Ma model a anatomical osindikizidwa a magawo atatu (3DPAMs) akuoneka kuti ndi chida choyenera chifukwa cha kufunika kwawo pamaphunziro komanso kuthekera kwawo. Cholinga cha ndemangayi ndikufotokozera ndikuwunika njira zomwe zimagwiritsidwa ntchito popanga 3DPAM pophunzitsa kapangidwe ka thupi la munthu komanso kuwunika momwe imathandizira pophunzitsa.
Kufufuza kwa pakompyuta kunachitika ku PubMed pogwiritsa ntchito mawu otsatirawa: maphunziro, sukulu, kuphunzira, kuphunzitsa, kuphunzitsa, maphunziro, magawo atatu, 3D, magawo atatu, kusindikiza, kusindikiza, kusindikiza, kapangidwe ka thupi, kapangidwe ka thupi, ndi kapangidwe ka thupi. . Zomwe zapezeka zikuphatikizapo makhalidwe a kafukufuku, kapangidwe ka chitsanzo, kuwunika mawonekedwe a thupi, magwiridwe antchito a maphunziro, mphamvu ndi zofooka.
Pakati pa nkhani 68 zomwe zasankhidwa, chiwerengero chachikulu cha maphunziro omwe adayang'ana kwambiri dera la cranial (nkhani 33); nkhani 51 zatchula kusindikiza mafupa. M'nkhani 47, 3DPAM idapangidwa kutengera computed tomography. Njira zisanu zosindikizira zalembedwa. Mapulasitiki ndi zotumphukira zake zidagwiritsidwa ntchito mu maphunziro 48. Kapangidwe kalikonse kamakhala ndi mtengo kuyambira $1.25 mpaka $2,800. Maphunziro makumi atatu mphambu asanu ndi awiri adayerekeza 3DPAM ndi mitundu yofotokozera. Nkhani makumi atatu mphambu zitatu zidafufuza zochitika zamaphunziro. Ubwino waukulu ndi mawonekedwe ndi mawonekedwe, kuphunzira bwino, kubwerezabwereza, kusintha ndi kusinthasintha, kusunga nthawi, kuphatikiza kapangidwe ka thupi, luso labwino losinthasintha maganizo, kusunga chidziwitso ndi kukhutitsidwa kwa aphunzitsi/ophunzira. Zoyipa zazikulu zikugwirizana ndi kapangidwe kake: kusinthasintha, kusowa kwa tsatanetsatane kapena kuwonekera bwino, mitundu yowala kwambiri, nthawi yayitali yosindikiza komanso mtengo wokwera.
Kuwunika kumeneku kukuwonetsa kuti 3DPAM ndi yotsika mtengo komanso yothandiza pophunzitsa kapangidwe ka thupi. Ma model enieni amafunikira kugwiritsa ntchito ukadaulo wokwera mtengo kwambiri wa kusindikiza kwa 3D komanso nthawi yayitali yopangira, zomwe zidzawonjezera mtengo wonse. Chofunika kwambiri ndikusankha njira yoyenera yojambulira zithunzi. Kuchokera pamalingaliro ophunzitsira, 3DPAM ndi chida chothandiza pophunzitsa kapangidwe ka thupi, chomwe chimakhudza bwino zotsatira za kuphunzira ndi kukhutira. Zotsatira za kuphunzitsa za 3DPAM zimakhala bwino kwambiri zikaberekanso madera ovuta a kapangidwe ka thupi ndipo ophunzira amazigwiritsa ntchito koyambirira kwa maphunziro awo azachipatala.
Kudula mitembo ya nyama kwakhala kukuchitika kuyambira ku Greece wakale ndipo ndi njira imodzi yayikulu yophunzitsira za kapangidwe ka thupi. Kudula mitembo komwe kumachitika panthawi yophunzira ntchito kumagwiritsidwa ntchito mu maphunziro a zamaganizo a ophunzira azachipatala aku yunivesite ndipo pakadali pano kumaonedwa ngati muyezo wagolide wophunzirira za kapangidwe ka thupi [1,2,3,4,5]. Komabe, pali zopinga zambiri pakugwiritsa ntchito zitsanzo za mitembo ya anthu, zomwe zimapangitsa kuti pakhale kufunafuna zida zatsopano zophunzitsira [6, 7]. Zina mwa zida zatsopanozi zikuphatikizapo zenizeni zowonjezera, zida zama digito, ndi kusindikiza kwa 3D. Malinga ndi ndemanga yaposachedwa ya mabuku ndi Santos et al. [8] Ponena za kufunika kwa ukadaulo watsopanowu wophunzitsira kapangidwe ka thupi, kusindikiza kwa 3D kumawoneka ngati chimodzi mwazinthu zofunika kwambiri, ponse pawiri pankhani ya phindu la maphunziro kwa ophunzira komanso potengera kuthekera kogwiritsa ntchito [4,9,10].
