Mitundu itatu yosindikizidwa yamitundu itatu (3DPAMs) ikuwoneka ngati chida choyenera chifukwa cha maphunziro awo komanso kuthekera kwawo.Cholinga cha ndemangayi ndi kufotokoza ndi kusanthula njira zomwe zimagwiritsidwa ntchito popanga 3DPAM pophunzitsa thupi laumunthu ndikuwunika momwe amaphunzitsira.
Kufufuza pakompyuta kunachitika mu PubMed pogwiritsa ntchito mawu otsatirawa: maphunziro, sukulu, kuphunzira, kuphunzitsa, maphunziro, kuphunzitsa, maphunziro, mbali zitatu, 3D, 3-dimensional, kusindikiza, kusindikiza, kusindikiza, anatomy, anatomy, anatomy, ndi anatomy. ..Zomwe anapeza zinaphatikizapo makhalidwe a phunziro, mapangidwe a zitsanzo, kufufuza kwa morphological, ntchito ya maphunziro, mphamvu ndi zofooka.
Pakati pa zolemba zosankhidwa za 68, chiwerengero chachikulu cha maphunziro chinayang'ana dera la cranial (zolemba za 33);Nkhani za 51 zimatchula kusindikiza kwa mafupa.Muzolemba za 47, 3DPAM idapangidwa kutengera computed tomography.Njira zisanu zosindikizira zalembedwa.Pulasitiki ndi zotuluka zake zidagwiritsidwa ntchito m'maphunziro 48.Kapangidwe kalikonse kamakhala pamtengo kuchokera pa $1.25 mpaka $2,800.Maphunziro makumi atatu ndi asanu ndi awiri adayerekeza 3DPAM ndi mitundu yofotokozera.Nkhani makumi atatu ndi zitatu zidasanthula ntchito zamaphunziro.Zopindulitsa zazikulu ndizowoneka bwino komanso zowoneka bwino, luso la kuphunzira, kubwerezabwereza, kusinthika komanso kulimba mtima, kupulumutsa nthawi, kuphatikizika kwa anatomy yogwira ntchito, kuthekera kozungulira bwino kwamaganizidwe, kusunga chidziwitso komanso kukhutitsidwa kwa aphunzitsi / ophunzira.Zoyipa zazikulu zimagwirizana ndi kapangidwe kake: kukhazikika, kusowa kwatsatanetsatane kapena kuwonekera, mitundu yowala kwambiri, nthawi yayitali yosindikiza komanso mtengo wokwera.
Ndemanga mwadongosoloyi ikuwonetsa kuti 3DPAM ndiyotsika mtengo komanso yothandiza pakuphunzitsa anatomy.Zitsanzo zenizeni zimafuna kugwiritsa ntchito matekinoloje osindikizira a 3D okwera mtengo komanso nthawi yayitali yopangira, zomwe zidzakulitsa mtengo wonse.Chinsinsi ndicho kusankha njira yoyenera yojambula.Kuchokera pamalingaliro ophunzitsira, 3DPAM ndi chida chothandiza pophunzitsira anatomy, chomwe chimakhala ndi zotsatira zabwino pakuphunzira komanso kukhutira.Kuphunzitsa kwa 3DPAM ndikwabwino kwambiri ikatulutsanso zigawo zovuta za anatomical ndipo ophunzira amazigwiritsa ntchito koyambirira kwa maphunziro awo azachipatala.
Kudula mitembo ya nyama kwakhala kukuchitika kuyambira ku Greece wakale ndipo ndi imodzi mwa njira zazikulu zophunzitsira anatomy.Ma dissections a Cadaveric omwe amachitidwa panthawi yophunzitsidwa bwino amagwiritsidwa ntchito m'maphunziro aukadaulo a ophunzira azachipatala aku yunivesite ndipo pano amawonedwa ngati muyezo wagolide wophunzirira anatomy [1,2,3,4,5].Komabe, pali zopinga zambiri pakugwiritsa ntchito zitsanzo za cadaveric za anthu, zomwe zimapangitsa kufufuza zida zatsopano zophunzitsira [6, 7].Zina mwa zida zatsopanozi zikuphatikiza zenizeni zenizeni, zida zama digito, ndi kusindikiza kwa 3D.Malinga ndi kafukufuku waposachedwa wa mabuku a Santos et al.[8] Ponena za kufunika kwa matekinoloje atsopanowa pophunzitsa anatomy, kusindikiza kwa 3D kumawoneka ngati imodzi mwazinthu zofunika kwambiri, pokhudzana ndi maphunziro apamwamba kwa ophunzira komanso momwe angagwiritsire ntchito [4,9,10] .
Kusindikiza kwa 3D sikwachilendo.Zovomerezeka zoyamba zokhudzana ndi teknolojiyi zinayambira mu 1984: A Le Méhauté, O De Witte ndi JC André ku France, ndipo masabata atatu pambuyo pake C Hull ku USA.Kuyambira nthawi imeneyo, luso lamakono likupitirizabe kusintha ndipo kugwiritsidwa ntchito kwake kwafalikira m'madera ambiri.Mwachitsanzo, NASA idasindikiza chinthu choyamba kupitilira Dziko Lapansi mu 2014 [11].Othandizira azachipatala atenganso chida chatsopanochi, potero akukulitsa chikhumbo chofuna kupanga mankhwala azikhalidwe [12].
Olemba ambiri awonetsa ubwino wogwiritsa ntchito 3D printed anatomical models (3DPAM) pamaphunziro azachipatala [10, 13, 14, 15, 16, 17, 18, 19].Pophunzitsa anatomy yaumunthu, zitsanzo zopanda pathological ndi anatomically ndizofunikira.Ndemanga zina zawunikira njira zophunzitsira zachipatala kapena zamankhwala / opaleshoni [8, 20, 21].Kuti tipange chitsanzo chosakanizidwa chophunzitsira za thupi la munthu chomwe chimaphatikiza zida zatsopano monga kusindikiza kwa 3D, tidachita kuwunika mwadongosolo kuti tifotokoze ndi kusanthula momwe zinthu zosindikizidwa za 3D zimapangidwira pophunzitsa zathupi la munthu komanso momwe ophunzira amawonera mphamvu yophunzirira pogwiritsa ntchito zinthu za 3D izi.
