Mechanically strong porous bioceramic tubes facilitate large segmental bone defect repair by providing long-term structurally stability and promoting osteogenesis

Mechanically strong magnesium-doped Ca-silicate bioceramic scaffolds have many advantages in repairing large segmental bone defects.Herein we combine β-TCP with 6 mol%magnesium-doped calcium silicate(Mg6)at three different ratios(TCP,TCP+15%Mg6,TCP+85%Mg6)to find an appropriate ratio which can exert considerable influence on bone regeneration.In this study,the bioceramic scaffolds were assessed for mechanical strength,bioactive ion release,biocompatibility,and osteogenic capacity through in vitro testing.Additionally,the potential for promoting bone regeneration was investigated through in vivo implantation of porous tube-like scaffolds.The results showed that the compressive strength increased with the augmentation of Mg6 component.Especially the compressive strength of the TCP+85%Mg6 group reached 38.1±3.8 MPa,three times that of the other two groups.Furthermore,extensive in vivo investigations revealed that the TCP+85%Mg6 bioceramic scaffolds were particularly beneficial for the osteogenic capacity of critical-sized femoral defects(20 mm in length).Altogether,magnesium doping in bioceramic implants is a promising strategy to provide stronger mechanical support and enhance osteogenesis to accelerate the repair of large defects.

Effect of beta-tricalcium phosphate/poly-1-lactide composites on radial bone defects of rabbit

Objective:To explore the effect ofβ-TCP/PLLA scaffold in repairing rabbit radial lone defects.Methods:Thirty New Zealand rabbits were divided intoβ-TCP/PLLA group(group A),pure PLLA group(group B)and contrast group(group C)randomly.The rabbits were sacrificed respectively after 4.8.12,24 weeks and the X-ray film was performed at the same time to evaluate the repair effect in different groups.Retiults:X-ray film showed there was uneven low density bone callus development in defect region after 4 weeks in group A.The defect region was filled with neonate osseous tissue completely during 12-24 weeks.X-ray score revealed that repair of bone defect results significantly better than group B and group C.Conclusions:Theβ-PCP/PLLA composite is capable of repairing radial lone lone defects.β-TCP/PLLA scaffold is significant because of rapid degradation ability,good histocompatihility and osteogenic action.

Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts:A retrospective,comparative cohort study

BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The appropriate treatment for proximal humerus comminuted fractures has not been established.Therefore,this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.AIM To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.METHODS This retrospective,comparative cohort study included two groups of patients.Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data.Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation.Group 2 was treated with open reduction and locking plates to enable internal fixation.The intraoperative blood loss volume from the shoulder wound,operative time,shoulder wound pain,bone fracture healing time,Constant-Murley score of the shoulder joint,preoperative Holden walking function score,Mallet score of the shoulder joint,and humeral neck-shaft angle during surgery of the two groups were compared,and the differences were analysed using an independent sample t-test.RESULTS Group 1 had a shorter mean operative time than group 2(2.25±0.30 h vs 2.76±0.44 h;P=0.000).Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2(7.91±1.15 points vs 8.56±1.00 points;P=0.044).Group 1 had a shorter fracture healing time than group 2(2.68±0.48 mo vs 3.64±0.64 mo;P=0.000).Group 1 had higher Constant-Murley scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(76.64±4.02 points vs 72.72±3.02 points,86.36±3.53 points vs 82.96±3.40 points,and 87.95±2.77 points vs 84.68±2.63 points,respectively;P=0.000,0.002,and 0.000,respectively).Group 1 had higher Mallet scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(10.32±0.57 points vs 9.96±0.54 points,13.36±1.00 points vs 12.60±0.87 points,and 13.91±0.75 points vs 13.36±0.70 points,respectively;P=0.032,0.007,and 0.013,respectively).CONCLUSION Using locking plates with a fibular autograft can recreate medial support,facilitate fracture healing,and improve shoulder function;therefore,this may be an effective treatment option for severe proximal humerus comminuted fractures.

