvidzidzo zveanatomy, kosi yekutanga yeanatomy yenhoroondo yeanatomy inopiwa, mushure mezvo vadzidzi vanotora mhiko.Chinangwa chikuru chemhiko ndechekuisa muvadzidzi kunzwisisa kwehunhu hwevanhu, kuremekedza zviridzwa zveanatomical, uye hunyanzvi.Kubatanidzwa kwezviridzwa zveanatomical uye kuzvipira kunogona kubatsira kuisa pfungwa yekuva nehanya, kuremekedza, uye zvichida kuyeuchidza vadzidzi nezvemabasa avo emangwana kune varwere [54].
Nezvekuvandudza mune ramangwana mumidziyo yekudzidza, vadzidzi vanobva kumapoka eplastination ne3DP vakabatanidza kutya kwekuparadzwa kwechimiro mukutora chikamu kwavo nekudzidza.Zvakadaro, kushushikana pamusoro pekukanganisika kwechimiro chemienzaniso yakapfava kwakasimbiswa panguva yenhaurirano dzeboka.Uku kucherechedzwa kunosimbiswa nezvidzidzo zvekare pamasampuli epurasitiki [9, 10].Maitiro ekugadzirisa, kunyanya mamodheru emutsipa, anodiwa kuti uongorore zvakadzika zvimiro uye unzwisise matatu-dimensional hukama hwepakati.Kushandiswa kwetactile (tactile) uye ruzivo rwekuona kunobatsira vadzidzi kuti vagadzire mufananidzo wakadzama uye wakakwana wepfungwa wezvikamu zvitatu-dimensional anatomical [55].Zvidzidzo zvakaratidza kuti tactile manipulation yezvinhu zvemuviri zvinogona kuderedza kurangarira mutoro uye kutungamirira kunzwisisa zviri nani nekuchengetedza ruzivo [55].Zvave zvichinzi kuwedzera 3DP modhi nemhando dzepurasitiki zvinogona kuvandudza kudyidzana kwevadzidzi nemuenzaniso pasina kutya kukuvadza zvimiro.
Nguva yekutumira: Jul-21-2023