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1.
Medicine (Baltimore) ; 99(7): e19046, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049803

RESUMO

INTRODUCTION: It is well known that the main segments of spinal fracture is thoracolumbar (T11-L11). Therefore, in addition to the lumbar, the lower thoracic vertebra (T9-T12) often has the clinical needs of implantation of cortical bone trajectory (CBT) screws. However, the anatomic parameters of the lower thoracic vertebrae are quite different from those of the lumbar vertebrae, which means that if CBT screws are to be implanted in the lower thoracic vertebrae, the selection of the screw entry point, the length, diameter, angle and path of the screws in each segment need to be redefined. Methods In this part, 3-dimensional finite element model was established to analyze the stress and fixation efficiency of CBT screws in thoracic vertebrae after 5000 times of fatigue loading of normal model and osteoporosis model. Discussion If the outcomes indicate the trial is feasible and there is evidence to provide some basic anatomical parameters for CBT screw implantation in the lower thoracic spine, so that the ideal insertion point, length, diameter, and angle of CBT screw in different segments of the lower thoracic spine were determined.Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026915.Registered on September 26, 2019.


Assuntos
Procedimentos Ortopédicos/instrumentação , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Fenômenos Biomecânicos , Parafusos Ósseos , Osso Cortical/anatomia & histologia , Osso Cortical/cirurgia , Estudos de Viabilidade , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Vértebras Torácicas/anatomia & histologia , Adulto Jovem
2.
Khirurgiia (Mosk) ; (1): 40-45, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994498

RESUMO

OBJECTIVE: To improve the results of treatment of patients undergoing laparotomy by using of a new method of aponeurosis suturing after laparotomy. MATERIAL AND METHODS: Training process for a new method of aponeurosis suturing after laparotomy was organized on the patented medical simulator for learning the technique of laparotomy closure. The method was introduced into surgical practice later. The study involved 130 patients who underwent emergency abdominal surgery through median laparotomy. The main group consisted of 70 patients (laparotomy closure using the proposed method (RF patent No.2644846 dated 02/14/18). Interrupted sutures were applied for aponeurosis suturing in the control group. RESULTS: Duration of laparotomy closure was similar in both groups. Postoperative ventral hernias in 1 year after surgery occurred in 5 (8%) patients of the main group and in 11 (18%) patients of the control group. CONCLUSION: The proposed method of aponeurosis suturing after laparotomy is mastered by students and serves as effective method for prevention of postoperative ventral hernias and eventration.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/educação , Aponeurose/cirurgia , Hérnia Ventral/prevenção & controle , Hérnia Incisional/prevenção & controle , Laparotomia/efeitos adversos , Técnicas de Sutura/educação , Fáscia , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Laparotomia/educação , Modelos Anatômicos
3.
PLoS One ; 15(1): e0219954, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31990914

RESUMO

A new methodology was developed to quickly generate whole body models with detailed neck musculoskeletal architecture that are properly scaled in terms of anthropometry and muscle strength. This method was implemented in an anthropometric model generation software that allows users to interactively generate any new male or female musculoskeletal models with adjustment of anthropometric parameters (such as height, weight, neck circumference, and neck length) without the need of subject-specific motion capture or medical images. 50th percentile male and female models were developed based on the 2012 US Army Anthropometric Survey (ANSUR II) database and optimized with a novel bilevel optimization method to have strengths comparable to experimentally measured values in the literature. Other percentile models (ranging from the 1st to 99th percentile) were generated based on anthropometric scaling of the 50th percentile models and compared. The resultant models are reasonably accurate in terms of both musculoskeletal geometry and neck strength, demonstrating the effectiveness of the developed methodology for interactive neck model generation with anthropometric scaling.