Ndemanga mwadongosolo yolembedwayi idachitika mu June 2022 popanda zoletsa nthawi pogwiritsa ntchito malangizo a PRISMA (Zokonda Kufotokozera Zowunikira Mwadongosolo ndi Meta-Analyses) [22].
Njira zophatikizira anali mapepala onse ofufuza omwe amagwiritsa ntchito 3DPAM pakuphunzitsa / kuphunzira kwa anatomy.Ndemanga zamabuku, makalata, kapena nkhani zokhudzana ndi matenda, zinyama, zitsanzo zakale, ndi maphunziro a zachipatala / opaleshoni sizinaphatikizidwe.Nkhani zofalitsidwa m’Chingelezi zokha zinasankhidwa.Zolemba zopanda zidule zapaintaneti sizinaphatikizidwe.Zolemba zomwe zinali ndi mitundu ingapo, imodzi mwazomwe zinali zachibadwa kapena zomwe zinali ndi matenda ang'onoang'ono osakhudza phindu la kuphunzitsa, zidaphatikizidwa.
Kufufuza kwa mabuku kunachitika muzinthu zamagetsi za PubMed (National Library of Medicine, NCBI) kuti mudziwe maphunziro oyenerera omwe adasindikizidwa mpaka June 2022. Gwiritsani ntchito mawu ofufuzira awa: maphunziro, sukulu, kuphunzitsa, kuphunzitsa, kuphunzira, kuphunzitsa, maphunziro, atatu- dimensional, 3D, 3D, kusindikiza, kusindikiza, kusindikiza, anatomy, anatomy, anatomy ndi anatomy.Funso limodzi linachitidwa: ((((maphunziro[Mutu/Abstract] KAPENA sukulu[Mutu/Abstract] KAPENA kuphunzira[Mutu/Abstract] KAPENA kuphunzitsa[Mutu/Abstract] KAPENA maphunziro[Mutu/Abstract] OReach[Title/Abstract] ] KAPENA Maphunziro [Mutu/Abstract]) NDI (Miyezo itatu [Mutu] KAPENA 3D [Mutu] KAPENA 3D [Mutu])) NDI (Sindikirani [Mutu] OR Sindikizani [Mutu] OR Sindikizani [Mutu])) NDI (Anatomy) [Mutu. ] ]/abstract] kapena anatomy [mutu/abstract] kapena anatomy [mutu/abstract] kapena anatomy [mutu/abstract]).Zolemba zowonjezera zidadziwika pofufuza pamanja nkhokwe ya PubMed ndikuwunikanso zolemba zina zasayansi.Palibe zoletsa masiku zomwe zidayikidwa, koma fyuluta ya "Munthu" idagwiritsidwa ntchito.
Mitu yonse yobwezeredwa ndi zidule zidawunikidwa motsutsana ndi kuphatikizidwa ndi kuchotsedwa kwa olemba awiri (EBR ndi AL), ndipo kafukufuku uliwonse wosakwaniritsa njira zonse zoyenerera sanaphatikizidwe.Zolemba zathunthu zamaphunziro otsala zidatengedwa ndikuwunikidwanso ndi olemba atatu (EBR, EBE ndi AL).Pamene kuli kofunikira, kusagwirizana pakusankhidwa kwa nkhani kunathetsedwa ndi munthu wachinayi (LT).Zofalitsa zomwe zinakwaniritsa zofunikira zonse zophatikizidwa zidaphatikizidwa mu ndemangayi.
Kutulutsa kwa data kunachitika mwaokha ndi olemba awiri (EBR ndi AL) moyang'aniridwa ndi wolemba wachitatu (LT).
- Deta yamapangidwe amitundu: zigawo za anatomical, magawo enieni a anatomical, mtundu woyamba wa kusindikiza kwa 3D, njira yopezera, magawo ndi mapulogalamu amitundu, mtundu wa chosindikizira cha 3D, mtundu wazinthu ndi kuchuluka, sikelo yosindikiza, mtundu, mtengo wosindikiza.
- Kuwunika kwa morphological kwa zitsanzo: zitsanzo zomwe zimagwiritsidwa ntchito poyerekezera, kuunika kwachipatala kwa akatswiri / aphunzitsi, chiwerengero cha owunika, mtundu wa kafukufuku.
- Kuphunzitsa chitsanzo cha 3D: kuunika kwa chidziwitso cha ophunzira, njira yowunikira, chiwerengero cha ophunzira, chiwerengero cha magulu oyerekeza, kusasintha kwa ophunzira, maphunziro / mtundu wa wophunzira.
Maphunziro a 418 adadziwika mu MEDLINE, ndipo zolemba za 139 sizinaphatikizidwe ndi fyuluta ya "munthu".Pambuyo powunikira mitu ndi zidule, maphunziro a 103 adasankhidwa kuti awerenge zolemba zonse.Zolemba za 34 sizinaphatikizidwe chifukwa mwina zinali zamatenda (zolemba 9), zitsanzo zachipatala/zopangira opaleshoni (zolemba 4), zitsanzo za nyama (zolemba 4), zitsanzo za 3D zama radiology (nkhani imodzi) kapena sizinali zolemba zoyambirira zasayansi (mitu 16).).Zolemba zonse za 68 zidaphatikizidwa pakuwunikaku.Chithunzi 1 chikuwonetsa njira yosankhidwa ngati tchati choyenda.
Tchati choyenda chikufotokoza mwachidule chizindikiritso, kuwunika, ndi kuphatikizika kwa zolemba pakuwunika mwadongosolo
Maphunziro onse adasindikizidwa pakati pa 2014 ndi 2022, ndi chaka chofalitsidwa cha 2019. Mwa 68 omwe adaphatikizapo zolemba, maphunziro 33 (49%) anali ofotokozera komanso oyesera, 17 (25%) anali oyesera chabe, ndipo 18 (26%) anali zoyesera.Zofotokoza bwino.Mwa maphunziro oyesera a 50 (73%), 21 (31%) adagwiritsa ntchito mwachisawawa.Maphunziro a 34 okha (50%) adaphatikizapo kusanthula kwa ziwerengero.Gulu 1 likufotokozera mwachidule za phunziro lililonse.
