基于薄层标本断面建立可视性三维颅底模型*

目的：为了帮助临床医生学习颅底解剖,创建一个颅底三维模型。方法：应用冷冻铣切技术,获得横断和 冠状薄层断面照片,对于系列照片进行分割、标志、提取颅底结构信号,然后通过Amira 3D 软件,重建了1 个颅 底三维模型。结果：共获得了780 张冠状断面和430 张横断面图片,在这些断面上,颅底的一些精细解剖结构可 以被追踪。成功重建的颅底3D模型可以在任何模式旋转和缩放。但是,因为该模型是在2 个头部标本的基础上 建立的,颅底解剖的变异不能被该模型显示。结论：重建的3D模型可以准确展示颅底解剖结构,它有利于外科 解剖培训,可用来完成术前的手术模拟。     

中国学龄前男童连续薄层标本数据集建立及可视化

目的 建立国人学龄前男童连续超薄解剖标本数据集,并行可视化应用研究。方法 选择经64排螺旋CT 和3.0T MRI全身扫描排除器质性病变和畸形的男童标本,6周岁,身高1.14 m,体重23 kg,发育正常,皮肤、内脏无破损,整体无挤压变形。经定型、冷冻及包埋,置于-25 ℃冷库中3周,由山东数字人公司在-25 ℃低温实验室中逐层数控冷冻无锯损铣切,从脚到头0.10 mm铣切,使用Rencay16k3Scanback相机逐层扫描获取高清晰度数据集图像。结果 共采集11 421张断面图像,所有图像原始保存为PNG格式,每张图像为13 000像素×8000像素,约27.4 MB,整体学龄前男童数据集共计305.60 G。结论 经文献检索,国内目前尚鲜见有从脚到头完整采集成功的学龄前男童数字化可视人体数据集,成功建立的数字化可视男童数据集,为儿童发育形态研究,各器官虚拟手术入路探索,教材与专著编写及儿童疾病预防、诊治及科普等提供高精度的基础大数据集。     

利用废旧头部神经血管标本制作头部颅骨的瓶装标本

利用学生解剖实习用过的头部神经血管标本 ,制作颅骨标本的颅底内面及颅前面观 ,取得满意的效果。处理和制作方法如下 :1 废旧头部标本的处理 ,先将头颅旧标本作水平锯切 ,清除颅腔内脑、脑膜 ,眶腔、鼻腔以及头颅表面软组织 ,并经流水充分冲洗。2 把清除干净软组织的头部颅骨标本晾干或晒干后 ,用 95 %的酒精浸泡 1～ 4周 ,进行脱脂处理。3 用浓度为 5 %～ 10 %的过氧化氢漂白。可依据过氧化氢浓度、室温的高低和骨质坚实程度而灵活掌握漂白时间 ,通常在正常室温下浓度为 10 %的过氧化氢漂白 2～ 3天即可。而后用流水冲洗一周左右取出晾干…     

10岁儿童头部有限元模型的建立及验证

运用ANSYS ICEM CFD以及HYPERMESH软件对10岁儿童头部几何模型进行合理的网格划分,获得具有高度解剖学细节的10岁儿童头部有限元模型。利用MADYMO软件自带的假人,模拟一起典型跌落事故中,受伤儿童从3个不同高度跌落时人体的动力学响应过程,并计算头部与地面碰撞接触瞬间的方位和速度等运动学参数。然后将这些参数输入到10岁儿童头部有限元模型中,模拟头部与地面的碰撞过程,并分析与损伤相关的生物力学参数。结果表明,颅骨的最大应力和最大应变分布在枕骨右侧,与碰撞点的位置较为吻合,但均未超过颅骨的耐受极限。利用颅内压力可较好地预测脑组织的损伤程度,而利用脑组织的von mises应力可较好地判断脑组织的损伤位置。事故重建的结果表明,该模型具有较好的生物逼真度,可以用于儿童头部损伤生物力学的研究。     

儿童头部有限元模型研究进展

头部损伤是导致儿童死亡与伤残的重要原因,对儿童头部损伤生物力学的深入研究意义重大。近年来,通过构建真实的儿童头部有限元模型来研究儿童头部损伤的方法日益成熟,逐步代替了尸体实验、动物实验以及物理实验。对儿童头部有限元模型的年龄特点、构建方法、模型应用以及发展趋势等进行较为全面的综述,并对该领域还有待研究的内容以及未来的发展方向做出展望。     

6岁儿童头部有限元模型的构建与验证

借助6岁儿童医用头部CT扫描图片,通过图像分析处理,提取几何参数,重构生成三维几何模型。对几何模型进行有限元前处理,构建了一个6岁儿童头部有限元模型。模型中包含颅骨、骨缝、脑脊液、大脑、小脑、脑干、脑室等各个器官,共有44 886个节点,11 675个壳单元,37 482个六面体单元。.各器官材料属性采用来自参考文献的数据。仿真分析计算中,力加载时窗为11 ms时,模型的CPU计算时长低于1 h。采用Nahum尸体实验数据与仿真结果进行对比。仿真分析结果显示:成人头部撞击时撞击压与对撞压的形成规律同样适用于儿童头部碰撞。在7 900 N力作用下,尸体头部撞击侧最大压应力为140 kPa,对撞侧最大压应力为-60 kPa,而儿童头部的值分别为220.2 kPa和-135.2 kPa;在HIC值均为775的作用下,成人头部撞击侧和对撞侧最大压应力分别为140 kPa和-60 kPa,而儿童头部的值分别为160 kPa和-89 kPa。这表明,在相同作用力或HIC值下与成人相比,儿童头部更容易受到损伤。     

