3D Vector Reconstruction of the Typical Cervical Vertebra from Anatomical Sections of Korean Visible Human at the Laboratory of Clinical and Digital Anatomy of Paris Descartes University

Aim: To carry out a 3D vector reconstruction of the typical cervical vertebra from anatomical sections of the “Korean Visible Human” for educational purposes. Material and Methods: The anatomical subject was a 33-year-old Korean man who died of leukemia. He was 164 cm tall and weighed 55 kg. This man donated his body to science. Her body was frozen and cut into several anatomical sections after an MRI and CT scan. These anatomical sections were made using a special saw called a 0.2 mm thick cryomacrotome. Thus 8100 cuts were obtained. Only the sections numbered 940 to 1200 were used for our study. A segmentation by manual contouring of the different parts of the typical cervical vertebra was made using the software Winsurf version 3.5 on a laptop PC running Windows 7 equipped with a Ram of 8 gigas. Results: Our 3D vector model of the typical cervical vertebra is easily manipulated using the Acrobat 3DPDF interface. Each part of the vertebra accessible in a menu can be displayed, hidden or made transparent, and 3D labels are available as well as educational menus for learning anatomy. Conclusion: This original work constitutes a remarkable educational tool for the anatomical study of the typical cervical vertebra and can also be used as a 3D atlas for simulation purposes for training in therapeutic gestures.

Three-dimensional digital technology-assisted precise tumor resection and reconstruction of the femoral trochanter and postoperative functional recovery:a retrospective study

Background The trochanter of the femur is a common site for bone tumors.However,locating the specificboundary of bone tumor infiltration and determining the surgical method can be challenging.The objective of thisstudy was to review the diagnosis,treatment,and surgical outcomes of patients with tumors or tumor-like changesin the femoral trochanter after computer-assisted precise tumor resection and hip-preserving reconstruction ofthe trochanter.Methods From January 2005 to September 2020,11 patients with trochanteric tumors(aged:18–53 years;sixmales and five females)were treated in Guangzhou First People’s Hospital.The cases included aneurysmal bonecyst(n=1),giant cell tumor of bone(n=2),fibrous histiocytoma of bone(n=1),endochondroma(n=1),andfibrous dysplasia of bone(n=6).For patients with trochanteric tumors,computed tomography and magnetic resonance imaging scanning were performed before operation to obtain two-dimensional image data of the lesion.Athree-dimensional digital model of bilateral lower limbs was reconstructed by computer technology,the boundary of tumor growth was determined by computer simulation,the process of tumor resection and reconstructionwas simulated,and the personalized guide template was designed.During the operation,the personalized guideplate guided the precise resection of the tumor,and the allogeneic bone was trimmed to match the shape of thebone defect.Results All 11 patients underwent accurate resection of the tumor or tumor-like lesion and reconstruction ofthe hip.In eight cases,the lesion was confined to the trochanter,which was fixed with large segment allogeneicbone,autologous iliac bone,and proximal femoral anatomic plate.In three cases,allogeneic bone,autologousiliac bone,and femoral reconstruction nail were used to fix the tumor under the trochanter.Postoperative Xray examination showed that the repair and reconstruction of the bone defect was effective,and callus bridgingbetween the allogenic bone and autogenous bone was observed 6 months after operation.All patients recoveredtheir walking function 3–6 months after operation.The duration of the follow-up period ranged from 6 monthsto 6 years.A patient experienced recurrence of endochondroma;pathological examination revealed chondrocyticsarcoma.The remaining 10 patients were treated with segmental resection and reconstruction.The operationtime ranged 2.5–4.5 h(average:3.2 h).Intraoperative blood loss ranged from 300 to 500 ml(average:368 ml).The local recurrence rate was 9.1%,and the overall survival rate was 100%.The average Musculoskeletal TumorSociety score was 27(excellent and good for eight and three patients,respectively).Conclusions Three-dimensional computer skeleton modeling and simulation-assisted resection and reconstruction of femoral trochanteric tumor is a new surgical technique,which might markedly improve the surgical effect,shorten the surgical time,increase the overall survival rate of patients with tumors,reduce the local recurrencerate,assist in the digitization and programming of femoral trochanteric tumor surgery,and improve surgicalaccuracy.

