3D打印模型在泌尿外科血管相关性疾病教学中的应用探讨

评价3D打印模型在泌尿外科血管相关性疾病（胡桃夹综合征、腔静脉后输尿管）教学中的应用效果，探讨其可行性与有效性。将实习学员随机分为两组，分别采用传统教学法（对照组）和结合3D打印模型的教学法（试验组）进行教学，以理论和实践考核进行对比，并对结合3D打印模型的教学模式满意度予以问卷调查测评。试验组考核成绩优于对照组（P<0.05）。试验组问卷调查教学模式满意度的结果显示，96.67%的学生对结合3D打印模型的教学模式的总体评价是满意的。3D打印模型在泌尿外科血管相关性疾病教学中的应用，可以直观展示疾病模型，有助于加深学生对相关知识的理解、记忆，能够提高教学质量，是一种有效的教学方法。     

3D打印技术应用于心血管疾病精准医疗的临床进展

<正>心血管疾病(cardiovascular disease,CVD)的发病率逐年上升,死亡率不断增长,患病率趋于年轻化,给家庭和社会带来了巨大的压力和沉重的负担,因此心血管疾病的精确防治已经刻不容缓。CVD主要包括先天性心脏病、瓣膜病、冠心病、心律失常以及大血管病变等。在医疗技术不断发展的历程中,CVD经历了外科手术、介入治疗的过程,在目前提倡精     

3D打印在神经外科应用的新进展

3D打印自20世纪90年代迅速兴起并逐步应用于各行各业。近年来3D打印在医学领域的应用一定意义上带动了神经外科发展,其带来的变化或许将改变整个医疗行业面貌,其在未来还有多种应用可能。本文就3D打印在神经外科的应用作一综述。     

3D打印心血管模型体外手术模拟在经导管主动脉瓣置换手术教学中的应用

目的 探究3D打印心血管模型体外手术模拟在经导管主动脉瓣置换（TAVR）教学中的应用效果。 方法 选取2021年3月～2021年9月参加西京医院心血管外科举办的瓣膜介入治疗培训班40名学员为教学对象,分为教学实验组和对照组。对照组（25人）采用理论授课+手术直播教学方法,教学实验组（15人）采用理论授课+ 3D打印心血管模型体外手术模拟教学方法,两组教学学时一致。培训班课程结束后对两组学员进行考核比较。 结果 考核采用的试卷主要从三个方面进行测试评价,即手术适应症和禁忌症（30分）、影像学评估（30分）和标准化手术操作流程（40分）。在手术适应症和禁忌症方面,两组学员考试成绩无明显差异;影像学评估方面,两组学员成绩无明显差异;标准化手术操作流程方面,教学实验组学员的成绩明显高于对照组（P < 0.01）。从总成绩方面,教学实验组学员的成绩明显高于对照组（P < 0.01）。课程结束后调查问卷结果显示,3D打印心血管模型进行体外手术模拟这种教学方法更能提高学习兴趣、提高团队协作能力、提高分析问题能力、增加师生互动、利于实际工作能力,并且有更高比例的学员喜欢该教学方式（均P < 0.05）。对照组考核结束后补充3D打印心血管模型体外手术模拟视频教学,再次考核后两组成绩无明显差异,充分保证了教学公平。 结论 在TAVR手术教学方面,采用3D打印心血管模型体外模拟手术过程的教学方式对于提高学员手术掌握程度和学习效率方面有重要作用。     

特发性肺动脉瘤3D打印模型的构建与评估

目的 构建特发性肺动脉瘤3D打印模型,并对构建模型的准确性进行评估。方法 收集1例特发性肺动脉瘤患者的CT影像资料,用医学影像控制系统Mimics Research、3-Matic Research软件建立3D肺动脉瘤模型（3D模型）,并对其进行优化（优化模型）,将优化模型输入3D打印机构建肺动脉瘤3D打印模型（3D打印模型）。采用线性拟合回归分析、Bland-Altman分析法评价3D打印模型的准确性。结果 构建并打印出肺动脉瘤3D打印模型（肺动脉瘤直径为55.38 mm）。测量CT模型与优化模型、优化模型与3D打印模型所得到两组测量值相关性强（r=0.99）,且一致性强。结论 成功构建特发性肺动脉瘤3D打印模型,且构建模型的准确性高。     

