Objective To investigate the significance of three dimensional (3D) visualization and virtual surgery system in liver transplantation surgery. Methods Two patients suffered from cholangiolithiasis were scanned by 64 slice helical-CT on livers and the data were collected. Man-made segmentation and true up on the image from the data were carried out. 3D moulds of the liver and the intrahepatic vessels were reconstructed by VTK software respectively. And then, the moulds were imported to the FreeForm Modeling System for modifying. At last, auxiliary partial orthotopic liver transplantation was simulated with the force-feedback equipment (PHANTOM). Results ①It had greatly verisimilar image for the reconstructed 3D liver moulds with artery, vein, portal vein and bile duct; By liver seeing through, it had high fidelity and b 3D effect for the intrahepatic artery, vein, portal vein and bile duct, and their spatial disposition and course and correlationship were shown clearly. ②In the virtual surgery system, the virtual scalpel could be manipulated on 3D liver mould with PHANTOM. The simulating effect was the same as the clinic operation for auxiliary partial orthotopic liver transplantation. Plane visualization of hepatic resection and intrahepatic vessel cutting was achieved by adjusting the transparency of the resection part. Life-like could be felt and power feeling could be touched during virtul operation. Conclusion ①The visualized liver mould reconstructed is 3D and verisimilar, and it is helpful to design reasonable scheme for liver transplantation. ②It not only can improve the surgical effect and decrease the surgical risk, but also can reduce the complications and enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery. ③Visualized liver transplantation surgery is helpful for medical workers to train and study.
ObjectiveTo study the clinical value of digital technology assisted minimally invasive surgery in diagnosis and treatment of hepatolithiasis. MethodsThe image data of 64-slice spiral CT scanning were obtained from five patients of complicated hepatolithiasis and introduced into medical image three-dimensional visualization system (MI-3DVS) for three-dimensional reconstruction. On the basis of the data of three-dimensional reconstruction, minimally invasive surgical planning of preoperation was made to obtain reasonable hepatectomy and cholangiojejunostomy, and then preoperative emulational surgery was carried out to minimize the extent of tissue damage and provide guidance to actual operation. ResultsLiver, biliary system, stone, blood vessel, and epigastric visceral organ were successfully reconstructed by MI-3DVS, which showed clearly size, number, shape, and space distribution of stone, and location, degree, length, and space distribution of biliary stricture, and anatomical relationship of ducts and vessels. The results of three-dimensional reconstruction were successfully confirmed by actual operation, which was in accordance with emulational surgery. There was no operative complication. No retained stone in internal and external bile duct was found by Ttube or other supporting tube cholangiography on one month after operation. ConclusionThree-dimensional digitizing reconstruction and individual emulational surgery have important significance in diagnosis and treatment of complicated hepatolithiasis by minimally invasive technique.
Objective To investigate the methods of establishing 3-dimensional skull model using electron beam CT(EBCT) data rapid prototyping technique, andto discuss its application in repairing crainomaxillofacial trauma. Methods The data were obtained by EBCTcontinuous volumetric scanning with 1.0 mm slice at thickness. The data were transferred to workstation for 3-dimensional surface reconstruction by computeraided design software and the images were saved as STL file. The data can be usedto control a laser rapid-prototyping device(AFS-320QZ) to construct geometricmodel. The material for the model construction is a kind of laser-sensitive resinpower, which will become a mass when scanned by laser beam .The design and simulation of operation can be done on the model. The image data were transferred to the device slice by slice. Thus a geometric model is constructed according to the image data by repeating this process. Preoperative analysis, surgery simulation and implant of bone defect could be done on this computer-aided manufacture d3D model. One case of craniomaxillofacial bone defect resulting from trauma wasreconstructed with this method. The EBCT scanning showed that the defect area was 4 cm×6 cm. The nose was flat and deviated to left. Results The -3dimensional -skull was reconstructed with EBCT data and rapid prototyping technique. The model can display the structure of 3-dimenstional anatomyand their relationship.The prefabricated implant by 3-dimensional model was well-matched with defect .The deformities of flat and deviated nose were corrected. The clinical result wassatisfactory after a follow-up of 17 months. Conclusion The 3-dimensional model of skull can replicate the prototype of disease and play an important role in the diagnosis and simulation of operation for repairing craniomaxillofacial trauma.