Ilizarov骨搬移联合抗生素骨水泥促进胫骨大段骨缺损的对接点愈合

背景:Ilizarov骨搬移治疗开放性胫骨大段骨缺损十分有效,但仍有并发症,其中对接点愈合困难是治疗难点之一。目的:探讨Ilizarov骨搬移联合抗生素骨水泥对开放性胫骨大段骨缺损术后对接点愈合的影响。方法:选择2010年8月至2022年1月滨州医学院附属医院收治的开放性胫骨大段(骨缺损> 4 cm)骨缺损患者51例,其中28例接受单纯Ilizarov骨搬移治疗(对照组),23例接受Ilizarov骨搬移联合抗生素骨水泥治疗(试验组)。统计比较两组患者外固定时间、骨愈合时间、骨愈合指数、骨搬移过程中的目测类比评分、末次随访时的骨缺损肢体功能、对接点愈合及并发症发生情况。结果与结论:(1)51例患者均获得完整随访,平均随访(22.53±5.77)个月,试验组患者外固定时间、骨愈合时间、骨愈合指数、术后感染率及对接点未愈合率均少于对照组(P <0.05),两组二期手术后6个月的目测类比评分、末次随访时的骨缺损肢体功能优良率比较差异无显著性意义(P> 0.05);(2)结果表明,相较于单纯的Ilizarov骨搬移治疗,Ilizarov骨搬移联合抗生素骨水泥治疗可促进开放性胫骨骨折对接点的愈合,提高骨愈合率。

内源性骨膜引导骨再生过程中信号通路富集及FZD家族动态表达研究

目的研究内源性骨膜引导骨再生过程中信号通路富集及卷曲蛋白(FZD)家族动态表达。方法建立猪闭合肋骨膜引导下的骨再生模型,选择7个时间点采集骨膜和再生骨组织进行基因测序,分析差异基因筛选以及相关信号通路富集的情况。选取与骨再生过程中密切相关的FZD分子家族,检测并分析FZD各成员的动态表达变化及其表达相关性。结果实验组相较于对照组,共有7个基因在建模后1个月内的不同时间点持续存在差异表达。差异基因富集显示,早期主要存在免疫反应,后实现组织发展和重塑。FZD家族各成员在不同时间点的表达存在波动,大多数成员的表达高峰在术后3 d,而实验组的倍数改变高峰在术后1个月最为明显,FZD1和FZD2最高,且二者具有较高的相关性。结论本研究筛选出的骨膜引导性骨再生过程中的差异基因以及相关信号通路,为进一步的分子机制研究提供了理论依据,而FZD分子家族动态表达变化在该过程中发挥着重要作用,其具体参与的生物机制尚需进一步研究验证。

组织工程骨移植物的血管化策略研究

利用骨组织工程修复大段骨缺损是一种富有前景的方法。骨骼是动态的高度血管化组织,在适当时间内形成血管组织是保证骨移植物存活、修复、重塑的关键,也是骨组织工程的主要挑战之一。本文将从血管化的意义,以及基于种子细胞、促血管生成因子、支架结构、免疫调控、体外预血管化等策略来综述组织工程骨移植物血管化的研究进展。

经椎弓根椎体内植骨联合短节段内固定术治疗骨质疏松性脊柱骨折的效果观察

目的:观察骨质疏松性脊柱骨折患者联合应用短节段内固定术、经椎弓根椎体内植骨术治疗的临床效果。方法:选取阿克苏地区第一人民医院骨科2021年1月—2023年5月接收的骨质疏松性脊柱骨折患者90例,按随机数字表法分组,对照组(n=45)单纯应用短节段内固定术治疗,观察组(n=45)联合应用短节段内固定术、经椎弓根椎体内植骨术治疗。对比两组围手术期指标、术后并发症、伤椎恢复情况[伤椎弯曲角度(Cobb角)、伤椎矢状面指数(VSI)、伤椎前缘高度比(FVHR)、伤椎压缩率]、Oswestry功能障碍指数(ODI)评分、巴氏(Barthel)指数评分、预后优良率。结果:观察组手术时间、围手术期失血量、总住院时间与对照组对比,差异均无统计学意义(P>0.05)。观察组后凸畸形、伤椎愈合延迟、内固定物松脱等并发症发生率比对照组低,差异有统计学意义(P<0.05)。术前,两组Cobb角、VSI、FVHR、伤椎压缩率、ODI评分、Barthel评分对比,差异均无统计学意义(P>0.05);术后6个月,两组VSI、FVHR、Barthel评分均较术前升高,Cobb角、伤椎压缩率、ODI评分均较术前降低,且观察组VSI、FVHR、Barthel评分均较对照组高,观察组Cobb角、伤椎压缩率、ODI评分均较对照组低,差异均有统计学意义(P<0.05)。观察组术后6个月预后优良率比对照组高,差异有统计学意义(P<0.05)。结论:骨质疏松性脊柱骨折患者联合应用短节段内固定术、经椎弓根椎体内植骨术治疗能够进一步减少相关并发症,减轻脊柱功能障碍,提高患者生活质量,促使预后改善,有利于伤椎恢复。