Nkhani za 33 (48%) zinayang'ana mutu wa mutu, nkhani za 19 (28%) zinayang'ana dera la thoracic, nkhani za 17 (25%) zinayang'ana dera la mimba, ndipo nkhani za 15 (22%) zinayang'ana kumapeto.Zolemba makumi asanu ndi chimodzi (75%) zidatchula mafupa osindikizidwa a 3D ngati zitsanzo za anatomical kapena mitundu yambiri yamagulu a anatomical.
Ponena za magwero a magwero kapena mafayilo omwe amagwiritsidwa ntchito popanga 3DPAM, nkhani za 23 (34%) zinatchula kugwiritsa ntchito deta ya odwala, nkhani za 20 (29%) zinatchula kugwiritsa ntchito deta ya cadaveric, ndipo nkhani za 17 (25%) zinatchula kugwiritsa ntchito deta.zinagwiritsidwa ntchito, ndipo maphunziro a 7 (10%) sanaulule kumene zolembazo zinagwiritsidwa ntchito.
Maphunziro a 47 (69%) adapanga 3DPAM pogwiritsa ntchito computed tomography, ndipo maphunziro a 3 (4%) adanena kugwiritsa ntchito microCT.Zolemba za 7 (10%) zikuwonetseratu zinthu za 3D pogwiritsa ntchito makina opangira kuwala, zolemba za 4 (6%) pogwiritsa ntchito MRI, ndi nkhani ya 1 (1%) pogwiritsa ntchito makamera ndi ma microscopes.Zolemba za 14 (21%) sizinatchule gwero la mafayilo amtundu wa 3D.Mafayilo a 3D amapangidwa ndi kusanja kwapakati kwapakati pa 0.5 mm.Kuwongolera koyenera ndi 30 μm [80] ndipo kusamvana kwakukulu ndi 1.5 mm [32].
Mapulogalamu makumi asanu ndi limodzi a mapulogalamu osiyanasiyana (magawo, ma modeling, mapangidwe kapena kusindikiza) anagwiritsidwa ntchito.Mimics (Materialise, Leuven, Belgium) amagwiritsidwa ntchito nthawi zambiri (maphunziro a 14, 21%), akutsatiridwa ndi MeshMixer (Autodesk, San Rafael, CA) (maphunziro 13, 19%), Geomagic (3D System, MO, NC, Leesville) .(maphunziro 10, 15%), 3D Slicer (Slicer Developer Training, Boston, MA) (9 maphunziro, 13%), Blender (Blender Foundation, Amsterdam, Netherlands) (8 maphunziro, 12%) ndi CURA (Geldemarsen, Netherlands) (maphunziro 7, 10%).
Zitsanzo zosindikizira makumi asanu ndi limodzi mphambu zisanu ndi ziwiri ndi njira zisanu zosindikizira zimatchulidwa.Ukadaulo wa FDM (Fused Deposition Modeling) udagwiritsidwa ntchito pazinthu 26 (38%), kuphulika kwa zinthu 13 (19%) ndipo pomaliza kuphulika kwa binder (11 product, 16%).Ukadaulo wosagwiritsidwa ntchito kwambiri ndi stereolithography (SLA) (zolemba 5, 7%) ndi laser sintering (SLS) (zolemba 4, 6%).Chosindikizira chomwe chimagwiritsidwa ntchito kwambiri (zolemba 7, 10%) ndi Connex 500 (Stratasys, Rehovot, Israel) [27, 30, 32, 36, 45, 62, 65].
Pofotokoza zinthu zomwe zimagwiritsidwa ntchito popanga 3DPAM (zolemba 51, 75%), maphunziro 48 (71%) adagwiritsa ntchito mapulasitiki ndi zotuluka zawo.Zida zazikulu zomwe zimagwiritsidwa ntchito zinali PLA (polylactic acid) (n = 20, 29%), resin (n = 9, 13%) ndi ABS (acrylonitrile butadiene styrene) (mitundu 7, 10%).Zolemba za 23 (34%) zidasanthula 3DPAM yopangidwa kuchokera kuzinthu zingapo, zolemba za 36 (53%) zidapereka 3DPAM zopangidwa kuchokera ku chinthu chimodzi chokha, ndipo zolemba za 9 (13%) sizinatchule chilichonse.
Zolemba makumi awiri mphambu zisanu ndi zinayi (43%) zidanenanso zosindikiza kuyambira 0.25:1 mpaka 2:1, ndi avareji ya 1:1.Zolemba makumi awiri ndi zisanu (37%) zidagwiritsa ntchito chiŵerengero cha 1:1.28 3DPAMs (41%) inali ndi mitundu ingapo, ndipo 9 (13%) idapakidwa utoto pambuyo posindikiza [43, 46, 49, 54, 58, 59, 65, 69, 75].
Zolemba makumi atatu ndi zinayi (50%) zatchula mtengo.Zolemba 9 (13%) zidatchula mtengo wa osindikiza a 3D ndi zida.Osindikiza amasiyana pamtengo kuchokera pa $302 mpaka $65,000.Potchulidwa, mitengo yachitsanzo imachokera ku $ 1.25 mpaka $ 2,800;izi monyanyira zimagwirizana ndi zitsanzo za chigoba [47] ndi high-fidelity retroperitoneal zitsanzo [48].Table 2 ikufotokoza mwachidule deta yachitsanzo pa phunziro lililonse lophatikizidwa.