【Abstract】ObjectiveTo evaluate the value of MR imaging with a contrast-enhanced multi-phasic isotropic volumetric interpolated breath-hold examination (VIBE) in diagnosis of primary liver carcinoma. MethodsThirty-two consecutive patients with surgical-pathologically confirmed 42 foci of primary carcinoma of liver underwent comprehensive MR examination of the upper abdomen, routine two-dimensional (2D) T1WI and T2WI images were acquired before administration of Gd-DTPA for contrast enhancement. Then, contrast-enhanced multi-phasic VIBE was acquired followed by 2D T1WI images. The lesion appearances on hepatic arterial, portal venous and equilibrium phases of VIBE sequence were carefully observed along with delineation of hepatic arterial and portal venous structures. The lesion detection rates and lesion characterization ability were compared among various MR sequences. Results33(78.6%), 30(71.4%), 38(90.5%) and 42(100%) foci were displayed respectively on T2WI, non-enhanced T1WI, enhanced T1WI and enhanced 3D-VIBE images (P＜0.05). The hepatic arterial anatomy of 30 patients （93.8%） and the portal venous structure of 31 patients （96.9%） were clearly depicted on enhanced 3D-VIBE images. Using MIP and MPR reconstruction techniques, the feeding arteries of 14 foci and draining vein of 12 foci were clearly displayed.ConclusionHigh-quality 3D-VIBE images are not only better than 2D images in lesion detection and characterization for primary liver carcinoma, but also able to provide much more information about hepatic vascular anatomy.
With the development of three-dimensional (3D) printing technology, more and more researches have focused on its application in the region of intervertebral fusion materials; the prospects are worth looking forward to. This article reviews the researches about 3D printing technology in spinal implants, and summarizes the materials and printing technology applied in the field of spinal interbody fusion, and the shortcomings in the current research and application. With the rapid development of 3D printing technology and new materials, more and more 3D printing spinal interbodies will be developed and used clinically.
Objective To discuss the effect of the calcaneocuboid arthrodesis on three-dimensional kinematics of talonavicular joint and its clinical significance. Methods Ten freshfrozen foot specimens, three-dimensional kinematics oftalonavicular joint were determined in the case of neutral position, dorsiflexion, plantoflexion, adduction, abduction, inversion and eversion motion by meansof threedimensional coordinate instrument（Immersion MicroScribe G2X） before and after calcaneocuboid arthrodesis under non-weight with moment of couple, bending moment, equilibrium dynamic loading. Calcaneocuboid arthrodesis was performed on these feet in neutral position and the lateral column of normal length. Results A significant decrease in the three-dimensional kinematics of talonavicular joint was observed（P＜0.01）in cadaver model following calcaneocuboid arthrodesis. Talonavicular joint motion was diminished by 31.21%±6.08％ in sagittal plane; by 51.46%±7.91％ in coronal plane; by 36.98%±4.12％ in transverse plane; and averagely by 41.25%±6.02％. Conclusion Calcaneocuboid arthrodesis could limite motion of the talonavicular joints, and the disadvantage of calcaneocuboid arthrodesis shouldn’t be neglected.
Objective To study digitize design of custom-made radial head prosthesis and to verify its matching precision by the surgery of preoperative three-dimensional (3-D) virtual replacement. Methods Six healthy adult volunteers (3 males and 3 females, aged 25-55 years with an average of 33 years) received slice scan of bilateral elbow by Speed Light 16-slice spiral CT. The CT Dicom data were imported into Mimics 10.0 software individually for 3-D reconstruction image, and the left proximal radial 3-D image was extracted, the mirror of the image was generated and it was split into 2 pieces: the head and the neck. The internal diameter and the length of the radial neck were obtained by Mimics 10.0 software measurement tools. In Geomagic Studio 12 software, the radial head was simulated to cover the cartilage surface (1 mm thickness) and generated to an entity. In UG NX 8.0 software, the stem of prosthesis was designed according to the parameters above and assembled head entity. Each custom-made prosthesis was performed and verified its matching precision by the surgery of preoperative 3-D virtual replacement. Results Comparing the morphology of 6 digitize custom-made prostheses with ipsilateral radial heads by the 3-D virtual surgery, the error was less than 1 mm. The radial head prosthesis design on basis of the contralateral anatomy was verified excellent matching. Conclusion The 3-D virtual surgery test and the digitized custom-made radial head prosthesis will be available for clinical accurate replacement.