下颌骨数字化可视模型的建立

目的:建立下颌骨的三维数字化可视模型。方法:选择合适的尸体标本,经固定、动脉灌注、冷冻、包埋、洗切、数据采集,获得数字人数据集,取数字人数据图像中下颌骨有关的二维图像,提取其轮廓线,利用Amira软件系统进行下颌骨的外形及下颌管的重建。结果:利用数字人数据得到下颌骨精细的三维模型,在三维空间上真实地再现了下颌骨、下颌牙的解剖形态,并准确地显示出下颌管的位置与走行。结论:通过数字人数据,采用应用软件重建方法获得下颌骨三维模型,为口腔解剖及外科教学、下颌骨的美容整形及正颌外科手术治疗、下颌牙齿种植等提供了解剖学依据。

跟骨骨折畸形愈合的数字化虚拟重建及在矫形手术设计中的初步应用

目的探讨跟骨骨折畸形愈合的数字化虚拟重建的技术方法及其在矫形手术设计中应用的可行性。方法利用跟骨骨折畸形愈合病例患侧、健侧足踝部CT扫描图像及其数据收集,应用Mimics14.0软件进行三维重建,在重建出三维数字化模型及相关测量基础上,进行虚拟截骨及内固定等手术设计,并将虚拟截骨后的相关解剖学参数与健侧进行对比及拟合,据此进行手术治疗。结果重建出跟骨骨折畸形愈合的三维数字化可视模型,制备出相应的3D实物模型,可进行跟骨骨折畸形愈合相关解剖学参数的测量,可在个人计算机上初步实现截骨、内固定等矫形手术设计的可视化与可操作化。结论数字化虚拟重建技术能够为跟骨骨折畸形愈合的术前判断、临床诊治方式的选择等提供更为精准的解剖学及影像学依据,并可望用于跟骨畸形愈合截骨治疗手术的设计。

数字化三维手术模拟在正颌外科专科医师培训中的应用

牙颌面畸形患者面部形态异常和咬合功能障碍常较严重,需要采用正颌—正畸联合治疗的方法进行矫正。治疗牙颌面畸形的正颌手术术野狭小、操作复杂、风险较大,其手术教学和操作培训手段有限,限制了此类技术的推广应用。文章介绍了将数字化三维手术设计与模拟系统应用于正颌外科专科医师培训,可取得良好的手术教学效果。实践表明,通过手术虚拟操作,可使受训医师加深对牙颌面畸形和正颌外科手术的理解。

数字化三维正颌手术设计与模拟系统在本科生教学中的应用

牙颌面畸形患者常需要采用正畸结合正颌手术治疗的方法进行矫正。由于正颌外科学手术设计灵活抽象,操作复杂,如何使本科生在短时间内理解并掌握正颌手术的相关知识一直是口腔颌面外科临床教学的难点。数字化三维手术设计与模拟系统应用于本科生教育,既形象直观又可进行模拟手术操作,可使本科生加深对牙颌面畸形和正颌外科手术的理解和知识点的掌握。与传统教学方法相比,数字化三维手术设计与模拟系统是一种更加科学有效的本科生教学方式。

肱骨近端四部分骨折的数字化术前模拟手术规划

目的研究根据CT数据在个人计算机上对肱骨近端四部分骨折进行术前模拟手术规划的可行性及其临床意义。方法对5例肱骨近端四部分骨折进行模拟手术规划。将肱骨近端骨折CT扫描原始数据导入Mimics及UG软件中,进行计算机术前模拟手术。根据接骨板长度、放置位置、螺钉长度、入钉方向及数量对比模拟手术与实际手术情况是否相符。结果 5例肱骨近端四部分骨折均成功完成模拟内固定。接骨板长度符合率100%;1例接骨板放置位置略向前移;螺钉长度符合率96.36%,螺钉方向符合率98.18%,螺钉数量符合率100%。结论利用个人计算机辅助术前模拟肱骨近端骨折手术情况与实际手术情况基本相符,对肱骨近端骨折术前计划制定有良好的临床应用价值。

Digital medical technology based on 64-slice computed tomography in hepatic surgery

Background With the rapid development of computer technology, digital medicine has become a new direction in surgery. The application of digital medicine in hepatic surgery is still at the early stage and less reported in the literature. The aim of this study was to apply digital medical technology in the context of hepatic surgery. Methods Data from 64-slice helical computed tomography of 17 patients, including 13 with hepatocellular carcinoma and 4 with hepatic hemangioma, were imported into independently developed medical image software program, segmentation and three-dimensional reconstruction were performed. The three-dimensional models were then processed with the FreeForm Modeling System. We used virtual surgical instruments to perform surgery on the models. Simulated surgeries included six hepatic segmentectomies, four left hemihepatectomies, three right hemihepatectomies for hepatocellular carcinoma, one hepatic segmentectomy, two stripping surgeries, and one irregular segmentectomy combined with stripping surgery for hemangioma. For resections involving more than three hepatic segments, total and residual functional hepatic volumes were measured before and after simulation surgery, and the resection ratio was calculated.Results The anatomy of the models was distinct and was used to localize lesions. We used virtual surgical instruments to perform simulated surgeries and used the models to optimize actual surgeries. We were able to minimize resection volume as well as surgical risk.Conclusions Digital medical technology is helpful in the diagnosis of hepatic disease and in optimizing surgical plans. Three-dimensional models can decrease surgical risk and help prevent postoperative hepatic failure.