Maphunziro makumi atatu ndi asanu ndi awiri (54%) anayerekezera 3DAPM ndi chitsanzo.Pakati pa maphunzirowa, wofanizira wodziwika bwino anali chitsanzo cha anatomical, chomwe chimagwiritsidwa ntchito m'nkhani 14 (38%), kukonzekera kopangidwa ndi pulasitiki muzolemba za 6 (16%), zokonzekera zapulasitiki muzolemba za 6 (16%).Kugwiritsa ntchito zenizeni zenizeni, computed tomography imaging 3DPAM imodzi muzolemba 5 (14%), 3DPAM ina muzolemba 3 (8%), masewera akulu m'nkhani 1 (3%), ma radiographs m'nkhani 1 (3%), mitundu yamabizinesi mu 1 nkhani (3%) ndi chowonadi chowonjezereka mu nkhani imodzi (3%).Maphunziro makumi atatu ndi anayi (50%) adayesa 3DPAM.Maphunziro khumi ndi asanu (48%) adalongosola zomwe adakumana nazo mwatsatanetsatane (Table 3).3DPAM idachitidwa ndi madokotala ochita opaleshoni kapena opezeka ndi madokotala mu maphunziro a 7 (47%), akatswiri a anatomical mu maphunziro a 6 (40%), ophunzira mu maphunziro a 3 (20%), aphunzitsi (chilango sichinatchulidwe) mu maphunziro a 3 (20%) kuti ayesedwe. ndi wowunika winanso m'nkhaniyi (7%).Avereji ya owunika ndi 14 (ochepera 2, opambana 30).Maphunziro makumi atatu ndi atatu (49%) adayesa 3DPAM morphology moyenera, ndipo maphunziro 10 (15%) adayesa 3DPAM morphology mochulukira.Mwa maphunziro 33 omwe adagwiritsa ntchito kuwunika koyenera, 16 adagwiritsa ntchito zowunika zongofotokoza (48%), 9 adagwiritsa ntchito mayeso / mavoti / kafukufuku (27%), ndipo 8 adagwiritsa masikelo a Likert (24%).Table 3 ikufotokoza mwachidule kuwunika kwa morphological kwa zitsanzo mu phunziro lililonse lophatikizidwa.
Zolemba makumi atatu ndi zitatu (48%) zidaunika ndikuyerekeza mphamvu ya kuphunzitsa 3DPAM kwa ophunzira.Mwa maphunzirowa, zolemba za 23 (70%) zidayesa kukhutira kwa ophunzira, 17 (51%) adagwiritsa ntchito masikelo a Likert, ndipo 6 (18%) adagwiritsa ntchito njira zina.Zolemba makumi awiri ndi ziwiri (67%) zidayesa kuphunzira kwa ophunzira kudzera pakuyesa chidziwitso, pomwe 10 (30%) adagwiritsa ntchito zoyeserera ndi / kapena zoyeserera.Maphunziro khumi ndi limodzi (33%) adagwiritsa ntchito mafunso ndi mayeso angapo kuti awone zomwe ophunzira akudziwa, ndipo maphunziro asanu (15%) adagwiritsa ntchito zilembo zazithunzi / chizindikiritso cha thupi.Pafupifupi ophunzira 76 adatenga nawo gawo paphunziro lililonse (osachepera 8, opitilira 319).Maphunziro makumi awiri ndi anayi (72%) anali ndi gulu lolamulira, lomwe 20 (60%) linagwiritsa ntchito mwachisawawa.Mosiyana ndi izi, kafukufuku wina (3%) adapereka mwachisawawa zitsanzo za anatomical kwa ophunzira 10 osiyanasiyana.Pafupifupi, magulu a 2.6 anafananizidwa (osachepera 2, opambana 10).Maphunziro makumi awiri ndi atatu (70%) adakhudza ophunzira azachipatala, omwe 14 (42%) anali ophunzira a chaka choyamba azachipatala.Maphunziro asanu ndi limodzi (18%) anakhudza okhalamo, 4 (12%) ophunzira mano, ndi 3 (9%) ophunzira sayansi.Maphunziro asanu ndi limodzi (18%) adakhazikitsa ndikuwunika kuphunzira pawokha pogwiritsa ntchito 3DPAM.Table 4 ikufotokoza mwachidule zotsatira za 3DPAM yophunzitsa bwino pa phunziro lililonse lophatikizidwa.
Ubwino waukulu womwe olemba amafotokoza kuti agwiritse ntchito 3DPAM ngati chida chophunzitsira cha chibadwa chamunthu ndi mawonekedwe owoneka bwino komanso owoneka bwino, kuphatikiza zenizeni [55, 67], kulondola [44, 50, 72, 85], ndi kusinthasintha kosasintha [34, 45] ]., 48, 64], mtundu ndi kuwonekera [28, 45], kukhazikika [24, 56, 73], zotsatira za maphunziro [16, 32, 35, 39, 52, 57, 63, 69, 79], mtengo [27, 41, 44, 45, 48, 51, 60, 64, 80, 81, 83], reproducibility [80], kuthekera kwa kusintha kapena makonda [28, 30, 36, 45, 48, 51, 53, 59, 61, 67 , 80], luso loyendetsa ophunzira [30, 49], kupulumutsa nthawi yophunzitsa [61, 80], kusungirako mosavuta [61], kutha kuphatikizira ma anatomy ogwira ntchito kapena kupanga mapangidwe enieni [51, 53], 67] , mapangidwe ofulumira a zitsanzo za chigoba [81], kuthekera kopanga zitsanzo ndikupita nazo kunyumba [49, 60, 71], kupititsa patsogolo luso losinthasintha maganizo [23] ndi kusunga chidziwitso [32], komanso aphunzitsi [ 25, 63] ndi kukhutira kwa ophunzira [25, 45, 46, 52, 52, 57, 63, 66, 69, 84].
Zoyipa zazikulu ndizogwirizana ndi mapangidwe: kukhazikika [80], kusasinthika [28, 62], kusowa kwatsatanetsatane kapena kuwonekera [28, 30, 34, 45, 48, 62, 64, 81], mitundu yowala kwambiri [45].ndi kufooka kwa pansi[71].Zoyipa zina ndikuphatikizira kutayika kwa chidziwitso [30, 76], nthawi yayitali yofunikira kuti pakhale magawo azithunzi [36, 52, 57, 58, 74], nthawi yosindikiza [57, 63, 66, 67], kusowa kwa kusintha kwa thupi [25], ndi mtengo.Wapamwamba [48].
Kuwunika mwadongosolo kumeneku kumapereka chidule cha zolemba 68 zomwe zasindikizidwa zaka 9 ndikuwunikira chidwi cha asayansi ku 3DPAM ngati chida chophunzitsira momwe thupi limakhalira.Chigawo chilichonse cha anatomical chinawerengedwa ndipo 3D inasindikizidwa.Mwazolembazi, zolemba za 37 zidafanizira 3DPAM ndi mitundu ina, ndipo zolemba za 33 zidawunika kufunika kwa maphunziro a 3DPAM kwa ophunzira.