Assuntos
Antropometria/métodos , Modelos Anatômicos , Sistema Musculoesquelético/anatomia & histologia , Pescoço/anatomia & histologia , Adulto , Estatura , Peso Corporal , Feminino , Humanos , Contração Isométrica/fisiologia , Masculino , Força Muscular/fisiologia , Pescoço/fisiologia , Software
4.
World Neurosurg ; 133: e327-e341, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520760

RESUMO

BACKGROUND: Medical implications of 3-dimensional (3D) printing technology have evolved and are increasingly used. Surgical spine oncology involves at times complex resection using various surgical approaches and unique spinal reconstruction. As high general complication rates, including hardware failure, are reported, careful preoperative planning and optimized fixation techniques should be performed. 3D printing technology allows the improvement of preoperative planning, practice and exploration of various surgical approaches, and designing customized surgical tools and patient specific implants. OBJECTIVE: To investigate the use of 3D printing technology in complex spine surgeries. METHODS: Between 2015 and 2018, all complex spine oncological cases were evaluated and assessed for the possible benefit of use of 3D printing technology. Following high-quality imaging, a computerized integrated 3D model was created. Based on the planned procedure considering the various surgical steps, a customized 3D model was planned and printed, and in select cases a 3D custom-made implant was designed and printed in various sizes with matching trials. RESULTS: A total of 7 cases were selected for the use of a 3D printing technology. For all, a custom-made model was created. In 3 of these cases, a customized 3D-printed implant was used. Special customized intraoperative instruments were made for 2 cases, and a simulated surgical approach was performed in 5 cases. In 2 cases, pre-bent rods were made based on the model created and were used in surgery later on. CONCLUSIONS: For complex spine oncology cases, the use of 3D printing allowed better preoperative planning, simplified the operative procedure, and enabled improved reconstruction.


Assuntos
Imagem por Ressonância Magnética , Modelos Anatômicos , Impressão Tridimensional , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Transplante Ósseo , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Condrossarcoma/cirurgia , Desenho de Equipamento , Feminino , Tumores de Células Gigantes/diagnóstico por imagem , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Hemangioma/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/secundário , Sarcoma de Ewing/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/secundário , Cirurgia Assistida por Computador/instrumentação , Instrumentos Cirúrgicos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Adulto Jovem
5.
World Neurosurg ; 133: e356-e368, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521759

RESUMO

BACKGROUND: Intracranial aneurysms (IAs) located in the midline region represent formidable challenge owing to their deep location. The objective of this study was to assess feasibility and identify the limitations of endoscopic endonasal clipping of IAs. We further aimed to describe the locations and characteristics of aneurysms that may be amenable for endoscopic endonasal clipping; thus outlining the indications of these approaches. METHODS: Fifteen latex-injected cadaveric heads were used for endoscopic endonasal exposure of anterior and posterior cerebral circulations. An aneurysm simulator model with 2 different sizes was used at the common sites for IAs to emulate a real surgery. Key measured parameters included "exposure of vessels and their respective perforators," "ability to gain proximal/distal control," and "possibility of clip placement" according to the size, direction, and location of the aneurysm model. Maneuverability of instruments and the need for pituitary gland transposition were assessed and recorded as well. RESULTS: Exposure of the anterior communicating artery complex and the common sites of posterior circulation aneurysms were feasible. The size, location, and direction of the aneurysm model had an impact on obtaining proximal and/or distal control, and the ability of clip placement. CONCLUSIONS: Clipping of midline aneurysms of the posterior circulation is feasible via endoscopic endonasal approach. Small-sized ventrally and medially directed aneurysm models carried a better probability of getting proximal and/or distal control, as well as better overall ability to place a clip. The endonasal route seems to provide a limited condition for proper management of anterior circulation aneurysms.


Assuntos
Artérias Cerebrais/anatomia & histologia , Aneurisma Intracraniano/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Cadáver , Circulação Cerebrovascular , Estudos de Viabilidade , Humanos , Modelos Anatômicos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/instrumentação , Neuroendoscopia/instrumentação
6.
World Neurosurg ; 133: e722-e729, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589981

RESUMO

OBJECTIVE: To evaluate the usefulness of 3-dimensional (3D) printed models as an aid for the treatment of complex CVJ anomalies. METHODS: 3D printed models were fabricated for 21 patients with complex CVJ anomalies, including vertebral artery anomaly, thin C2 pedicle, vertical atlantoaxial facet joint, or rotational dislocation combined with atlantoaxial dislocation and basilar invagination. Preoperative planning, surgical simulation, and intraoperative reference were achieved using the 3D model during the surgical treatment. The usefulness of 3D printed models, and postoperative clinical and radiological outcomes were assessed. RESULTS: Direct posterior reduction and atlantoaxial fixation were achieved in 19 patients. Transoral odontoidectomy followed by posterior fixation was implemented for 2 patients with vertical facet joint and rotational dislocation. All screws were safely inserted with no complication, and 90% patients achieved a >60% reduction of both horizontal and vertical dislocation. Clinical symptoms improved in all patients, with the averaged Japanese Orthopedic Association scores increasing from 11.14 to 14.43 (P < 0.01). CONCLUSIONS: The patient-specific 3D printed model would be an effective tool for evaluation of the reducibility of the atlantoaxial dislocation and basilar invagination, decision making in choosing the optimal surgical approach and way of fixation, and precise placement of the screw while protecting the vertebral artery and spinal cord. The risk of neurovascular injury was minimized, and encouraging outcomes were achieved with the aid of this technique.