颅脑组织材料参数对儿童头部冲击响应的影响

目的针对目前对儿童颅脑组织材料参数的不确定性,研究直接冲击载荷条件下颅脑组织材料参数对儿童头部冲击响应的影响。方法应用已验证的3岁儿童头部有限元模型进行冲击仿真实验,采用正交实验设计和方差分析对儿童颅脑组织材料进行参数分析。结果颅骨弹性模量对儿童头部冲击响应具有显著性影响,随着颅骨弹性模量的增加,头部撞击侧颅内压力显著减小(P=0.000),对撞侧颅内压力显著增大(P=0.000),颅骨最大Von Mises应力显著增大(P=0.000)。脑组织的线性黏弹性材料参数对儿童头部冲击响应同样具有显著性影响,随着脑组织短效剪切模量的增加,脑组织最大主应变显著减小(P=0.000),脑组织最大剪应力则显著增加(P=0.000)。结论参数分析结果可为今后儿童头部有限元模型的材料选取提供参考依据,进而提升模型在预测临床上无法通过脑CT影像确诊的脑震荡等脑损伤时的准确性。     

显示中耳结构的头部标本锯切法

中耳咽鼓管细小,且位置较深,解剖时容易损坏,不易显示全貌。作者采用探针穿入咽鼓管先行探路指引的锯切法制作的标本,能较好显示咽鼓管。 1 选材 选用经过福尔马林防腐固定的成人尸     

6岁儿童行人-汽车碰撞中碰撞角度对头部损伤的影响

目的应用符合欧洲新车安全评鉴协会(the European New Car Assessment Programme,Euro NCAP)要求的6岁儿童行人有限元模型,探究不同碰撞角度对儿童头部损伤的影响。方法应用符合Euro NCAP技术公告(TB024)并且具有详细解剖学结构的6岁儿童行人有限元模型,设置4组行人-汽车碰撞仿真试验,探究不同碰撞角度下儿童头部损伤情况。人体头部质心初始位置在车的纵向中心线上,轿车初速度为40 km/h,轿车分别与人体右侧、前侧、左侧、后侧碰撞(即0°、90°、180°、270°)。比较不同碰撞角度下运动学差异和头部碰撞响应,同时分析面骨和颅骨的损伤情况。结果通过分析儿童行人头部接触力、头部质心合加速度、头部质心相对于车的合速度、头部损伤标准(head injury criterion,HIC_(15))、面骨骨折情况以及颅骨应力分布发现,背面、正面碰撞下儿童头部骨折及发生脑组织损伤的风险大于侧面碰撞,其中背面碰撞下儿童行人头部损伤风险最高,侧面碰撞下儿童行人头部损伤风险最低。结论背面碰撞下儿童行人头部损伤风险最大,研究结果对行人-汽车碰撞评估和防护装置研发具有重要的应用价值。     

基于薄层标本断面建立可视性三维颅底模型（英文）

目的 :为了帮助临床医生学习颅底解剖,创建一个颅底三维模型。方法 :应用冷冻铣切技术,获得横断和冠状薄层断面照片,对于系列照片进行分割、标志、提取颅底结构信号,然后通过Amira 3D软件,重建了1个颅底三维模型。结果 :共获得了780张冠状断面和430张横断面图片,在这些断面上,颅底的一些精细解剖结构可以被追踪。成功重建的颅底3D模型可以在任何模式旋转和缩放。但是,因为该模型是在2个头部标本的基础上建立的,颅底解剖的变异不能被该模型显示。结论 :重建的3D模型可以准确展示颅底解剖结构,它有利于外科解剖培训,可用来完成术前的手术模拟。     

Epidemiology of traumatic head injury in Korean children

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD ± 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism.     

Informational needs in families after their child's mild head injury

OBJECTIVE: When a child is hospitalized due to an illness or injury, the entire family may experience stress and/or anxiety. According to parents who have been in such a situation, providing adequate information is one of the most valuable ways to help the family deal with such feelings. Most mild head injuries suffered by children do not require hospitalisation and in such cases, their families should be provided with appropriate information in connection with their visit to the emergency ward. In the present study, family informational needs are characterized. METHODS: The families of 57 children who had suffered a mild head injury at 0-15 years of age answered one open-ended question. The analysis was carried out using content analysis. RESULTS: This analysis revealed two types of needs, i.e., a need for information concerning the head injury itself and how to provide care, as well as a need for reassurance and support in sharing and coping with the emotional burden. CONCLUSION: Despite differences in the severity of the child's head injury and requirement for hospitalisation, all the families expressed the same informational needs but also the need for emotional support. PRACTICE IMPLICATIONS: In connection with the treatment of children with head injuries, health-care personnel should provide the parents both with information concerning the injury and its treatment and with emotional support.     