Chifukwa cha kusiyana kwa mapangidwe a maphunziro osindikizira a 3D, sitinaone kuti n'koyenera kuchita meta-analysis.Kusanthula kwa meta komwe kudasindikizidwa mu 2020 makamaka kumayang'ana kwambiri mayeso a chidziwitso cha anatomical ataphunzitsidwa osasanthula zaukadaulo ndiukadaulo wamapangidwe a 3DPAM ndi kupanga [10].
Dera lamutu ndilomwe limaphunziridwa kwambiri, mwina chifukwa chovuta kwa thupi lake kumapangitsa kuti zikhale zovuta kwambiri kwa ophunzira kuwonetsera chigawo cha anatomical ichi mu malo atatu-dimensional poyerekeza ndi miyendo kapena torso.CT ndiyo njira yomwe imagwiritsidwa ntchito kwambiri pojambula zithunzi.Njirayi imagwiritsidwa ntchito kwambiri, makamaka pazachipatala, koma imakhala ndi malo ochepa komanso kusiyana kochepa kwa minofu yofewa.Zolepheretsa izi zimapangitsa kuti ma CT scans akhale osayenera kugawikana ndi kutsanzira dongosolo lamanjenje.Kumbali inayi, computed tomography ndi yoyenera kugawanika kwa fupa / kutsanzira;Kusiyanitsa kwa mafupa / zofewa kumathandiza kumaliza masitepe awa pamaso pa mitundu yosindikiza ya 3D.Kumbali inayi, microCT imatengedwa ngati ukadaulo wofotokozera potengera kusinthika kwapamalo pamaganizidwe a mafupa [70].Ma scanner a Optical kapena MRI angagwiritsidwenso ntchito kupeza zithunzi.Kusasunthika kwapamwamba kumalepheretsa kusalaza kwa mafupa ndikusunga chinsinsi cha mawonekedwe a anatomical [59].Kusankhidwa kwachitsanzo kumakhudzanso kusintha kwa malo: mwachitsanzo, zitsanzo za pulasitiki zimakhala ndi malingaliro otsika [45].Ojambula zithunzi ayenera kupanga zitsanzo za 3D, zomwe zimawonjezera mtengo ($25 mpaka $150 pa ola) [43].Kupeza mafayilo apamwamba kwambiri a .STL sikokwanira kupanga zitsanzo zamtundu wapamwamba kwambiri.Ndikofunikira kudziwa magawo osindikizira, monga momwe mawonekedwe a anatomical amathandizira pa mbale yosindikizira [29].Olemba ena amanena kuti matekinoloje apamwamba osindikizira monga SLS ayenera kugwiritsidwa ntchito ngati kuli kotheka kuti 3DPAM ikhale yolondola [38].Kupanga 3DPAM kumafuna thandizo la akatswiri;akatswiri omwe amafunidwa kwambiri ndi mainjiniya [72], akatswiri a radiology, [75], ojambula zithunzi [43] ndi anatomists [25, 28, 51, 57, 76, 77].
Mapulogalamu a magawo ndi ma modeling ndi zinthu zofunika kwambiri kuti mupeze zitsanzo zolondola za anatomical, koma mtengo wa mapulogalamuwa ndi zovuta zawo zimalepheretsa kugwiritsa ntchito kwawo.Maphunziro angapo ayerekezera kugwiritsa ntchito mapulogalamu osiyanasiyana a mapulogalamu ndi matekinoloje osindikizira, kuwonetsa ubwino ndi kuipa kwa teknoloji iliyonse [68].Kuphatikiza pa pulogalamu yachitsanzo, pulogalamu yosindikiza yogwirizana ndi chosindikizira yosankhidwa imafunikanso;olemba ena amakonda kugwiritsa ntchito kusindikiza kwa 3D pa intaneti [75].Ngati zinthu zokwanira 3D zitasindikizidwa, ndalamazo zitha kubweretsa kubweza ndalama [72].
Pulasitiki ndi chinthu chomwe chimagwiritsidwa ntchito kwambiri.Mitundu yake yambiri yamitundu ndi mitundu imapangitsa kuti ikhale yosankha 3DPAM.Olemba ena adayamika mphamvu zake zapamwamba poyerekeza ndi mitundu yakale ya cadaveric kapena pulasitiki [24, 56, 73].Mapulasitiki ena amakhala ndi zinthu zopindika kapena zotambasula.Mwachitsanzo, Filaflex yokhala ndi teknoloji ya FDM imatha kutambasula mpaka 700%.Olemba ena amawona kuti ndizosankhidwiratu za minofu, tendon ndi ligament replication [63].Kumbali inayi, maphunziro awiri adadzutsa mafunso okhudza ulusi wa fiber panthawi yosindikiza.M'malo mwake, kuyang'ana kwa ulusi wa minofu, kuyika, kulowa mkati, ndi ntchito ndizofunikira kwambiri pakufanizira minofu [33].
Chodabwitsa n'chakuti, kafukufuku wochepa amatchula kukula kwa makina osindikizira.Popeza anthu ambiri amaona kuti chiŵerengero cha 1:1 ndi choyenera, wolembayo angakhale atasankha kusatchulapo.Ngakhale kukulitsa kungakhale kothandiza pophunzira molunjika m'magulu akuluakulu, kuthekera kwa kukula sikunafufuzidwebe, makamaka ndi kukula kwa kalasi ndi kukula kwachitsanzo kukhala chinthu chofunikira.Zowonadi, masikelo akulu akulu amathandizira kuti azitha kupeza komanso kufotokoza matupi osiyanasiyana kwa wodwala, zomwe zingafotokoze chifukwa chake amagwiritsidwa ntchito nthawi zambiri.