Kusindikiza kwa 3D sikwatsopano. Ma patent oyamba okhudzana ndi ukadaulo uwu adachokera mu 1984: A Le Méhauté, O De Witte ndi JC André ku France, ndipo patatha milungu itatu C Hull ku USA. Kuyambira pamenepo, ukadaulowu wapitilizabe kusintha ndipo kugwiritsidwa ntchito kwake kwafalikira m'malo ambiri. Mwachitsanzo, NASA idasindikiza chinthu choyamba kupitirira Dziko Lapansi mu 2014 [11]. Madera azachipatala agwiritsanso ntchito chida chatsopanochi, motero akuwonjezera chikhumbo chopanga mankhwala apadera [12].
Olemba ambiri awonetsa ubwino wogwiritsa ntchito mitundu ya anatomical yosindikizidwa ndi 3D (3DPAM) mu maphunziro azachipatala [10, 13, 14, 15, 16, 17, 18, 19]. Pophunzitsa kapangidwe ka thupi la munthu, mitundu yosakhudzana ndi matenda komanso yachibadwa imafunika. Ndemanga zina zafufuza mitundu yophunzitsira matenda kapena zachipatala/opaleshoni [8, 20, 21]. Kuti tipange chitsanzo chosakanikirana chophunzitsira kapangidwe ka thupi la munthu chomwe chimaphatikizapo zida zatsopano monga kusindikiza kwa 3D, tinachita ndemanga yokonzedwa bwino kuti tifotokoze ndikusanthula momwe zinthu zosindikizidwa za 3D zimapangidwira pophunzitsa kapangidwe ka thupi la munthu komanso momwe ophunzira amawunikira momwe kuphunzira kumagwirira ntchito pogwiritsa ntchito zinthu za 3D izi.
Kuwunikanso mabuku mwadongosolo kumeneku kunachitika mu June 2022 popanda zoletsa za nthawi pogwiritsa ntchito malangizo a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [22].
Zofunikira zonse zophatikizira zinali mapepala ofufuza pogwiritsa ntchito 3DPAM pophunzitsa/kuphunzira za kapangidwe ka thupi. Ndemanga za mabuku, makalata, kapena nkhani zokhudzana ndi zitsanzo za matenda, zitsanzo za nyama, zitsanzo zakale, ndi zitsanzo za maphunziro azachipatala/opaleshoni sizinaphatikizidwe. Nkhani zokha zomwe zinasindikizidwa mu Chingerezi ndizo zinasankhidwa. Nkhani zopanda chidule cha pa intaneti sizinaphatikizidwe. Nkhani zomwe zinali ndi zitsanzo zingapo, chimodzi mwa izo chomwe chinali chachibadwa kapena chomwe chinali ndi matenda ang'onoang'ono osakhudza phindu la kuphunzitsa, zinaphatikizidwa.
Kufufuza mabuku kunachitika mu database yamagetsi ya PubMed (National Library of Medicine, NCBI) kuti adziwe maphunziro oyenera omwe adafalitsidwa mpaka June 2022. Gwiritsani ntchito mawu otsatirawa: maphunziro, sukulu, kuphunzitsa, kuphunzitsa, kuphunzira, kuphunzitsa, maphunziro, atatu-dimensional, 3D, 3D, kusindikiza, kusindikiza, kapangidwe ka thupi, kapangidwe ka thupi, kapangidwe ka thupi ndi kapangidwe ka thupi. Funso limodzi linachitidwa: (((maphunziro [Mutu/Chidule] KAPENA sukulu [Mutu/Chidule] KAPENA kuphunzira [Mutu/Chidule] KAPENA kuphunzitsa [Mutu/Chidule] KAPENA maphunziro [Mutu/Chidule] KAPENA aliyense [Mutu/Chidule] ] KAPENA maphunziro [Mutu/Chidule]) NDI (Miyeso Itatu [Mutu] KAPENA 3D [Mutu] KAPENA 3D [Mutu])) NDI (Sindikizani [Mutu] KAPENA Sindikizani [Mutu] KAPENA Sindikizani [Mutu])) NDI (Anatomy) [Mutu] ]/chidule] kapena anatomy [mutu/chidule] kapena anatomy [mutu/chidule] kapena anatomy [mutu/chidule]). Nkhani zina zinazindikirika pofufuza pamanja mu database ya PubMed ndikuwunikanso maumboni a zolemba zina zasayansi. Palibe zoletsa za tsiku zomwe zinagwiritsidwa ntchito, koma fyuluta ya "Munthu" inagwiritsidwa ntchito.