Objective To elucidate the new development and effects of three-dimensional correction techniques of idiopathic scol iosis (IS). Methods The related home and abroad l iterature concerning three-dimensional correction techniques of IS was extensively reviewed. Results With more and more attention to three-dimensional correction of IS, all kinds of surgery and developed techniques of correction are applied to the correction of IS. The effects of three-dimensional correction of IS are satisfied. Conclusion With more knowledge about IS and more developed theory of correction, more safe and effective techniques of correction is therefore the hot spot for future study.
【Abstract】 Objective To evaluate the feasibility and effectiveness of reconstruction of mandibular bone defects using three-dimensional skull model and individualized titanium prosthetics from computer assisted design. Methods Between July 2002 and November 2009, 9 patients with mandibular defects accepted restorative operation using individualized bone prosthetics. Among 9 cases, 4 were male and 5 were female, aged 19-55 years. The causes of mandibulectomy were benign lesions in 8 patients and carcinoma of gingival in 1 patient. Mandibular defects exceeded midline in 2 cases, involved condylar in 4 cases, and was limited in one side without involvement of temporo-mandibular joint in 3 cases. The range of bone defects was 9.0 cm × 2.5 cm-17.0 cm × 2.5 cm. The preoperative spiral CT scan was performed and three-diamensional skull model was obtained. Titanium prosthetics of mandibular defects were designed and fabricated through multi-step procedure of reverse engineering and rapid prototyping. Titanium prosthetics were used for one-stage repair of mandibular bone defects, then two-stage implant denture was performed after 6 months. Results The individualized titanium prosthetics were inserted smoothly with one-stage operative time of 10-23 minutes. All the cases achieved incision healing by first intention and the oblique mandibular movement was corrected. They all got satisfactory face, had satisfactory contour and good occlusion. In two-stage operation, no loosening of the implants was observed and the abutments were in good position with corresponding teeth which were designed ideally before operation. All cases got satisfactory results after 1-9 years of follow-up. At last follow-up, X-ray examinations showed no loosening of implants with symmetry contour. Conclusion Computer assisted design and three-dimensional skull model techniques could accomplish the design and manufacture of individualized prosthetic for the repair of mandibular bone defects.
Objective To evaluate the security and clinical value of the combination of three-dimensional computed tomography-bronchography and angiography (3D-CTBA) and indocyanine green (ICG) staining in video-assisted thoracic surgery (VATS) segmentectomy. Methods The clinical data of 125 patients who received VATS segmentectomy from January 2020 to January 2021 in our hospital were retrospectively analyzed. There were 40 (32.0%) males and 85 (68.0%) females with an average age of 54.8±11.1 years. Results The procedure was almost identical to the preoperative simulation. All intersegment planes were displayed successfully by ICG reverse staining method. There was no allergic patient. A total of 130 pathological specimens were obtained from the 125 patients. The mean operation time was 126.8±41.9 min, the time of first appearance of fluorescence was 22.7±4.9 s, the mean mark time was 65.6±20.3 s, the median blood loss was 20.0 (10.0-400.0) mL, the postoperative hospital stay was 5.6 (4.0-28.0) d, and the postoperative retention of chest tube time was 3.2 (2.0-25.0) d. Pathological results showed that microinvasive adenocarcinoma was the most common type (38.5%, 50/130), followed by invasive adenocarcinoma (36.9%, 48/130); there were 3 metastatic tumors (3/130, 2.3%).Conclusion The combination of 3D-CTBA and ICG reverse staining is proved to be a safe, necessary and feasible method. It solves the difficult work encountered in the procedure of segmentectomy, and it is worth popularizing and applying in clinic.