经皮终板下植骨复位结合经皮椎弓根螺钉固定治疗A3+B2型胸腰椎爆裂骨折

背景:植骨是治疗胸腰椎爆裂骨折重要环节之一,由于骨折累及椎管或伴脊髓神经损伤、骨折易出血等因素,使微创植骨在胸腰椎爆裂骨折治疗中受到限制。目前胸腰椎爆裂骨折的微创治疗仅限于通道下经皮螺钉固定,微创下经皮伤椎植骨少有报道,经皮终板下精准植骨暂未见报道。目的:探讨经皮终板下植骨支撑复位结合经皮椎弓根螺钉短节段固定治疗A3+B2型胸腰椎爆裂骨折的临床效果。方法:2017年6月至2021年12月对90例A3+B2型无神经症状的胸腰椎爆裂骨折患者分组,根据入院时间分为3组,A组33例行C型臂X射线机透视下经皮穿刺通过椎弓根通道精准放置植骨漏斗,骨折终板下植骨支撑复位,经皮椎弓根螺钉短节段固定;B组30例行多裂肌间隙入路经椎弓根植骨支撑复位结合椎弓根螺钉短节段固定;C组27例行体位复位下经皮椎弓根螺钉短节段固定治疗。所有患者术后至少随访18个月,对3组患者的临床资料,包括术前、术后及末次随访Cobb角、伤椎前缘高度比值和疼痛目测类比评分等进行比较分析。结果与结论:①3组患者在年龄、性别、损伤节段和致伤因素方面差异无显著性意义(P>0.05);②随访中所有患者无神经功能损害,无明显腰背后凸畸形及顽固性腰背部疼痛;③C组手术时间比A、B组少(P<0.05);术中出血量A、C组较B组少(P<0.05);④术前3组椎体前缘高度比值、Cobb角比较差异无显著性意义(P>0.05);术后A、B组优于C组;末次随访时A、B组优于C组(P<0.05);3组丢失的椎体前缘高度、Cobb角比较,A、B组小于C组(P<0.05);⑤术后患者疼痛目测类比评分A、C组优于B组(P<0.05),末次随访时疼痛目测类比评分3组之间差异无显著性意义(P>0.05);⑥C组有1例患者术后1个月复查内固定松动移位,椎体高度再次丢失伴背痛,经严格卧床6周,椎体高度丢失无加重,疼痛缓解,1年后取出内固定,末次随访高度丢失无加重;A、B组无内固定失败病例;⑦提示经皮终板下植骨支撑复位结合经皮椎弓根螺钉短节段固定治疗A3+B2型胸腰椎爆裂骨折具有创伤小、出血少、术后疼痛症状轻等优势,伤椎复位及高度维持可以达到和多裂肌间隙入路经椎弓根植骨支撑复位结合椎弓根螺钉短节段固定相同的效果。

Optimal regenerative repair of large segmental bone defect in a goat model with osteoinductive calcium phosphate bioceramic implants

So far,how to achieve the optimal regenerative repair of large load-bearing bone defects using artificial bone grafts is a huge challenge in clinic.In this study,a strategy of combining osteoinductive biphasic calcium phosphate(BCP)bioceramic scaffolds with intramedullary nail fixation for creating stable osteogenic microenvironment was applied to repair large segmental bone defects(3.0 cm in length)in goat femur model.The material characterization results showed that the BCP scaffold had the initial compressive strength of over 2.0 MPa,and total porosity of 84%.The cell culture experiments demonstrated that the scaffold had the excellent ability to promote the proliferation and osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells(BMSCs).The in vivo results showed that the intramedullary nail fixation maintained the initial stability and structural integrity of the implants at early stage,promoting the osteogenic process both guided and induced by the BCP scaffolds.At 9 months postoperatively,good integration between the implants and host bone was observed,and a large amount of newborn bones formed,accompanying with the degradation of the material.At 18 months postoperatively,almost the complete new bone substitution in the defect area was achieved.The maximum bending strength of the repaired bone defects reached to the 100% of normal femur at 18 months post-surgery.Our results demonstrated the good potential of osteoinductive BCP bioceramics in the regenerative repair of large load-bearing bone defects.The current study could provide an effective method to treat the clinical large segmental bone defects.