Assuntos
Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Articulação Atlantoaxial/anormalidades , Articulação Atlantoccipital/anormalidades , Parafusos Ósseos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Artéria Vertebral , Adulto Jovem
7.
Int J Oral Maxillofac Surg ; 49(1): 143-148, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31300302

RESUMO

This study was performed to determine whether an in-house printed mandible model is sufficiently accurate for daily clinical practice. Ten example mandible models were produced with a desktop 3D printer (fused filament fabrication, FFF) and compared with 10 equivalent mandible models fabricated using a professional-grade 3D printer (selective laser sintering, SLS). To determine the precision of the printed models, each model was scanned with an optical scanner. Subsequently, every model was compared to its original standard tessellation language (STL) file and to its corresponding analogue. Mean±standard deviation and median (interquartile range) differences were calculated. Overall these were -0.019±0.219mm and -0.007 (-0.129 to 0.107) mm for all 10 pairs. Furthermore, correlation of all printed models to their original STL files showed a high level of accuracy. Comparison of the SLS models with their STL files revealed a mean difference of -0.036±0.114mm and median difference of -0.028 (-0.093 to 0.030) mm. Comparison of the FFF models with their STL files yielded a mean difference of -0.055±0.227mm and median difference of -0.022 (-0.153 to 0.065) mm. The study findings confirm that in-house 3D printed mandible models are economically favourable as well as suitable substitutes for professional-grade models, in particular considering the geometric aspects.


Assuntos
Modelos Anatômicos , Impressão Tridimensional , Algoritmos , Humanos , Mandíbula
8.
Clin Anat ; 33(1): 25-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31087400

RESUMO

We aim to provide an overview of the various digital three-dimensional visualizations used for learning anatomy and to assess whether these improve medical students' understanding of anatomy compared to traditional learning methods. Furthermore, we evaluate the attitudes of the users of three-dimensional visualizations. We included articles that compared advanced newer three-dimensional anatomy visualization methods (i.e., virtual reality, augmented reality, and computer-based three-dimensional visualizations) to traditional methods that have been used for a long time (i.e., cadaver and textbooks) with regard to users' understanding of anatomy. Of the 1,148 articles identified, 21 articles reported data on the effectiveness of using three-dimensional visualization methods compared to two-dimensional methods. Twelve articles found that three-dimensional visualization is a significantly more effective learning method compared to traditional methods, whereas nine articles did not find that three-dimensional visualization was a significantly more effective method. In general, based on these articles, medical students prefer to use three-dimensional visualizations to learn anatomy. In most of the articles, using three-dimensional visualization was shown to be a more effective method to gain anatomical knowledge compared to traditional methods. Besides that, students are motivated and interested in using these new visualization methods for learning anatomical structures. Clin. Anat. 32:25-33, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Anatomia/educação , Simulação por Computador , Educação Médica/métodos , Imagem Tridimensional , Modelos Anatômicos , Treinamento por Simulação/métodos , Humanos
9.
Clin Anat ; 33(1): 66-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31573101