Zolemba zonse ndi chidule zomwe zapezedwa zidawunikidwa motsutsana ndi zofunikira zonse zophatikizidwa ndi olemba awiri (EBR ndi AL), ndipo kafukufuku aliyense wosakwaniritsa zofunikira zonse zoyenerera sanachotsedwe. Mabuku onse a maphunziro otsalawo adapezedwa ndikuwunikidwanso ndi olemba atatu (EBR, EBE ndi AL). Pamene pakufunika, kusagwirizana pakusankha nkhani kunathetsedwa ndi munthu wachinayi (LT). Mabuku omwe adakwaniritsa zofunikira zonse zophatikizidwa adaphatikizidwa mu ndemangayi.
Kutulutsa deta kunachitika paokha ndi olemba awiri (EBR ndi AL) motsogozedwa ndi wolemba wachitatu (LT).
- Deta ya kapangidwe ka chitsanzo: madera a anatomical, magawo enieni a anatomical, chitsanzo choyambirira cha kusindikiza kwa 3D, njira yopezera, mapulogalamu ogawa magawo ndi modeling, mtundu wa chosindikizira cha 3D, mtundu wa zinthu ndi kuchuluka kwake, sikelo yosindikizira, mtundu, mtengo wosindikizira.
- Kuwunika kwa mawonekedwe a zitsanzo: zitsanzo zomwe zimagwiritsidwa ntchito poyerekeza, kuwunika kwa akatswiri azachipatala/aphunzitsi, chiwerengero cha owunika, mtundu wa kuwunika.
- Kuphunzitsa chitsanzo cha 3D: kuwunika chidziwitso cha ophunzira, njira yowunikira, chiwerengero cha ophunzira, chiwerengero cha magulu oyerekeza, kusankha ophunzira mwachisawawa, maphunziro/mtundu wa wophunzira.
Maphunziro 418 adapezeka mu MEDLINE, ndipo nkhani 139 zidachotsedwa ndi fyuluta ya "anthu". Pambuyo powunikira mitu ndi chidule, maphunziro 103 adasankhidwa kuti awerengedwe mokwanira. Nkhani 34 zidachotsedwa chifukwa zinali zitsanzo za matenda (nkhani 9), zitsanzo za maphunziro azachipatala/opaleshoni (nkhani 4), zitsanzo za nyama (nkhani 4), zitsanzo za 3D radiological (nkhani 1) kapena sizinali nkhani zoyambirira zasayansi (mitu 16). ). Nkhani zonse 68 zidaphatikizidwa mu ndemanga. Chithunzi 1 chikuwonetsa njira yosankha ngati tchati choyendera.
Tchati chofotokozera mwachidule kuzindikira, kufufuza, ndi kuphatikizidwa kwa zolemba mu ndemanga iyi yokonzedwa bwino
Maphunziro onse adasindikizidwa pakati pa 2014 ndi 2022, ndipo chaka chofalitsa chapakati cha 2019 chinali 2019. Mwa nkhani 68 zomwe zidaphatikizidwa, maphunziro 33 (49%) anali ofotokozera komanso oyesera, 17 (25%) anali oyesera okha, ndipo 18 (26%) anali oyesera okha. Ofotokozera okha. Mwa maphunziro 50 (73%) oyesera, 21 (31%) adagwiritsa ntchito njira zosasinthika. Maphunziro 34 okha (50%) adaphatikizapo kusanthula kwa ziwerengero. Gome 1 limafotokoza mwachidule makhalidwe a kafukufuku aliyense.
Nkhani 33 (48%) zinafufuza dera la mutu, nkhani 19 (28%) zinafufuza dera la chifuwa, nkhani 17 (25%) zinafufuza dera la m'mimba, ndipo nkhani 15 (22%) zinafufuza miyendo ndi miyendo. Nkhani 51 (75%) zinatchula mafupa osindikizidwa a 3D ngati zitsanzo za anatomical kapena zitsanzo za anatomical zokhala ndi magawo ambiri.
Ponena za magwero a zitsanzo kapena mafayilo omwe adagwiritsidwa ntchito popanga 3DPAM, nkhani 23 (34%) zidatchula za kugwiritsa ntchito deta ya odwala, nkhani 20 (29%) zidatchula za kugwiritsa ntchito deta yakufa, ndipo nkhani 17 (25%) zidatchula za kugwiritsa ntchito ma database.