Mwa osindikiza ambiri omwe akupezeka pamsika, omwe amagwiritsa ntchito ukadaulo wa PolyJet (zakuthupi kapena zomangira inkjet) kuti apereke utoto ndi mitundu ingapo (ndipo chifukwa chamitundu yambiri) mtengo wosindikiza wapamwamba pakati pa US$20,000 ndi US$250,000 (https: //www .aniwaa.com/).Mtengo wokwerawu ukhoza kuchepetsa kukwezedwa kwa 3DPAM m'masukulu azachipatala.Kuphatikiza pa mtengo wa chosindikizira, mtengo wazinthu zofunikira pakusindikiza kwa inkjet ndi wapamwamba kuposa osindikiza a SLA kapena FDM [68].Mitengo ya osindikiza a SLA kapena FDM ndiyotsika mtengo, kuyambira €576 mpaka €4,999 m'nkhani zomwe zalembedwa mu ndemangayi.Malinga ndi Tripodi ndi anzawo, gawo lililonse la chigoba likhoza kusindikizidwa US$1.25 [47].Maphunziro khumi ndi limodzi adatsimikiza kuti kusindikiza kwa 3D ndikotsika mtengo kuposa pulasitiki kapena mitundu yamalonda [24, 27, 41, 44, 45, 48, 51, 60, 63, 80, 81, 83].Kuphatikiza apo, mitundu yamalondayi idapangidwa kuti ipereke chidziwitso cha odwala popanda tsatanetsatane wokwanira pakuphunzitsa kwa anatomy [80].Mitundu yamalonda iyi imawonedwa ngati yotsika kwa 3DPAM [44].Ndikoyenera kudziwa kuti, kuwonjezera pa teknoloji yosindikizira yomwe imagwiritsidwa ntchito, mtengo womaliza umakhala wofanana ndi msinkhu choncho kukula komaliza kwa 3DPAM [48].Pazifukwa izi, kukula kwakukulu kumakondedwa [37].
Kafukufuku m'modzi yekha anayerekeza 3DPAM ndi mitundu ya anatomical yomwe ilipo pamalonda [72].Zitsanzo za Cadaveric ndizomwe zimagwiritsidwa ntchito kwambiri poyerekeza ndi 3DPAM.Ngakhale kuti ali ndi malire, zitsanzo za cadaveric zimakhalabe chida chofunika kwambiri pophunzitsa anatomy.Kusiyanitsa kuyenera kupangidwa pakati pa autopsy, dissection ndi youma fupa.Kutengera mayeso ophunzitsira, maphunziro awiri adawonetsa kuti 3DPAM inali yothandiza kwambiri kuposa dissection pulasitiki [16, 27].Kafukufuku wina anayerekezera ola limodzi la maphunziro pogwiritsa ntchito 3DPAM (m'munsi m'munsi) ndi ola limodzi la dissection ya dera lomwelo la anatomical [78].Panalibe kusiyana kwakukulu pakati pa njira ziwiri zophunzitsira.Zikuoneka kuti pali kafukufuku wochepa pamutuwu chifukwa kufananiza koteroko kumakhala kovuta kupanga.Dissection ndi nthawi yambiri yokonzekera ophunzira.Nthawi zina pamafunika maola ambiri kukonzekera, malingana ndi zomwe zikukonzedwa.Kuyerekezera kwachitatu kungapangidwe ndi mafupa owuma.Kafukufuku wa Tsai ndi Smith adapeza kuti mayeso anali abwino kwambiri pagulu pogwiritsa ntchito 3DPAM [51, 63].Chen ndi anzawo adazindikira kuti ophunzira omwe amagwiritsa ntchito mitundu ya 3D adachita bwino pozindikira zigaza (zigaza), koma panalibe kusiyana pamasewera a MCQ [69].Pomaliza, Tanner ndi anzake adawonetsa zotsatira zabwino pambuyo poyesa gululi pogwiritsa ntchito 3DPAM ya pterygopalatine fossa [46].Zida zina zatsopano zophunzitsira zidadziwika m'mabuku awa.Zodziwika kwambiri pakati pawo ndizowona zenizeni, zenizeni zenizeni komanso masewera akulu [43].Malinga ndi Mahrous ndi anzawo, zokonda zamitundu yofananira zimatengera kuchuluka kwa maola omwe ophunzira amasewera masewera a kanema [31].Kumbali ina, cholepheretsa chachikulu cha zida zatsopano zophunzitsira za anatomy ndi mayankho a haptic, makamaka pazida zenizeni [48].
Maphunziro ambiri omwe amawunika 3DPAM yatsopano agwiritsa ntchito zoyeserera za chidziwitso.Zoyeserera izi zimathandizira kupewa kukondera pakuwunika.Olemba ena, asanachite maphunziro oyesera, amapatula ophunzira onse omwe adapambana pa avareji pamayeso oyamba [40].Pakati pa kukondera Garas ndi anzake otchulidwa anali mtundu wa chitsanzo ndi kusankha odzipereka mu kalasi wophunzira [61].Kupaka utoto kumathandizira kuzindikira mawonekedwe a anatomical.Chen ndi anzake adakhazikitsa zoyesera zolimba popanda kusiyana koyambirira pakati pa magulu ndipo phunzirolo linachititsidwa khungu mpaka momwe zingathere [69].Lim ndi anzawo amalimbikitsa kuti kuwunika kwapambuyo-kuyesedwa kumalizidwe ndi munthu wina kuti apewe kukondera pakuwunika [16].Kafukufuku wina wagwiritsa ntchito masikelo a Likert kuti awone kuthekera kwa 3DPAM.Chida ichi ndi choyenera kuwunika kukhutitsidwa, komabe pali zokondera zofunika kuzidziwa [86].
Kufunika kwamaphunziro kwa 3DPAM kudawunikidwa makamaka pakati pa ophunzira azachipatala, kuphatikiza ophunzira azachipatala a chaka choyamba, m'maphunziro 14 mwa 33.Mu kafukufuku wawo woyendetsa ndege, Wilk ndi anzawo adanenanso kuti ophunzira azachipatala amakhulupirira kuti kusindikiza kwa 3D kuyenera kuphatikizidwa pakuphunzira kwawo kwa anatomy [87].87% ya ophunzira omwe adafunsidwa mu kafukufuku wa Cercenelli amakhulupirira kuti chaka chachiwiri cha maphunziro inali nthawi yabwino yogwiritsira ntchito 3DPAM [84].Zotsatira za Tanner ndi anzawo zidawonetsanso kuti ophunzira adachita bwino ngati sanaphunzirepo gawoli [46].Izi zikusonyeza kuti chaka choyamba cha sukulu ya zachipatala ndi nthawi yoyenera kuphatikizira 3DPAM mu chiphunzitso cha anatomy.Ye's meta-analysis idathandizira lingaliro ili [18].M'nkhani za 27 zomwe zaphatikizidwa mu phunziroli, panali kusiyana kwakukulu pamayeso pakati pa 3DPAM ndi zitsanzo zachikhalidwe za ophunzira azachipatala, koma osati kwa okhalamo.