RESUMO

The anatomy of the pallidothalamic tracts, including the ansa lenticularis, lenticular fasciculus, and thalamic fasciculus (field H1 of Forel), should be elucidated by neurosurgeons and neuroscientists who study deep brain stimulation. In this study, serially sectioned images of a human cadaver head were employed to overcome the limitations of existing methods to observe the pallidothalamic tracts. Owing to the high resolution and real color of the sectioned images, 28 structures, including the pallidothalamic tracts and mammillothalamic fasciculus, were identified. The structures were segmented and made into surface models, which are helpful in improving the stereoscopic understanding. Observing the sectioned images and surface models may help in understanding the detailed anatomy of the pallidothalamic tracts. The new findings, such as the spatial relationship of the tracts, were summarized in a schematic figure. Moreover, to elucidate the anatomical structures along the course of deep brain stimulation, virtual electrodes were inserted into the surface models. The sectioned images and surface models of this study are expected to enhance the understanding of the pallidothalamic tract anatomy. A portable document format file containing the surface models and the sectioned images can be freely downloaded from the authors' homepage. Clin. Anat. 32:66-76, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Globo Pálido/anatomia & histologia , Modelos Anatômicos , Vias Neurais/anatomia & histologia , Subtálamo/anatomia & histologia , Tálamo/anatomia & histologia , Cadáver , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional
10.
Clin Anat ; 33(1): 124-127, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31581311

RESUMO

Anatomical knowledge is a key tenet in graduate medical and surgical education. Classically, these principles are taught in the operating room during live surgical experience. This puts both the learner and the patient at a disadvantage due to environment, time, and safety constraints. Educational adjuncts such as cadaveric courses and surgical skills didactics have been shown to improve resident confidence and proficiency in both anatomical knowledge and surgical techniques. However, the cost-effectiveness of these courses is a limiting factor and in many cases prevents implementation within institutional training programs. Anatomical simulation in the form of "desktop" three-dimensional (3D) printing provides a cost-effective adjunct while maintaining educational value. This article describes the anatomical and patient-centered approach that led to the establishment of our institution's 3D printing laboratory for anatomical and procedural education. Clin. Anat. 32:124-127, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Anatomia/educação , Educação de Pós-Graduação em Medicina/métodos , Imagem Tridimensional , Modelos Anatômicos , Impressão Tridimensional , Treinamento por Simulação/métodos , Cirurgia Geral/educação , Humanos
11.
Gait Posture ; 75: 129-136, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31678694

RESUMO

BACKGROUND: Task-specific loading of the limbs-termed as functional resistance training-is commonly used in gait rehabilitation; however, the biomechanical and neuromuscular effects of various forms of functional resistance training have not been studied systematically. This information is crucial for correctly selecting the appropriate mode of functional resistance training when treating individuals with gait disorders. RESEARCH QUESTION: To comprehensively evaluate the biomechanical (i.e., joint moment and power) and muscle activation changes with different forms of functional resistance training that are commonly used in clinics and research using biomechanical simulation-based analyses. METHODS: We developed simulations of functional resistance training during walking using OpenSim (Gait2354, 23 degrees of freedom and 54 muscles) and custom MATLAB scripts. We investigated five modes of functional resistance training that have been commonly used in clinics or in research: (1) a weight attached at the ankle, (2) an elastic band attached at the ankle, (3) a viscous device attached to the hip and knee, (4) a weight attached at the pelvis, and (5) a constant backwards pulling force at the pelvis. Lower-extremity joint moments and powers were computed using inverse dynamics and muscle activations were estimated using computed muscle control while walking with each device under multiple resistance levels: normal walking with no resistance, and walking with 30, 60, and 90 Newtons of resistance. RESULTS: The results indicate that the way in which resistance is applied during gait training differentially affects the internal joint moments, powers, and muscle activations as well as the joints and phase of the gait cycle where the resistance was experienced. SIGNIFICANCE: The results highlight the importance of understanding the joints and muscles that are targeted by various modes of functional resistance training and carefully choosing the best mode of training that meets the specific therapeutic needs of the patient.


Assuntos
Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Treinamento de Resistência/métodos , Caminhada/fisiologia , Fenômenos Biomecânicos , Simulação por Computador , Marcha/fisiologia , Humanos , Modelos Anatômicos , Suporte de Carga/fisiologia
12.
J Laryngol Otol ; 134(1): 14-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31865920

RESUMO

OBJECTIVE: Three-dimensional printing is a revolutionary technology that is disrupting the status quo in surgery. It has been rapidly adopted by otolaryngology as a tool in surgical simulation for high-risk, low-frequency procedures. This systematic review comprehensively evaluates the contemporary usage of three-dimensional printed otolaryngology simulators. METHOD: A systematic review of the literature was performed with narrative synthesis. RESULTS: Twenty-two articles were identified for inclusion, describing models that span a range of surgical tasks (temporal bone dissection, airway procedures, functional endoscopic sinus surgery and endoscopic ear surgery). Thirty-six per cent of articles assessed construct validity (objective measures); the other 64 per cent only assessed face and content validity (subjective measures). Most studies demonstrated positive feedback and high confidence in the models' value as additions to the curriculum. CONCLUSION: Whilst further studies supported with objective metrics are merited, the role of three-dimensional printed otolaryngology simulators is poised to expand in surgical training given the enthusiastic reception from trainees and experts alike.