Electroactive barium titanate coated titanium scaffold improves osteogenesis and osseointegration with low-intensity pulsed ultrasound for large segmental bone defects

For large segmental bone defects,porous titanium scaffolds have some advantages,however,they lack electrical activity which hinders their further use.In this study,a barium titanate(BaTiO3)piezoelectric ceramic was used to modify the surface of a porous Ti6Al4V scaffold(pTi),which was characterized by scanning electron microscopy,energy dispersive spectroscopy,X-ray photoelectron spectroscopy,and roughness and water contact angle analyses.Low intensity pulsed ultrasound(LIPUS)was applied in vitro and in vivo study.The activity of bone marrow mesenchymal stem cells,including adhesion,proliferation,and gene expression,was significantly superior in the BaTiO3/pTi,pTi+LIPUS,and BaTiO3/pTi+LIPUS groups than in the pTi group.The activity was also higher in the BaTiO3/pTi+LIPUS group than in the BaTiO3/pTi and pTi+LIPUS groups.Additionally,micro-computed tomography,the mineral apposition rate,histomorphology,and the peak pull-out load showed that these scaffold conditions significantly enhanced osteogenesis and osseointegration 6 and 12 weeks after implantation in large segmental bone defects in the radius of rabbits compared with those resulting from the pTi condition.Consequently,the improved osteogenesis and osseointegration make the BaTiO3/pTi+LIPUS a promising method to promote bone regeneration in large segmental bone defects for clinical application.

Application of Novel Design Bone Grafting for Treatment of Segmental Acetabular Rim Defects During Revision Total Hip Arthroplasty

The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was reconstructed according to computed tomography images based on a healthy patient without any peri-acetabular bony defect according to the American Academy of Orthopedic Surgeons(AAOS).The FEA model of acetabular bone deficiency was performed to simulate and evaluate the mechanical performances of the grafts in different geometric structures,with the use of fixation implants(screws),along with the stress distribution and the relative micromotion of graft models.The stress distribution mainly concentrated on the region of contact of the screws and superolateral bone.Among the different structures,the mortise-tenone structure provided better relative micromotion,with suitable biomechanical property even without the use of screws.The novel grafting structures could provide sufficient biomechanical stability and bone remodeling,and the mortise-tenone structure is the optimal treatment option for acetabulum reconstruction.

聚醚醚酮棒与钛棒在后路腰椎椎间融合中的有限元分析

背景:聚醚醚酮棒是一种新型的半刚性固定材料,但是其在后路腰椎椎间融合术中的生物力学性能仍不清楚。目的:对比聚醚醚酮棒与钛棒在后路腰椎椎间融合过程中的生物力学性能,尝试回答聚醚醚酮棒是否有潜力成为钛棒的替代品,尤其在前柱支撑不充分的情况下。方法:利用有限元方法构建完整的人腰椎(L)模型,并进一步构建4个后路腰椎椎间融合模型:①聚醚醚酮棒+cage;②钛棒+cage;③聚醚醚酮棒+纯植骨;④钛棒+纯植骨。比较不同模型中节段活动度、相关结构应力以及应变。结果与结论:①所有手术模型在限制L节段活动度方面无明显差异;②与钛棒相比,聚醚醚酮棒增加了椎间植骨的平均应变、增加了终板以及cage的峰值应力,同时降低了螺钉以及骨-螺钉界面的峰值应力;聚醚醚酮棒的峰值应力与屈服应力之比为6%-26%,高于钛棒的3%-12%;③在L节段上,聚醚醚酮棒仅轻微地降低了节段活动度与椎间盘峰值应力;④因此与钛棒相比,聚醚醚酮棒可能降低假关节、螺钉断裂与松动的风险,但是也可能导致终板塌陷、cage损坏以及棒断裂的风险更高;聚醚醚酮棒在延缓邻近节段退变中可能较钛棒有微弱的优势;在不使用cage而仅采用骨移植物进行椎间融合时,聚醚醚酮棒也许是一个可供选择的方案。

Non-prosthetic treatment using segmental osteotomy and bone grafting in a patient with cleft lip and palate

This case report aimed to present the course of surgically combined comprehensive orthodontic treatment of a male adult with cleft lip and palate,showing a left alveolar cleft,lateral deviation of the major segment of the maxilla,and palatal transposition of the lateral incisor.Preoperatively,the midline of the upper central incisors was shifted by 7.0 mm to the right,the right lateral incisor showed palatal transposition,and the residual alveolar cleft was 6.5 mm.Segmental Le Fort I osteotomy of the major segment,and simultaneous bone grafting into the extended alveolar bone and former cleft region were performed at 18 years and 4 months of age.Thus,midline correction,alignment of the right lateral incisor,and cleft closure were achieved;no further prosthetic treatment was required.