Kafukufuku 47 (69%) adapanga 3DPAM kutengera computed tomography, ndipo kafukufuku 3 (4%) adanenanso za kugwiritsa ntchito microCT. Zolemba 7 (10%) zidawonetsa zinthu za 3D pogwiritsa ntchito ma scanner optical, zolemba 4 (6%) pogwiritsa ntchito MRI, ndi nkhani imodzi (1%) pogwiritsa ntchito makamera ndi ma microscope. Zolemba 14 (21%) sizinatchule komwe mafayilo oyambira kapangidwe ka 3D adachokera. Mafayilo a 3D amapangidwa ndi avareji ya malo osakwana 0.5 mm. Kutsimikiza kwabwino kwambiri ndi 30 μm [80] ndipo kutsimikiza kwakukulu ndi 1.5 mm [32].
Mapulogalamu makumi asanu ndi limodzi osiyanasiyana a mapulogalamu (kugawa magawo, kupanga mapangidwe, kupanga mapangidwe kapena kusindikiza) anagwiritsidwa ntchito. Mimics (Materialise, Leuven, Belgium) imagwiritsidwa ntchito kwambiri (maphunziro 14, 21%), kutsatiridwa 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) (maphunziro 9, 13%), Blender (Blender Foundation, Amsterdam, Netherlands) (maphunziro 8, 12%) ndi CURA (Geldemarsen, Netherlands) (maphunziro 7, 10%).
Mitundu yosindikizira yokwana makumi asanu ndi limodzi mphambu zisanu ndi ziwiri ndi njira zisanu zosindikizira zatchulidwa. Ukadaulo wa FDM (Fused Deposition Modeling) unagwiritsidwa ntchito muzinthu 26 (38%), kuphulika kwa zinthu muzinthu 13 (19%) ndipo potsiriza kuphulika kwa binder (zinthu 11, 16%). Ukadaulo womwe sugwiritsidwa ntchito kwambiri ndi stereolithography (SLA) (zinthu 5, 7%) ndi selective laser sintering (SLS) (zinthu 4, 6%). Chosindikizira chomwe chimagwiritsidwa ntchito kwambiri (zinthu 7, 10%) ndi Connex 500 (Stratasys, Rehovot, Israel) [27, 30, 32, 36, 45, 62, 65].
Pofotokoza zinthu zomwe zimagwiritsidwa ntchito popanga 3DPAM (zinthu 51, 75%), maphunziro 48 (71%) adagwiritsa ntchito mapulasitiki ndi zinthu zomwe zimachokera kuzinthuzo. Zinthu zazikulu zomwe zidagwiritsidwa ntchito zinali PLA (polylactic acid) (n = 20, 29%), resin (n = 9, 13%) ndi ABS (acrylonitrile butadiene styrene) (mitundu 7, 10%). Zinthu 23 (34%) zidafufuza 3DPAM yopangidwa kuchokera kuzinthu zingapo, zinthu 36 (53%) zidapereka 3DPAM yopangidwa kuchokera kuzinthu chimodzi chokha, ndipo zinthu 9 (13%) sizinatchule chinthu chilichonse.
Nkhani makumi awiri mphambu zisanu ndi zinayi (43%) zinanena kuti ziwerengero zosindikizidwa zinali kuyambira 0.25:1 mpaka 2:1, ndi avareji ya 1:1. Nkhani makumi awiri mphambu zisanu (37%) zinagwiritsa ntchito chiŵerengero cha 1:1. Ma 3DPAM 28 (41%) anali ndi mitundu yambiri, ndipo 9 (13%) anapakidwa utoto atasindikiza [43, 46, 49, 54, 58, 59, 65, 69, 75].
Nkhani makumi atatu mphambu zinayi (50%) zinatchula ndalama. Nkhani 9 (13%) zinatchula mtengo wa makina osindikizira a 3D ndi zipangizo zopangira. Mitengo ya makina osindikizira imayambira pa $302 mpaka $65,000. Pamene zafotokozedwa, mitengo ya makina osindikizira imayambira pa $1.25 mpaka $2,800; zinthu zopitirira muyesozi zikugwirizana ndi zitsanzo za mafupa [47] ndi zitsanzo zapamwamba za retroperitoneal [48]. Gome 2 likufotokoza mwachidule deta ya chitsanzo cha kafukufuku aliyense wophatikizidwa.