3D打印指导经导管主动脉瓣置换术的多中心回顾性研究

目的:利用3D打印主动脉根部模型评估分析来辅助指导经导管主动脉瓣置换术(TAVR),以减少TAVR并发症,提高手术成功率.方法:回顾性纳入2018～2021年在国内28家心脏中心行TAVR的868例患者临床资料,分为3D打印组(n=326)和非3D打印组(n=542).非3D打印组按照正常的影像评估规划行TAVR,3D...     

应用3D打印技术辅助治疗老年复杂肱骨近端骨折的疗效

目的探讨3D打印技术辅助治疗老年复杂肱骨近端骨折的临床应用效果。方法老年复杂肱骨近端骨折患者64例,采用随机数字表法分为实验组和对照组各32例,两组均给予常规治疗,实验组用3D打印技术辅助治疗,比较两组临床相关指标,随访12个月,并采用Neer肩关节评分法(Neer评分)和CMS肩关节评分系统(CMS评分)评价术后肩关节功能。结果手术后X线片可见内固定状况良好,与对照组相比,实验组内固定过程中手术时间、出血量、内固定后引流量及骨折愈合时间均小于对照组(P<0.05)。手术结束后随访12个月,实验组Neer评分的优良率高于对照组(P<0.05);两组术前CMS各项(疼痛、肌力、日常活动、关节活动范围)评分及总分比较差异无统计学意义(P>0.05),治疗后两组各项评分及总分均有改善,且实验组改善更明显(P<0.05)。结论应用3D打印技术辅助治疗老年复杂肱骨近端骨折能够减少手术时间、出血量、内固定后引流量及骨折愈合时间,改善肩关节活动功能,提高了手术质量。     

3D打印Dry Lab模型在腹腔镜胃底折叠手术教学中的应用

3D打印模型的腹腔镜下手术培训寻是一种新颖、教学成本低、效果好的教学方法,一定程度上弥补传统教育和实践操作教育之间的不足。利用3D抗反流手术模型在腹腔镜下完成胃底折叠手术学习曲线,对于外科医师手术技术的提高将有极大的帮助,同时也可以弥补由于手术量不足及患者个体解剖变异所带来的手术难度及风险的提升,有利于规避患者术中和术后并发症的发生,为手术规范化标准化提供保证。     

数字化3D打印技术在口腔医学中的临床应用进展

数字化3D打印是医疗卫生行业发展迅速的一项技术,在口腔临床医学领域表现出巨大潜力,包括牙体牙髓病学、口腔修复学、正畸学、颌面外科和口腔种植学。新型数字化3D打印可以辅助设计并制作个性化导板、模型、假体和生物支架等,具有高精准、微创化、操作时长短和工作效率高等优点。借助医理工多学科交叉和数字化程序辅助设计,数字化3D打印技术可为口腔疾病的预防和诊疗提供更具个性化和多元化的方案或策略。对数字化3D打印技术在口腔医学各个领域的临床应用进行总结,可为不同的口腔临床医学领域应用数字化3D打印技术提供参考依据。     

3D打印数字化技术辅助治疗髋臼后壁骨折的临床探讨

目的探讨和比较传统切开复位内固定术和3D打印数字化技术辅助手术治疗髋臼后壁骨折的临床治疗效果。方法对该院2014-05~2016-02分别采用传统切开复位内固定术(传统手术组,31例)和3D打印数字化技术辅助手术(3D打印手术组,32例)治疗髋臼后壁骨折共63例,对两组患者手术时间、术中出血量、术后引流量、术后髋关节疼痛评分(VAS)和髋关节功能评分(Harris)进行比较分析。结果两组共63例患者均顺利完成手术,住院和随访期间无死亡病例,两组病例无并发症发生。63例患者术后均获得6~12个月随访,平均9.7个月。3D打印手术组在手术时间、术中出血量和术后引流量方面优于传统手术组,两组比较差异有统计学意义(P0.05);3D打印手术组在术后2周和3个月髋关节VAS评分、Harris评分优于传统手术组,两组比较差异有统计学意义(P0.05);两组在术后6个月髋关节VAS评分、Harris评分比较差异无统计学意义(P0.05)。结论 3D打印数字化技术辅助髋臼后壁骨折的手术治疗,有助于术者制定个体化的治疗方案,缩短手术时间,减少软组织损伤,减少失血量,实现微创、精准治疗,疗效满意。     