数字化技术设计偏突颌患者手术方案的研究

目的:参考不同平面在偏突颌畸形伴高低眼患者手术模拟设计的对称性差异。方法:2019年1月至2020年6月,天津市口腔医院正颌外科偏突颌畸形患者15例,男3例、女12例,年龄18~26岁,平均23.8岁。分别建立3种不同三维参考平面系统;选取软硬组织解剖标志点并测量各标志点距离正中矢状面的距离,用镜像技术定性分析颅骨对称性。通过单因素方差分析评估3种参考平面在偏突颌伴高低眼患者手术模拟对称性的差异。结果:定性分析:通过镜像技术可见,在3种测量平面中用方法3参考平面进行手术模拟的骨组织对称性最佳,方法2与方法1对称性较差。定量分析:头颅硬组织测量指标中用方法3建立的参考平面各标志点距离正中矢状面的距离(1.65±1.19)mm与方法1、方法2之间差异有统计学意义[(3.37±1.58)、(3.26±2.36)mm,P<0.05];方法1、方法2之间差异无统计学意义(P>0.05)。软组织测量结果与硬组织保持一致,同时各软组织标志点在方法3距离正中矢状面距离非常小,平均误差<0.5 mm,与临床面诊结果一致。结论:数字化模型外科技术可辅助正颌外科进行手术方案设计与预测分析,尤其在特殊偏突颌畸形患者设计中有重要作用。

数字化三维手术模拟结合3D打印在正颌外科专科医师培训中的应用

正颌外科手术复杂,强调理论与实践相结合,教学难度大,受条件限制不能开展有效的实践教学,学生难以掌握手术操作。本文将数字化三维手术模拟和3D打印结合应用于正颌外科专科医师培训,分别在理论知识教学、手术操作教学、总结与反思等教学环节应用数字化软件以及3D打印,将实践教学与理论教学相结合,积极发挥学生的主观能动性。结果显示,实验组教学评价[(3.89±0.84)分]优于对照组[(2.91±1.21)分],数字化三维手术模拟结合3D打印的教学模式取得了满意的效果。

数字技术在人工全髋关节置换术中的应用研究

目的探索把数字技术应用于人工全髋关节置换术,为临床选择更适配的人工全髋关节假体提供新的方法。方法6例成人病变的髋关节和42-56号的髋臼假体和01-04号钛合金股骨柄(矩形,HA微孔)假体连续CT扫描,将CT扫描数据经Mimics软件处理,3D计算建立髋关节和假体的数字模型。将数据输入SPSS 17.0进行统计学分析。根据术前选择的假体施行手术,术后6个月根据Harris评分进行评价,并与同期6例行传统人工全髋关节置换术患者髋关节Harris评分进行统计学比较。结果 6例骨盆三维模型数据测量结果分析:髋臼前倾角、外展角与身高、性别、侧别因素无显著性差异;股骨颈前倾角及颈干角与侧别、性别及身高因素无统计学差异。结论数字技术可以指导选择更匹配的全髋关节假体,提高人工全髋关节置换术的近期效果,为临床术前选择全髋关节假体提供一种新的方法。

颅颌面外科的技术进步

影像学技术如CT、MRI、DSA等在颅颌面外科的临床应用、基因学的检测分析、三维可视化的全景解剖、颅面骨骼模型的快速精准成型、精密的设计制造技术、术前仿真的模型外科技术、术中实时的导航操作系统、网络信息的远程传输会诊体系等，有效提高了颅颌面畸形的诊断与治疗水平；应用坚固内固定技术提高了骨折和截骨治疗的稳定性和精准性；骨牵引技术在颅颌面外科研究和应用，使Le Fort Ⅲ型截骨牵引、半侧颜面短小征颌骨牵引获得再生的骨量，明显减少了手术后的复发。颅颌面外科与相关医、工学科的先进技术结合，促进了颅颌面外科发展。

数字化智能化技术在颅颌面整形外科的应用

数字化技术广义上是指计算机技术、信息网络技术、精密设计制造技术、三维重建与可视化技术、手术模拟仿真、模型快速成型、手术实时导航、远程医疗、机器人辅助技术及人工智能等先进技术,近年来在颅颌面整形外科领域的应用日益增多,如影像资料处理、三维信息采集与储存、术前规划与手术模拟、模型的精确制造、个性化手术导板及修复体的定制、手术导航、机器人辅助手术、医学大数据处理、远程医疗等,该文就上述方面进行了梳理和评价。