3DPAM monga chida chophunzirira imapangitsa kuti maphunziro apite patsogolo [16, 35, 39, 52, 57, 63, 69, 79], kusunga chidziwitso kwa nthawi yayitali [32], ndi kukhutira kwa ophunzira [25, 45, 46, 52, 57, 63 , 66]., 69, 84].Magulu a akatswiri adapezanso zitsanzozi zothandiza [37, 42, 49, 81, 82], ndipo maphunziro awiri adapeza kukhutitsidwa ndi aphunzitsi ndi 3DPAM [25, 63].Mwa magwero onse, Backhouse ndi anzawo amawona kusindikiza kwa 3D kukhala njira yabwino kwambiri yosinthira mitundu yachikhalidwe [49].Pakuwunika kwawo koyamba, Ye ndi anzawo adatsimikizira kuti ophunzira omwe adalandira malangizo a 3DPAM anali ndi zotsatira zabwino pambuyo poyesa kuposa ophunzira omwe adalandira malangizo a 2D kapena cadaver [10].Komabe, adasiyanitsa 3DPAM osati ndi zovuta, koma ndi mtima, dongosolo lamanjenje, ndi m'mimba.M'maphunziro asanu ndi awiri, 3DPAM sinapambane mitundu ina kutengera mayeso a chidziwitso omwe amaperekedwa kwa ophunzira [32, 66, 69, 77, 78, 84].Pakuwunika kwawo kwa meta, a Salazar ndi anzawo adatsimikiza kuti kugwiritsa ntchito 3DPAM kumathandizira kumvetsetsa kwa anatomy ovuta [17].Lingaliro ili likugwirizana ndi kalata ya Hitas kwa mkonzi [88].Madera ena a anatomical omwe amaonedwa kuti ndi ovuta kwambiri safuna kugwiritsa ntchito 3DPAM, pamene madera ovuta kwambiri a anatomical (monga khosi kapena dongosolo lamanjenje) angakhale kusankha koyenera kwa 3DPAM.Lingaliro ili litha kufotokozera chifukwa chake ma 3DPAM ena samawonedwa kuti ndi apamwamba kuposa zitsanzo zachikhalidwe, makamaka ophunzira akapanda chidziwitso pamalo pomwe magwiridwe antchito amawonedwa kuti ndi apamwamba.Chifukwa chake, kupereka chitsanzo chosavuta kwa ophunzira omwe ali ndi chidziwitso cha phunzirolo (ophunzira azachipatala kapena okhalamo) sikuthandiza pakuwongolera magwiridwe antchito a ophunzira.
Pazopindulitsa zonse zamaphunziro zomwe zalembedwa, maphunziro a 11 adatsindika mawonekedwe owoneka kapena owoneka bwino amitundu [27,34,44,45,48,50,55,63,67,72,85], ndipo maphunziro a 3 adakulitsa mphamvu ndi kulimba (33). , 50 -52, 63, 79, 85, 86).Ubwino wina ndi woti ophunzira amatha kugwiritsa ntchito zida, aphunzitsi amatha kusunga nthawi, ndi zosavuta kusunga kuposa ma cadavers, ntchitoyo imatha kutha mkati mwa maola 24, itha kugwiritsidwa ntchito ngati chida chophunzirira kunyumba, ndipo itha kugwiritsidwa ntchito pophunzitsa ndalama zambiri. za chidziwitso.magulu [30, 49, 60, 61, 80, 81].Kusindikiza kobwerezabwereza kwa 3D kwa chiphunzitso cha anatomy chapamwamba kumapangitsa kuti mitundu yosindikizira ya 3D ikhale yotsika mtengo [26].Kugwiritsa ntchito 3DPAM kumatha kupititsa patsogolo kusinthasintha kwamaganizidwe [23] ndikuwongolera kutanthauzira kwa zithunzi zamagulu osiyanasiyana [23, 32].Maphunziro awiri adapeza kuti ophunzira omwe adakumana ndi 3DPAM amatha kuchitidwa opaleshoni [40, 74].Zolumikizira zitsulo zimatha kuphatikizidwa kuti apange kayendedwe kofunikira kuti aphunzire momwe zimagwirira ntchito [51, 53], kapena zitsanzo zitha kusindikizidwa pogwiritsa ntchito mapangidwe oyambitsa [67].
Kusindikiza kwa 3D kumapangitsa kuti pakhale mitundu yosinthika ya anatomical mwa kukonza zinthu zina panthawi yachitsanzo, [48, 80] kupanga maziko abwino, [59] kuphatikiza mitundu ingapo, [36] kugwiritsa ntchito kuwonekera, (49) mtundu, [45] kapena kupanga zomangira zina zamkati [30].Tripodi ndi anzawo adagwiritsa ntchito chosema dongo kuti agwirizane ndi mafupa awo osindikizidwa a 3D, kugogomezera kufunika kwa zitsanzo zopangidwa limodzi ngati zida zophunzitsira [47].M'maphunziro 9, mtundu unkagwiritsidwa ntchito pambuyo posindikiza [43, 46, 49, 54, 58, 59, 65, 69, 75], koma ophunzira adagwiritsa ntchito kamodzi kokha [49].Tsoka ilo, phunziroli silinayese ubwino wa maphunziro achitsanzo kapena ndondomeko ya maphunziro.Izi ziyenera kuganiziridwa pokhudzana ndi maphunziro a anatomy, monga ubwino wa maphunziro ophatikizana ndi kupanga nawo limodzi zimakhazikitsidwa bwino [89].Pofuna kuthana ndi ntchito yotsatsa yomwe ikukula, kudziphunzira kwagwiritsidwa ntchito nthawi zambiri kuyesa zitsanzo [24, 26, 27, 32, 46, 69, 82].