Kafukufuku makumi atatu ndi asanu ndi awiri (54%) anayerekeza 3DAPM ndi chitsanzo chofotokozera. Pakati pa maphunzirowa, choyerekeza chofala kwambiri chinali chitsanzo chofotokozera za anatomical, chomwe chinagwiritsidwa ntchito m'nkhani 14 (38%), kukonzekera kopangidwa ndi pulasitiki m'nkhani 6 (16%), kukonzekera kopangidwa ndi pulasitiki m'nkhani 6 (16%). Kugwiritsa ntchito zenizeni zenizeni, kujambula zithunzi za 3DPAM imodzi m'nkhani 5 (14%), 3DPAM ina m'nkhani 3 (8%), masewera ofunikira m'nkhani 1 (3%), ma x-ray munkhani 1 (3%), zitsanzo zamabizinesi m'nkhani 1 (3%) ndi zenizeni zowonjezeredwa m'nkhani 1 (3%). Kafukufuku makumi atatu ndi anayi (50%) adayesa 3DPAM. Kafukufuku khumi ndi asanu (48%) adafotokoza zomwe owerengera adakumana nazo mwatsatanetsatane (Table 3). 3DPAM idachitidwa ndi madokotala ochita opaleshoni kapena madokotala omwe amapita kuchipatala m'maphunziro 7 (47%), akatswiri a anatomical m'maphunziro 6 (40%), ophunzira m'maphunziro 3 (20%), aphunzitsi (udindo sunatchulidwe) m'maphunziro 3 (20%) kuti ayesedwe ndi wowunika wina m'nkhaniyi (7%). Chiwerengero chapakati cha owunika ndi 14 (osachepera 2, osapitirira 30). Maphunziro makumi atatu ndi atatu (49%) adayesa mawonekedwe a 3DPAM molingana ndi umunthu, ndipo maphunziro 10 (15%) adayesa mawonekedwe a 3DPAM molingana ndi kuchuluka. Pa maphunziro 33 omwe adagwiritsa ntchito mayeso ofotokozera, 16 adagwiritsa ntchito mayeso ofotokozera okha (48%), mayeso 9 adagwiritsa ntchito/mavoti/kafukufuku (27%), ndipo 8 adagwiritsa ntchito masikelo a Likert (24%). Gome 3 limafotokoza mwachidule mayeso a mawonekedwe a zitsanzo zomwe zili mu kafukufuku aliyense wophatikizidwa.
Nkhani makumi atatu ndi zitatu (48%) zinafufuza ndikuyerekeza momwe kuphunzitsa 3DPAM kumagwirira ntchito kwa ophunzira. Mwa maphunzirowa, nkhani 23 (70%) zinayesa kukhutira kwa ophunzira, 17 (51%) zinagwiritsa ntchito masikelo a Likert, ndipo 6 (18%) zinagwiritsa ntchito njira zina. Nkhani makumi awiri ndi ziwiri (67%) zinayesa kuphunzira kwa ophunzira kudzera mu mayeso a chidziwitso, pomwe 10 (30%) zinagwiritsa ntchito mayeso asanayambe ndi/kapena mayeso atatha. Maphunziro khumi ndi limodzi (33%) adagwiritsa ntchito mafunso ndi mayeso osankha mayankho kuti ayese chidziwitso cha ophunzira, ndipo maphunziro asanu (15%) adagwiritsa ntchito zilembo zazithunzi/kuzindikiritsa thupi. Avereji ya ophunzira 76 adachita nawo kafukufuku aliyense (osachepera 8, opitilira 319). Maphunziro makumi awiri ndi anayi (72%) anali ndi gulu lowongolera, pomwe 20 (60%) adagwiritsa ntchito mwachisawawa. Mosiyana ndi zimenezi, kafukufuku mmodzi (3%) adapereka mwachisawawa zitsanzo za anatomical kwa ophunzira 10 osiyanasiyana. Pa avareji, magulu 2.6 adayerekezeredwa (osachepera 2, opitilira 10). Maphunziro makumi awiri ndi atatu (70%) adakhudza ophunzira azachipatala, omwe 14 (42%) anali ophunzira azachipatala chaka choyamba. Maphunziro asanu ndi limodzi (18%) adakhudza okhala m'deralo, ophunzira anayi (12%) a mano, ndi ophunzira atatu (9%) a sayansi. Maphunziro asanu ndi limodzi (18%) adakhazikitsa ndikuwunika kuphunzira kodziyimira pawokha pogwiritsa ntchito 3DPAM. Gome 4 likufotokoza mwachidule zotsatira za kuwunika kogwira mtima kwa kuphunzitsa kwa 3DPAM pa kafukufuku aliyense wophatikizidwa.