Assuntos
Procedimentos Cirúrgicos Otológicos/educação , Impressão Tridimensional/instrumentação , Competência Clínica , Humanos , Modelos Anatômicos , Treinamento por Simulação
13.
J Surg Res ; 245: 99-106, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415935

RESUMO

BACKGROUND: Brainstem hemorrhage is an acute and severe neurosurgical disease. Cerebral hemorrhage is surgically treated via hematoma puncture drainage because of its minimally invasive nature. However, the placement of puncture must be extremely accurate due to the special anatomical location of the brainstem and its physiological functions. The present study aimed to evaluate whether the application of a three-dimensional (3D)-printed navigation mold achieved good outcomes in the surgical treatment of brainstem hemorrhage. MATERIAL AND METHODS: The present study included seven patients (three men and four women aged 40-56 y) who underwent 3D print-assisted hematoma puncture drainage between June 2016 and March 2018 at Binzhou Medical University Hospital. The amount of brainstem hemorrhage was 15-47 mL. We analyzed the basic surgical conditions, deviation distance, and postoperative clinical improvement. RESULTS: In all cases, the operation was completed successfully; no patient died or contracted an infection intraoperatively. The end of the puncture tube was located in the hematoma cavity in all cases. The deviation distance ranged from 2.5 to 7.2, and this distance gradually reduced with improvements in the technique. The hematoma drainage achieved satisfactory postoperative outcomes, with improvements in symptoms such as respiratory failure and hyperthermia. CONCLUSIONS: Use of a 3D-printed navigation mold for puncture drainage of brainstem hemorrhage realized the purpose of individualized and precision medicine, which is important in maintaining the vital signs of patients with severe brainstem hemorrhage.


Assuntos
Hemorragia Cerebral/cirurgia , Drenagem/instrumentação , Hematoma/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Punções/instrumentação , Adulto , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Drenagem/métodos , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções/métodos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Int Braz J Urol ; 45(6): 1129-1135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808400

RESUMO

PURPOSE: To report our initial experience using a patient-specific 3D-printed renal tumor model for the surgical planning of a complex heminephrectomy in a horseshoe kidney. MATERIALS AND METHODS: We selected a clinical case for a complex laparoscopic surgery consisting in a 53 year-old male presenting a local recurrence of a renal tumor in a horseshoe kidney with aberrant vascularisation previously treated with a laparoscopic partial nephrectomy. He is now proposed for a laparoscopic left heminephrectomy. Along with conventional imaging, a real-size 3D-printed renal model was used to plan de surgical approach. The perioperative experience of the surgical team was recorded. RESULTS: The surgical team found the patient-specifi c 3D printed model useful for a better understanding of the anatomy and an easier surgical planning. CONCLUSION: The use of patient-specifi c 3D-printed renal models seem to be helpful for the surgical planning in complex renal tumors.


Assuntos
Carcinoma de Células Renais/cirurgia , Rim Fundido/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Modelos Anatômicos , Impressão Tridimensional , Carcinoma de Células Renais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Imagem Tridimensional/métodos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Reprodutibilidade dos Testes , Resultado do Tratamento
15.
Rhinology ; 57(6): 444-450, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31840148

RESUMO

BACKGROUND: The aims of this study were to propose a novel and uniï¬ed classiï¬cation system of the optico-carotid recess (OCR) and anterior clinoid process (ACP) pneumatization, determine their frequency in a Caucasian population and measure the size of the OCR. METHODOLOGY: A total of 200 specimen (400 sphenoid sinuses) were evaluated in a separate anatomic cadaveric study (n=100) and radiologic study (n=100) by using sphenoidal sinus cast and computed tomography (CT) scan. OCR was divided according to its location to the optic nerve into sub-optical and latero-optical OCR grade I-III. RESULTS: An OCR was found in 39% of the samples (78/200) and in 19% (38/200) it occurred bilaterally. Both, sub-optical and latero-optical OCR were identiï¬ed in 14% of the sides (58/400), with a mean length and depth of 6.9 mm; 7.7 mm and 2.3 mm, 7.1 mm, respectively. We determined the pneumatized ACP frequency with 23% (46/200) and deï¬ned 3 uniï¬ed different types of pneumatization. CONCLUSIONS: The OCR is a reliable landmark to identify the optico-carotid region in endoscopic sphenoid sinus surgery, and can even be visualized by CT. Hence, preoperative investigation of the sphenoid region is mandatory. In our opinion, the classiï¬cation presented in this study can be useful in order to avoid surgical complications.