Percutaneous closure of left ventricle pseudoaneurysm using 3D printed heart model for procedure planning: A novel approach

Left ventricle pseudoaneurysm is a rare complication of myocardial infarction that carries a high risk of mortality. In this report, we present a case of successful percutaneous closure of left ventricle pseudoaneurysm using 3D printing for procedure guidance.     

A decisional balance measure and the stages of change model for weight loss

Two studies were conducted to explore the cognitive and motivational aspects related to progression through the stages of intentional change in weight loss and control. Study I developed a Decisional Balance Measure for comparison of the positive and negative aspects of a decision to try to lose weight. Based on principal components analysis, item analysis, and coefficient alpha, 20 items were retained, 10 for each of two orthogonal scales labeled Pros and Cons. These two components accounted for 50% of the total variance. In Study II, the Pro, Con, and Pro-Con difference scores were compared across groups representing four stages in the change process: Precontemplation, Contemplation, Action, and Maintenance. External validity for the Decisional Balance Measure was provided by significant ANOVAs for the Pro and the Pro-Con scale scores, with the Action group showing the greatest imbalance of Pros over Cons. The combination of the decisional balance and stages of change models appears to offer a powerful tool for relating two important elements in an integrated theory of how change occurs naturally, and how it could be enhanced through planned treatment.     

Controlling form errors in 3D printed models associated to size and position on the working plane

The purpose of this paper is to assess the main effects on the geometric errors in terms of flatness, circularity and cylindricity based on the size of the printed benchmarks and according to the position of the working plane of the 3D printer. Three benchmark models of different sizes, with a parallelepiped and cylinder shape placed in five different positions on the working plane are considered. The sizes of models are chosen from the Renard series R40. Benchmark models are fabricated in ABS (Acrylonitrile Butadiene Styrene) using RepRap Prusa i3 3D printer. A sample of five parts for each geometric category, as defined from the R40 geometric series of numbers, is printed close to each corner of the plate, and in the plate center position. Absolute Digimatic Height Gauge 0–450 mm with an accuracy of ± 0.03 mm by Mitutoyo is used to perform all measurements: flatness on box faces, and circularity/cylindricity on cylinders. Results show that the best performances, in terms of form accuracy, are reached in the upper-left printable area while they decrease with the sample size. Being quality a critical factor for a successful industrial application of the AM processes, the results discussed in this paper can provide the AM community with additional scientific data useful to understand how to improve the quality of parts which may be obtained through new generations of 3D printer.     

糖化血清白蛋白正常参考值的多中心临床研究

目的 通过多中心协作研究,初步建立中国人糖化血清白蛋白(GA)的正常参考值,为临床应用提供依据.方法 采用液态酶法测定全国10个中心380例正常体重、正常糖调节者(20～69岁,男183例,女197例)的GA水平.结果 (1)380例正常人GA值为(14.5±1.9)%,将研究对象分为20～39、40～59及60～69岁3个年龄亚组,可见GA水平在年龄亚组间差异无统计学意义(P>0.05);男女之间比较,20～39岁年龄段女性GA高于男性(P=0.028),但校正BMI后差异消失(P>0.05).(2)根据BMI水平将正常人分为18.5～20.9、21.0～22.9及23.0～24.9 ks/m<'2>3个亚组,男性各哑组间GA水平差异无统计学意义(P>0.05),女性BMI 18.5～20.9 kg/m<'2>亚组GA水平高于BMI 23.0～24.9 kg/m<'2>亚组(P=0.024).(3)以百分位数法取GA的2.5%～97.5%作为正常参考值范围为10.8%～17.1%.(4)60例正常人在相隔2～3周后再次检测GA以进行重复性评估,结果显示两次GA水平分别为(14.2±1.7)%和(14.0±1.6)%,差异无统计学意义(P=0.073).结论 推荐11%～17%作为中国人GA的正常参考值.     