Ubwino waukulu womwe olemba adalemba pogwiritsa ntchito 3DPAM ngati chida chophunzitsira za thupi la munthu wabwinobwino ndi mawonekedwe owoneka ndi ogwira, kuphatikizapo zenizeni [55, 67], kulondola [44, 50, 72, 85], ndi kusinthasintha kosasinthasintha [34, 45]. , 48, 64], mtundu ndi kuwonekera bwino [28, 45], kulimba [24, 56, 73], zotsatira zamaphunziro [16, 32, 35, 39, 52, 57, 63, 69, 79], mtengo [27, 41, 44, 45, 48, 51, 60, 64, 80, 81, 83], kubwerezabwereza [80], kuthekera kosintha kapena kusintha umunthu [28, 30, 36, 45, 48, 51, 53, 59, 61, 67, 80], kuthekera koyendetsa ophunzira [30, 49], kusunga nthawi yophunzitsa [61, 80], kusasunga mosavuta [61], kuthekera kophatikiza kapangidwe ka thupi kapena kupanga mapangidwe enaake [51, 53], 67], kapangidwe ka mafupa mwachangu zitsanzo [81], kuthekera kopanga zitsanzo pamodzi ndikupita nazo kunyumba [49, 60, 71], kukonza luso losinthasintha maganizo [23] ndi kusunga chidziwitso [32], komanso mphunzitsi [25, 63] ndi kukhutitsidwa kwa ophunzira [25, 45, 46, 52, 52, 57, 63, 66, 69, 84].
Zoyipa zazikulu zimagwirizana ndi kapangidwe kake: kulimba [80], kusasinthasintha [28, 62], kusowa kwa tsatanetsatane kapena kuwonekera bwino [28, 30, 34, 45, 48, 62, 64, 81], mitundu yowala kwambiri [45]. ndi kufooka kwa pansi [71]. Zoyipa zina ndi monga kutayika kwa chidziwitso [30, 76], nthawi yayitali yofunikira pakugawa zithunzi [36, 52, 57, 58, 74], nthawi yosindikiza [57, 63, 66, 67], kusowa kwa kusinthasintha kwa kapangidwe ka thupi [25], ndi mtengo . Wapamwamba [48].
Kuwunikaku mwadongosolo kukufotokoza mwachidule nkhani 68 zomwe zafalitsidwa kwa zaka 9 ndipo kukuwonetsa chidwi cha gulu la asayansi pa 3DPAM ngati chida chophunzitsira za thupi la munthu. Gawo lililonse la thupi linaphunziridwa ndipo linasindikizidwa mu 3D. Mwa nkhanizi, nkhani 37 zinayerekeza 3DPAM ndi mitundu ina, ndipo nkhani 33 zinayesa kufunika kwa 3DPAM pa maphunziro kwa ophunzira.
Popeza pali kusiyana kwa kapangidwe ka maphunziro osindikizira a 3D, sitinaone kuti ndikoyenera kuchita meta-analysis. Meta-analysis yomwe inafalitsidwa mu 2020 makamaka imayang'ana kwambiri mayeso a chidziwitso cha anatomy pambuyo pa maphunziro popanda kusanthula mbali zaukadaulo ndi ukadaulo za kapangidwe ndi kupanga kwa 3DPAM [10].
Gawo la mutu ndilo lomwe limaphunziridwa kwambiri, mwina chifukwa chakuti kuuma kwa kapangidwe kake kumapangitsa kuti zikhale zovuta kwa ophunzira kuwonetsa gawo ili la thupi m'malo atatu poyerekeza ndi miyendo kapena thupi. CT ndiyo njira yojambulira yomwe imagwiritsidwa ntchito kwambiri. Njirayi imagwiritsidwa ntchito kwambiri, makamaka m'malo azachipatala, koma ili ndi kusiyana kochepa kwa malo komanso kusiyana kochepa kwa minofu yofewa. Zofooka izi zimapangitsa kuti ma CT scans asagwiritsidwe ntchito pogawa ndi kupanga chitsanzo cha mitsempha. Kumbali ina, computed tomography ndiyoyenera kwambiri pakugawa/kupanga mawonekedwe a minofu ya mafupa; Kusiyana kwa mafupa/minofu yofewa kumathandiza kumaliza masitepe awa asanayambe kusindikiza ma 3D. Kumbali ina, microCT imaonedwa ngati ukadaulo wofotokozera momwe malo amagwirira ntchito pojambula mafupa [70]. Ma scanner a Optical kapena MRI angagwiritsidwenso ntchito kupeza zithunzi. Kuchuluka kwa mawonekedwe kumalepheretsa kusalala kwa malo a mafupa ndikusunga mawonekedwe a mawonekedwe a thupi [59]. Kusankha chitsanzo kumakhudzanso kusiyana kwa malo: mwachitsanzo, ma plasticization models ali ndi kusiyana kochepa [45]. Opanga zithunzi ayenera kupanga ma 3D models, omwe amawonjezera ndalama ($25 mpaka $150 pa ola limodzi) [43]. Kupeza mafayilo apamwamba a .STL sikokwanira kupanga mitundu yapamwamba ya anatomical. Ndikofunikira kudziwa magawo osindikizira, monga momwe chitsanzo cha anatomical chimayendera pa mbale yosindikizira [29]. Olemba ena amati ukadaulo wapamwamba wosindikiza monga SLS uyenera kugwiritsidwa ntchito kulikonse komwe kungatheke kuti uwonjezere kulondola kwa 3DPAM [38]. Kupanga 3DPAM kumafuna thandizo la akatswiri; akatswiri omwe amafunidwa kwambiri ndi mainjiniya [72], akatswiri a radiology, [75], opanga zithunzi [43] ndi akatswiri a anatomical [25, 28, 51, 57, 76, 77].