面向CBCT图像口腔移植骨区域分割的改进ResUNet网络

口腔移植骨区域自动分割在计算机辅助诊断中具有重要的临床意义。针对口腔移植骨区域大小不一,形状相异以及正负样本不平衡等特点,提出一种改进的ResUNet深度学习网络,实现对口腔移植骨区域的自动分割。该算法设计了一个新颖的通道敏感注意力,用来捕获所有通道特征图之间的相互依赖关系,进而使用空间注意力关注这些通道特征上感兴趣的区域,提升口腔移植骨区域分割的准确性。实验结果表明,在口腔移植骨区域自动分割任务中,本文所提算法性能均优于目前医学图像分割的主流方法。

自体颗粒植骨与髂骨块植骨在单节段胸腰椎结核中的应用对照研究

目的比较自体颗粒植骨与髂骨块植骨在单节段胸腰椎结核中的应用效果。方法选取2019年11月—2021年10月吉林省结核病医院收治的64例单节段胸腰椎结核患者作为研究对象,按照随机数表法分为对照组(32例)与研究组(32例)。两组均开展椎体间植骨融合术治疗,研究组采用自体颗粒植骨,对照组采用自体髂骨块植骨。针对两组术中及术后情况、并发症,术前与术后7 d时疼痛及神经功能、术前与术后6个月时椎间高度与Cobb角进行比较。结果研究组手术操作时间(140.52±18.65)min、术中失血量(426.65±55.56)mL较对照组(156.32±30.42)min、(514.65±48.60)mL低,差异有统计学意义(t=2.505、6.774,P<0.05),两组住院时间差异无统计学意义(P>0.05)。研究组术后并发症发生率为3.13%,与对照组的9.38%比较,差异无统计学意义(χ^(2)=0.267,P>0.05)。术后7 d时两组疼痛视觉模拟评分法(VAS)与日本骨科学会(JOA)评分比较,差异无统计学意义(P>0.05)。术后6个月时研究组椎间高度(15.30±3.00)cm与Cobb角(8.32±2.02)°较对照组(17.60±2.98)cm、(10.46±2.18)°低,差异有统计学意义(t=3.077、4.073,P<0.05)。结论相较于自体髂骨块植骨,自体颗粒植骨能够有效缩短单节段胸腰椎结核患者的手术时间,减少术中失血量,促进椎间高度与Cobb角恢复,具有临床应用价值。

大块骨缺损治疗研究进展

造成大块骨缺损的原因有多种,如高能量创伤、骨肿瘤、骨感染、骨髓炎及先天因素等。该病的治疗一直是临床骨科医生面临的一项重大挑战,其治疗难度大、周期长、并发症多,不仅严重影响患者的生活质量,而且给患者带来了极大的经济、心理及社会压力。当骨缺损范围达到“临界骨缺损长度”时,将超出骨自行修复的最大能力,缺损不能够自行愈合。此时需要手术干预修复大段的骨缺损。大块骨缺损多发于长骨,对肢体功能影响较大。目前临床上治疗大块骨缺损的方法主要有自体骨移植、同种异体骨移植、Ilizarov技术、骨诱导膜技术和人工骨替代材料移植等。上述治疗方法各有优势与不足,基于此,本文就目前大块骨缺损的治疗进展进行综述,以期为临床上选择治疗大块骨缺损合适的方法提供参考。