A retrospective cohort study of clinical value of PRL-3 in stage III human colorectal cancer

The aim of this study was to investigate the expression of phosphatase of regenerating live-3 (PRL-3) in human stage III colorectal cancer (CRC) and to evaluate its correlation with metachronous liver metastasis (MLM) and prognosis.The retrospective cohort study included 116 stage III CRC primary tumors and 60 normal colorectal tissues. PRL-3 expression was measured by immunohistochemistry. We investigated the correlation of PRL-3 with clinicopathologic features by the chi-square test. The association of PRL-3 expression with MLM was assessed by binary logistic regression. Overall survival (OS) and disease-free survival (DFS) between patients with positive PRL-3 expression and those with negative PRL-3 expression were compared by the Kaplan–Meier method and Cox proportional hazards regression model.We found that 32.8% of stage III CRC primary tumors were PRL-3 positive, and 15.0% of normal colorectal epithelia showed high PRL-3 expression (P = .012). Seventeen tumors (47.2%) among 36 cases that developed MLM were PRL-3 positive, and only 21 tumors (26.3%) in the 80 cases that did not develop MLM had positive PRL-3 expression (P = .026). PRL-3 expression was associated with MLM (P = .028). Patients with positive expression of PRL-3 showed a significantly shorter OS (40.32 ± 3.97 vs 53.96 ± 2.77 months, P = .009) and DFS (34.97 ± 4.30 vs 44.48 ± 2.89 months, P = .036). A multivariate analysis indicated that PRL-3 expression was an independent unfavorable prognostic factor for OS (P = .007).Our study suggested that high PRL-3 expression is an independent risk factor for MLM and poor prognosis. PRL-3 is expected to be a promising biomarker for predicting the incidence of MLM and prognosis in patients with stage III CRC.     

老年前列腺增生症患者逼尿肌功能变化的尿动力学检测意义

目的探讨前列腺增生症（ＢＰＨ）患者逼尿肌功能变化的尿动力学特点及其临床意义。方法应用尿动力学技术，检查３５例ＢＰＨ患者的尿流率、膀胱充盈期和排尿期压力、膀胱感觉，观察膀胱容量－压力相关关系，测定剩余尿量，评估膀胱的稳定性、顺应性及逼尿肌受损程度。结果逼尿肌不稳定２２例（６２．９％），逼尿肌收缩功能受损８例（２２．９％），膀胱顺应性改变５例（１４．２％），表明ＢＰＨ可引起逼尿肌功能变化。结论尿动力学对判断逼尿肌功能状态、确定排尿功能障碍原因、选择药物治疗或手术适应证有重要意义。     

A measure to assess the ablative margin using 3D-CT image fusion after radiofrequency ablation of hepatocellular carcinoma

ObjectivesTo examine the feasibility of three-dimensional computed tomography (3D-CT) image fusion in facilitating assessment of the ablative margin (AM) after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).MethodsThis study involved 75 patients with solitary HCC who underwent RFA. The AM was evaluated using 3D-CT image fusion. All cases were categorized into two groups based on the extent of the AM: in Group A, sufficient AM was obtained, which was greater than or equal to 5 mm; in Group B, the lesion was also ablated successfully, but a 5 mm AM was not obtained.Results3D-CT Image Fusion was performed on 36 and 39 patients in Group A and Group B, respectively. The 1, 3, 5 year RFS was 87.6%, 63.2%, 50.6% for Group A, and 77.2%, 51.5%, 35.6% for Group B, respectively (P = 0.042); the corresponding OS was 94.3%, 73.8%, 64.6%, and 86.2%, 60.5%, 47.6%, respectively (P = 0.046). Multivariate analysis showed that the AM (P = 0.048, HR = 2.15, 95% CI 1.01–4.60) and Pre-NLR were independent prognostic factors for PFS.Conclusions3D-CT image fusion is a feasible and useful method to evaluate the AM after RFA of HCC.