Mapulogalamu ogawa magawo ndi okonza mapangidwe ndi zinthu zofunika kwambiri pakupeza mitundu yolondola ya anatomical, koma mtengo wa mapulogalamuwa ndi zovuta zawo zimalepheretsa kugwiritsa ntchito. Kafukufuku angapo ayerekeza kugwiritsa ntchito mapulogalamu osiyanasiyana ndi ukadaulo wosindikiza, kuwonetsa zabwino ndi zoyipa za ukadaulo uliwonse [68]. Kuphatikiza pa mapulogalamu okonza mapangidwe, mapulogalamu osindikiza omwe amagwirizana ndi chosindikizira chosankhidwa amafunikanso; olemba ena amakonda kugwiritsa ntchito kusindikiza kwa 3D pa intaneti [75]. Ngati zinthu zokwanira za 3D zasindikizidwa, ndalama zomwe zayikidwazo zitha kubweretsa phindu la ndalama [72].
Pulasitiki ndiye chinthu chomwe chimagwiritsidwa ntchito kwambiri. Mitundu ndi mitundu yake yosiyanasiyana zimapangitsa kuti ikhale chinthu chomwe chimasankhidwa kwambiri pa 3DPAM. Olemba ena adayamikira mphamvu zake zapamwamba poyerekeza ndi zitsanzo zachikhalidwe zakufa kapena pulasitiki [24, 56, 73]. Mapulasitiki ena ali ndi mphamvu zopindika kapena kutambasula. Mwachitsanzo, Filaflex yokhala ndi ukadaulo wa FDM imatha kutambasula mpaka 700%. Olemba ena amaona kuti ndi chinthu chomwe chimasankhidwa kwambiri pakupanga minofu, tendon ndi ligament [63]. Kumbali ina, maphunziro awiri abweretsa mafunso okhudza momwe fiber imayendera panthawi yosindikiza. Ndipotu, momwe minofu imayendera, kuyika, kusunga, ndi ntchito yake ndizofunikira kwambiri pakukonza minofu [33].
Chodabwitsa n'chakuti, maphunziro ochepa okha ndi omwe amatchula kukula kwa kusindikiza. Popeza anthu ambiri amaona kuti chiŵerengero cha 1:1 ndi chokhazikika, wolembayo mwina anasankha kusatchula. Ngakhale kuti kukulitsa kungakhale kothandiza pophunzira molunjika m'magulu akuluakulu, kuthekera kwa kukulitsa sikunafufuzidwebe, makamaka chifukwa cha kukula kwa magulu ndi kukula kwa chitsanzocho kukhala chinthu chofunikira. Zachidziwikire, masikelo athunthu amapangitsa kuti zikhale zosavuta kupeza ndikulankhulana ndi wodwalayo zinthu zosiyanasiyana za thupi, zomwe zingafotokoze chifukwa chake nthawi zambiri zimagwiritsidwa ntchito.