先天性TORCH感染与头颅CT对照的临床分析

目的分析先天性TORCH感染与头颅CT的临床改变.方法CT扫描采用西门子Somatom DKL型或Smil型CT机,层厚层距均为8mm,从OM线至颅顶连续扫描.病原学采用TORCH-IgM四联筛检试剂盒检测.结果头颅CT显示所有病人均有钙化,脑发育不良8例,脑室扩大10例,异常脑裂6例,脑穿通畸形4例,平滑脑2例.实验室检查,巨细胞病毒感染11例,疱疹病毒感染4例,风疹病毒感染3例,弓形虫感染2例.结论TORCH感染对儿童神经系统的损害是严重的,当婴幼儿头颅CT有异常发现时,应尽早进行血清病原学的检查,及时治疗.     

Effects of head size and morphology on dynamic responses to impact loading

Head responses subjected to impact loading are studied using the finite element method. The dynamic responses of the stress, strain, strain energy density and the intracranial pressure govern the intracranial tissues and skull material failures, and therefore, the traumatic injuries. The objectivity and consistency of the prevailing head traumatic injury criteria, i.e., the energy absorption, the gravity centre acceleration and the head injury criterion (HIC), are examined with regard to the head dynamic responses. In particular, the structural intensity (STI) (the vector representation of energy flow rate) is calculated and discussed. From the simulations, the STI, instead of the gravity centre acceleration, the HIC and the energy absorption criteria, is found to be consistent with the dynamic response quantities. The different local skull curvatures at impact have a marginal effect whereas the locations of the impact loadings have significant effects on the dynamics responses or the head injury. The STI also shows the failure patterns.     

Peak accelerations of the head experienced in boxing

By forcing the torso of a subject to move in a fore and aft direction, in a sinusoidal manner at various frequencies, the response of the head-neck system to an external force has been established. The duration of a typical pulse of force, as encountered in boxing, was measured, and hence it was inferred that in this situation the head is mass-controlled; i.e. the effect of the rigidity and damping of the neck is negligible. The magnitude of the force pulses has been measured at the lower level of their range in a concurrent experiment on a human head and a dynamically equivalent dummy, and by extrapolation estimated for higher levels for the head. The duration and magnitude of the estimated pulse were used in conjunction with the Gadd Severity Index—developed for road safety—and it was found that in a realistic boxing situation a ‘safe level’ can be exceeded by a factor of 4.     

虚拟手术中的力学变形和力觉感知

虚拟手术是培训医生的新兴的有效手段,在虚拟环境中利用视觉、听觉、触觉力觉多感知交互信息,学习和感知手术过程,其中触觉力觉是至关重要的和较难的技术,本文分析了触觉力觉技术在虚拟手术过程中的重要性以及国内外研究现状,对力学变形算法和力觉感知硬件设备的研制和应用进行了探讨。虚拟手术研究的进一步开展,将提高我国数字医学研究的水平。     

Validation study of tripartite model of anxiety and depression in children and adolescents: clinical sample in Korea

Although the currently available literature has provided some empirical support for a tripartite model of child and adolescent anxiety and depression, one of the limitations of these studies was that they have been conducted in America, primarily with Caucasians. In order to make this model more applicable to diverse ethnic and cultural groups, this study used a tripartite model for child and adolescent anxiety and depression in Korea, using confirmatory factor analysis with logically selected items from the Revised Children's Manifest Anxiety Scale (RCMAS), as well as the Children's Depression Inventory (CDI). The results indicated that the model fit of a three-factor model was superior to one- and two-factor models. In addition, the findings of discriminant analysis demonstrated that the correct classification rate with three factors of the tripartite model was superior to the classification rate achievable using CDI and RCMAS. In a departure from Clark and Watson's hypothesis, however, the correlations of three factors were significantly higher than had been expected. The results are discussed on the basis of cultural background.     

Generation of geometry of closed human head and discretisation for finite element analysis

Medical &; Biological Engineering &; Computing -     

Finite-element models of the human head

A review is presented of the existing finite-element (FE) models for the biomechanics of human head injury. Finite element analysis can be an important tool in describing the injury biomechanics of the human head. Complex geometric and material properties pose challenges to FE modelling. Various assumptions and simplifications are made in model development that require experimental validation. More recent models incorporate anatomic details with higher precision. The cervical vertebral column and spinal cord are included. Model results have been more qualitative than quantitative owing to the lack of adequate experimental validation. Advances include transient stress distribution in the brain tissue, frequency responses, effects of boundary conditions, pressure release mechanism of the foramen magnum and the spinal cord, verification of rotation and cavitation theories of brain injury, and protective effects of helmets. These theoretical results provide a basic understanding of the internal biomechanical responses of the head under various dynamic loading conditions. Basic experimental research is still needed to determine more accurate material properties and injury tolerance criteria, so that FE models can fully exercise their analytical and predictive power for the study and prevention of human head injury.