Assuntos
Nervo Óptico/diagnóstico por imagem , Base do Crânio/anatomia & histologia , Base do Crânio/diagnóstico por imagem , Seio Esfenoidal/anatomia & histologia , Seio Esfenoidal/diagnóstico por imagem , Cadáver , Humanos , Modelos Anatômicos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Nervo Óptico/anatomia & histologia , Base do Crânio/cirurgia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/cirurgia , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X
16.
Orv Hetil ; 160(50): 1967-1975, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31814422

RESUMO

Use of 3D planning and 3D printing is expanding in healthcare. One of the common applications is the creation of anatomical models for the surgical procedure from DICOM files. These patient-specific models are used for multiple purposes, including visualization of complex anatomical situations, simulation of surgical procedures, patient education and facilitating communication between the different disciplines during clinical case discussions. Cardiac and thoracic surgical applications of this technology development include the use of patient-specific 3D models for exploration of ventricle and aorta function and surgical procedural planning in oncology. The 3D virtual and printed models provide a new visualization perspective for the surgeons and more efficient communication between the different clinical disciplines. The 3D project was started at the Semmelweis University with the cooperation of the Thoracic Surgery Department of the National Institute of Oncology in 2018. The authors want to share their experiences in 3D designed medical tools. Orv Hetil. 2019; 160(50): 1967-1975.


Assuntos
Modelos Anatômicos , Assistência Perioperatória , Impressão Tridimensional , Humanos , Hungria
17.
Acta Cir Bras ; 34(9): e201900906, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826098

RESUMO

PURPOSE: To develop 3D anatomical models, and corresponding radiographs, of canine jaw fractures. METHODS: A base model was generated from a mandibular bone scan. With this model it was possible to perform fracture planning according to the anatomical location. RESULTS: The 3D base model of the canine mandible was similar in conformation to the natural bone, demonstrating structures such as canine tooth crowns, premolars and molars, mental foramina, body of the mandible, ramus of the mandible, masseteric fossa, the coronoid process, condylar process, and angular process. It was not possible to obtain detail of the crown of the incisor teeth, mandibular symphysis, and the medullary channel. Production of the 3D CJF model took 10.6 h, used 150.1 g of filament (ABS) and cost US$5.83. CONCLUSION: The 3D canine jaw fractures models, which reproduced natural canine jaw fractures, and their respective radiographic images, are a possible source of educational material for the teaching of veterinary medicine.


Assuntos
Educação em Veterinária/métodos , Imagem Tridimensional/veterinária , Fraturas Mandibulares/veterinária , Modelos Anatômicos , Impressão Tridimensional , Animais , Cães , Imagem Tridimensional/métodos , Mandíbula/anatomia & histologia , Mandíbula/diagnóstico por imagem , Fraturas Mandibulares/diagnóstico por imagem , Radiografia/veterinária , Reprodutibilidade dos Testes , Fatores de Tempo
18.
Acta Cir Bras ; 34(10): e201901006, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826149

RESUMO

PURPOSE: To describe a guide for the construction of a laparoscopic training simulator. METHODS: Step-by-step description of an inexpensive and easy to assemble homemade laparoscopic training box, capable of simulating the laparoscopic environment in its peculiarities to enable technical skills training. RESULTS: The total cost of the materials for the construction of the simulator was US$ 75.00 (about R$ 250.00 "reais") and it can be reduced to US$ 60.00 if the builder judges that there is no need for internal lighting. The use of real trocars imposes the same challenges as real surgeries regarding positioning, visibility and limitation of movements. CONCLUSION: The proposed economical and efficient alternative can contribute to the teaching and practice of laparoscopic surgical technique worldwide, benefiting surgeons and patients.