Kafukufuku wina adapeza kuti mtundu wa pulasitiki unali wowala kwambiri[45], kafukufuku wina adatsimikizira kuti chitsanzocho chinali chosalimba kwambiri[71], ndipo maphunziro ena awiri amasonyeza kuti panalibe kusiyana kwa matupi a anatomical pamapangidwe amitundu imodzi [25, 45] ]..Maphunziro asanu ndi awiri adatsimikiza kuti tsatanetsatane wa anatomical wa 3DPAM ndi wosakwanira [28, 34, 45, 48, 62, 63, 81].
Kuti mudziwe zambiri zamtundu wa anatomical zigawo zazikulu ndi zovuta, monga retroperitoneum kapena khomo lachiberekero msana, kugawanika ndi nthawi yachitsanzo kumaonedwa kuti ndi yaitali kwambiri ndipo mtengo wake ndi wokwera kwambiri (pafupifupi US $ 2000) [27, 48].Hojo ndi anzake adanena mu phunziro lawo kuti zinatenga maola 40 kuti apange chitsanzo cha anatomical cha pelvis [42].Nthawi yayitali kwambiri yogawanitsa inali maola a 380 mu kafukufuku wa Weatherall ndi anzawo, momwe mitundu ingapo idaphatikizidwa kuti ipange mtundu wathunthu wapanjira ya ana [36].M'maphunziro asanu ndi anayi, kugawa magawo ndi nthawi yosindikiza kumawonedwa ngati koyipa [36, 42, 57, 58, 74].Komabe, maphunziro a 12 adadzudzula mawonekedwe amitundu yawo, makamaka kusasinthika kwawo, [28, 62] kusowa kuwonekera, [30] fragility ndi monochromaticity, [71] kusowa kwa minofu yofewa, [66] kapena kusowa kwatsatanetsatane [28, 34]., 45, 48, 62, 63, 81].Zoyipa izi zitha kuthetsedwa powonjezera magawo kapena nthawi yofananira.Kutaya ndi kubweza zidziwitso zoyenera kunali vuto lomwe magulu atatu adakumana nalo [30, 74, 77].Malinga ndi malipoti a odwala, othandizira omwe ali ndi ayodini sanapereke mawonekedwe abwino a mitsempha chifukwa cha kuchepa kwa mlingo [74].Jekeseni wa cadaveric model ikuwoneka ngati njira yabwino yomwe imachoka pa mfundo ya "pang'ono momwe ndingathere" ndi malire a mlingo wa jekeseni wosiyanitsa.
Tsoka ilo, zolemba zambiri sizitchula zina zazikulu za 3DPAM.Pasanathe theka la zolembazo zinanena momveka bwino ngati 3DPAM yawo inali yojambulidwa.Kufalikira kwa kuchuluka kwa kusindikiza kunali kosagwirizana (43% ya nkhani), ndipo 34% yokha inatchula kugwiritsa ntchito mauthenga ambiri.Zosindikizira izi ndizofunikira chifukwa zimakhudza momwe 3DPAM imaphunzirira.Zolemba zambiri sizimapereka chidziwitso chokwanira chokhudza zovuta zopezera 3DPAM (nthawi yopangira, ziyeneretso za ogwira ntchito, ndalama zamapulogalamu, ndalama zosindikizira, ndi zina).Chidziwitsochi ndi chofunikira kwambiri ndipo chiyenera kuganiziridwa musanayambe ntchito yokonza 3DPAM yatsopano.
Ndemanga mwadongosolo izi zikuwonetsa kuti kupanga ndi kusindikiza kwa 3D zitsanzo zamtundu wamba ndizotheka pamtengo wotsika, makamaka mukamagwiritsa ntchito osindikiza a FDM kapena SLA ndi zida zapulasitiki zotsika mtengo zamtundu umodzi.Komabe, mapangidwe ofunikirawa amatha kukulitsidwa powonjezera mtundu kapena kuwonjezera mapangidwe muzinthu zosiyanasiyana.Zitsanzo zenizeni (zosindikizidwa pogwiritsa ntchito zida zingapo zamitundu yosiyanasiyana ndi mawonekedwe kuti zifanizire bwino mawonekedwe amtundu wa cadaver) zimafuna umisiri wodula wa 3D komanso nthawi yayitali yopangira.Izi zidzakulitsa kwambiri mtengo wonse.Ziribe kanthu kuti ndi njira iti yosindikiza yomwe yasankhidwa, kusankha njira yoyenera yojambulira ndikofunikira kuti 3DPAM apambane.Kukwera kwa malo, m'pamenenso chitsanzocho chimakhala chenichenicho ndipo chingagwiritsidwe ntchito pa kafukufuku wapamwamba.Kuchokera pamalingaliro ophunzitsira, 3DPAM ndi chida chothandiza pophunzitsira anatomy, monga zikuwonekera ndi mayeso a chidziwitso omwe amaperekedwa kwa ophunzira komanso kukhutitsidwa kwawo.Kuphunzitsa kwa 3DPAM ndikwabwino kwambiri ikatulutsanso zigawo zovuta za anatomical ndipo ophunzira amazigwiritsa ntchito koyambirira kwa maphunziro awo azachipatala.
Zolemba zomwe zapangidwa ndi/kapena zofufuzidwa mu kafukufuku wapano sizipezeka poyera chifukwa cha zopinga za zilankhulo koma zimapezeka kuchokera kwa mlembi wogwirizana ndi pempho loyenera.
Drake RL, Lowry DJ, Pruitt CM.Kuwunikiridwa kwa gross anatomy, microanatomy, neurobiology, ndi maphunziro a embryology mu maphunziro asukulu yachipatala yaku US.Anat Rec.2002;269(2):118-22.
Ghosh SK Cadaveric dissection ngati chida chophunzitsira cha sayansi ya anatomical m'zaka za zana la 21: Dissection ngati chida chophunzitsira.Kusanthula maphunziro a sayansi.2017; 10 (3): 286-99.
Nthawi yotumiza: Apr-09-2024