骨搬运与Masquelet诱导膜技术治疗长骨感染合并大段骨缺损的效果比较

目的探讨骨搬运与Masquelet诱导膜技术在长骨感染合并大段骨缺损中的治疗效果。方法选取2017年1月至2020年1月河北省张家口市第二医院收治的40例长骨感染合并大段骨缺损患者为研究对象,按随机数字表法将其分为观察组(Masquelet诱导膜技术,20例)与对照组(骨搬运法,20例)。比较两组治疗效果、手术次数、临床愈合时间、下肢完全负重时间、治疗费用及术后的视觉模拟评分法(VAS)评分、Fereadez-Esteve骨痂评分、Iowa评分。记录两组并发症发生情况。结果两组治疗效果比较,差异无统计学意义(P>0.05)。观察组手术次数、治疗费用均低于对照组,临床愈合时间、下肢完全负重时间短于对照组,差异有统计学意义(P<0.05)。观察组术后VAS评分低于对照组,Fereadez-Esteve骨痂评分及Iowa评分中的膝、踝关节评分高于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论Masquelet诱导膜技术可有效加快长骨感染合并大段骨缺损患者的术后恢复。

诱导膜技术联合带血管蒂腓骨瓣移植治疗儿童慢性骨髓炎并大段骨缺损的临床价值研究

目的 分析诱导膜技术联合带血管蒂腓骨瓣移植治疗儿童慢性骨髓炎并大段骨缺损的临床价值。方法 5例慢性骨髓炎并大段骨缺损患儿,均应用诱导膜技术联合带血管蒂腓骨瓣移植治疗。观察患儿腓骨瓣成活情况和手术后患肢功能康复情况。结果 5例患儿的腓骨骨瓣均满意成活,手术后随访1.0~1.5年,移植骨均临床骨性愈合。并且腓骨移植后常常增粗,增粗时间为1.0~1.3年。以Enneking系统上下肢功能等级计分标准对患儿肢体功能进行评定, 1例上肢手术患儿术后功能评分为27分,肢体功能恢复良好;4例下肢手术患儿术后功能评分如下:11~20分0例, 21~25分1例, 26~30分3例,平均26.2分,肢体功能恢复88.0%。结论 儿童慢性骨髓炎并大段骨缺损在诱导膜技术及带血管蒂腓骨瓣移植的联合治疗下,临床治疗效果满意,此治疗方法有积极的临床意义。

一种面向口腔移植骨分割的SA-UNet网络

在牙齿种植治疗中,口腔移植骨分割对于辅助医生诊断有重要参考价值。口腔CBCT图像具有对比度较低,移植骨边缘模糊等诸多特征,严重制约着现有深度分割网络的应用。研究以U-Net为基准网络,通过设计一种新颖的轻量级Sharp-Attention模块,提出了一种改进的SA-UNet网络模型。具体地,在Sharp模块中,带锐化卷积核的Depthwise卷积操作通过锐化浅层特征以加强特征细节。CBAM模块提升模型对于图像低层信息的关注度。进而,采用新型联合损失函数,缓解样本比例失衡带来的影响。最后,在口腔移植骨数据集上验证了模型的有效性。在模型复杂度方面,与基准网络U-Net相比,在几乎没有增加计算开销的情况下,图像分割精度得到了有效的提升;在分割精度方面,与现有的主流医学分割模型对比,在IoU、Dice系数、Hausdorff距离三个评价指标上的表现最佳,得分达到了0.8665、0.9262、0.5092。

Automatic Segmentation Method for Cone-Beam Computed Tomography Image of the Bone Graft Region within Maxillary Sinus Based on the Atrous Spatial Pyramid Convolution Network

Sinus floor elevation with a lateral window approach requires bone graft(BG)to ensure sufficient bone mass,and it is necessary to measure and analyse the BG region for follow-up of postoperative patients.However,the BG region from cone-beam computed tomography(CBCT)images is connected to the margin of the maxillary sinus,and its boundary is blurred.Common segmentation methods are usually performed manually by experienced doctors,and are complicated by challenges such as low efficiency and low precision.In this study,an auto-segmentation approach was applied to the BG region within the maxillary sinus based on an atrous spatial pyramid convolution(ASPC)network.The ASPC module was adopted using residual connections to compose multiple atrous convolutions,which could extract more features on multiple scales.Subsequently,a segmentation network of the BG region with multiple ASPC modules was established,which effectively improved the segmentation performance.Although the training data were insufficient,our networks still achieved good auto-segmentation results,with a dice coefficient(Dice)of 87.13%,an Intersection over Union(Iou)of 78.01%,and a sensitivity of 95.02%.Compared with other methods,our method achieved a better segmentation effect,and effectively reduced the misjudgement of segmentation.Our method can thus be used to implement automatic segmentation of the BG region and improve doctors’work efficiency,which is of great importance for developing preliminary studies on the measurement of postoperative BG within the maxillary sinus.