Assuntos
Laparoscopia/educação , Treinamento por Simulação/métodos , Competência Clínica , Educação Médica/economia , Educação Médica/métodos , Humanos , Laparoscopia/instrumentação , Modelos Anatômicos , Reprodutibilidade dos Testes , Treinamento por Simulação/economia
19.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 451-454, Out.-Dez. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1024494

RESUMO

Introduction: The anatomy of the temporal bone is complex due to the large number of structures and functions grouped in this small bone space, which do not exist in any other region in the human body. With the difficulty of obtaining anatomical parts and the increasing number of ear, nose and throat (ENT) doctors, there was a need to create alternatives as real as possible for training otologic surgeons. Objective: Developing a technique to produce temporal bone models that allow them to maintain the external and internal anatomical features faithful to the natural bone. Methods: For this study, we used a computed tomography (CT) scan of the temporal bones of a 30-year-old male patient, with no structural morphological changes or any other pathology detected in the examination, which was later sent to a 3D printer in order to produce a temporal bone biomodel. Results: After dissection, the lead author evaluated the plasticity of the part and its similarity in drilling a natural bone as grade "4" on a scale of 0 to 5, in which 5 is the closest to the natural bone and 0 the farthest from the natural bone. All structures proposed in the method were found with the proposed color. Conclusion: It is concluded that it is feasible to use biomodels in surgical training of specialist doctors. After dissection of the bone biomodel, it was possible to find the anatomical structures proposed, and to reproduce the surgical approaches most used in surgical practice and training implants (AU)


Assuntos
Humanos , Masculino , Adulto , Osso Temporal/cirurgia , Simulação por Computador , Impressão Tridimensional , Modelos Anatômicos , Procedimentos Cirúrgicos Otológicos/métodos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Educação Médica , Treinamento por Simulação
20.
Medicine (Baltimore) ; 98(52): e18439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876724

RESUMO

BACKGROUND: Our previous three-dimensional finite element analysis found that posterior cruciate ligament (PCL) reconstruction in the modified tibial tunneling placement (MTT, 10 mm inferior and 5 mm lateral to the PCL anatomical insertion) could reduce the peak stress of the graft and may reduce the killer turn. The purpose of the current study was to compare the biomechanical results between MTT and traditional tibial tunneling technique (TTT, PCL anatomical insertion) during transtibial PCL reconstruction. METHODS: Fifty-six 3D-printed tibia models and fresh mature porcine flexor digitorum tendons were studied. The PCL reconstruction specimens were randomly divided into TTT group and MTT group based on tibial tunnel placement. A 50 to 300 N cyclic loading was applied using a material testing system. Each specimen completed 2000 cycles at a rate of 200 mm/min and a loading frequency of 80 cycles/min. Load-displacement curves, failure mode, and graft displacement were recorded. Mean maximum contact pressure was measured using a pressure-sensitive film. After cyclic loading test, the surviving grafts were randomly assigned to load-to-failure group or Scanning Electron Microscopy (SEM) group. Ultimate failure load and the appearance of graft abrasion were recorded and analyzed. RESULT: During the cyclic loading test, 3 samples in the TTT group, and 2 in the MTT group were excluded because of the graft pullout during the test. Mean maximum contact pressure of killer turn was 9.30 ±â€Š0.29 MPa in the TTT group and 7.27 ±â€Š0.25 MPa in MTT group (P < .05). Mean graft displacement was 4.54 ±â€Š0.23 mm in the TTT group and 3.37 ±â€Š3.56 mm in the MTT group (P < .05). Maximum failure load was 1886.0 ±â€Š41.83 N in the TTT group and 2019.30 ±â€Š20.10 N in the MTT group (P < .05). The SEM analysis showed heavy abrasion and fiber discontinuity in graft in the TTT group, while it showed slight abrasion and fiber arrangement disorders in the MTT group. CONCLUSIONS: The MTT PCL reconstruction significantly reduced stress concentration and graft abrasion as compared with the TTT PCL reconstruction, and it may be a better choice for the reduction of "killer Turn" effect during transtibial PCL construction.


Assuntos
Ligamento Cruzado Posterior/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fenômenos Biomecânicos , Humanos , Microscopia Eletrônica de Varredura , Modelos Anatômicos , Ligamento Cruzado Posterior/cirurgia , Suporte de Carga
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