Mwa ma printer ambiri omwe alipo pamsika, omwe amagwiritsa ntchito ukadaulo wa PolyJet (zinthu kapena binder inkjet) kuti apereke mitundu ndi mitundu yambiri (ndipo motero mitundu yambiri) yosindikiza yapamwamba imawononga pakati pa US$20,000 ndi US$250,000 (https: //www.aniwaa.com/). Mtengo wokwera uwu ukhoza kuchepetsa kukwezedwa kwa 3DPAM m'masukulu azachipatala. Kuphatikiza pa mtengo wa printer, mtengo wa zinthu zofunika posindikiza inkjet ndi wokwera kuposa wa ma printer a SLA kapena FDM [68]. Mitengo ya ma printer a SLA kapena FDM nayonso ndi yotsika mtengo, kuyambira €576 mpaka €4,999 m'nkhani zomwe zalembedwa mu ndemanga iyi. Malinga ndi Tripodi ndi anzake, gawo lililonse la mafupa likhoza kusindikizidwa pa US$1.25 [47]. Kafukufuku khumi ndi mmodzi adatsimikiza kuti kusindikiza kwa 3D ndikotsika mtengo kuposa pulasitiki kapena mitundu yamalonda [24, 27, 41, 44, 45, 48, 51, 60, 63, 80, 81, 83]. Komanso, mitundu iyi yamalonda idapangidwa kuti ipereke chidziwitso cha odwala popanda tsatanetsatane wokwanira pophunzitsa za kapangidwe ka thupi [80]. Mitundu iyi yamalonda imaonedwa kuti ndi yotsika poyerekeza ndi 3DPAM [44]. Ndikofunikira kudziwa kuti, kuwonjezera pa ukadaulo wosindikiza womwe umagwiritsidwa ntchito, mtengo womaliza umagwirizana ndi sikelo ndipo motero kukula komaliza kwa 3DPAM [48]. Pazifukwa izi, sikelo yonse ndi yomwe imakondedwa [37].
Kafukufuku mmodzi yekha ndiye anayerekeza 3DPAM ndi zitsanzo za thupi zomwe zimapezeka m'masitolo [72]. Zitsanzo za mtembo ndizo zoyerekeza zomwe zimagwiritsidwa ntchito kwambiri pa 3DPAM. Ngakhale kuti pali zofooka zake, zitsanzo za mtembo zimakhalabe chida chofunikira pophunzitsa za thupi. Kusiyana kuyenera kupangidwa pakati pa kusanthula thupi, kuduladula ... Chen ndi anzake adawona kuti ophunzira omwe amagwiritsa ntchito mitundu ya 3D adachita bwino pozindikira kapangidwe kake (zigaza), koma panalibe kusiyana kwa zigoli za MCQ [69]. Pomaliza, Tanner ndi anzake adawonetsa zotsatira zabwino pambuyo pa mayeso mu gululi pogwiritsa ntchito 3DPAM ya pterygopalatine fossa [46]. Zida zina zatsopano zophunzitsira zidapezeka mu ndemanga iyi ya mabuku. Zodziwika kwambiri pakati pawo ndi zenizeni zowonjezeredwa, zenizeni zenizeni ndi masewera ofunikira [43]. Malinga ndi Mahrous ndi anzake, kukonda mitundu ya anatomical kumadalira kuchuluka kwa maola omwe ophunzira amasewera masewera apakanema [31]. Kumbali ina, vuto lalikulu la zida zatsopano zophunzitsira anatomy ndi mayankho a haptic, makamaka pazida zenizeni zokha [48].
Kafukufuku wambiri wofufuza 3DPAM yatsopano wagwiritsa ntchito mayeso asanayambe. Mayeso asanayambe awa amathandiza kupewa tsankho mu mayeso. Olemba ena, asanachite maphunziro oyesera, amachotsa ophunzira onse omwe adapeza zigoli zoposa avareji pa mayeso oyamba [40]. Pakati pa tsankho lomwe Garas ndi anzake adatchulapo panali mtundu wa chitsanzo ndi kusankha odzipereka mu kalasi ya ophunzira [61]. Kupaka utoto kumathandiza kuzindikira kapangidwe ka thupi. Chen ndi anzake adakhazikitsa mikhalidwe yoyesera yolimba popanda kusiyana koyambirira pakati pa magulu ndipo kafukufukuyu adabisika kwambiri momwe angathere [69]. Lim ndi anzake amalimbikitsa kuti mayeso atatha mayeso amalizidwe ndi munthu wachitatu kuti apewe tsankho mu mayeso [16]. Kafukufuku wina wagwiritsa ntchito masikelo a Likert kuti awone kuthekera kwa 3DPAM. Chida ichi ndi choyenera kuwunika kukhutira, koma pakadali tsankho lofunika kudziwa [86].
Kufunika kwa maphunziro a 3DPAM kunayesedwa makamaka pakati pa ophunzira azachipatala, kuphatikizapo ophunzira azachipatala a chaka choyamba, m'maphunziro 14 mwa 33. Mu kafukufuku wawo woyeserera, Wilk ndi anzake adanena kuti ophunzira azachipatala ankakhulupirira kuti kusindikiza kwa 3D kuyenera kuphatikizidwa mu kuphunzira kwawo kwa anatomy [87]. 87% ya ophunzira omwe adafunsidwa mu kafukufuku wa Cercenelli ankakhulupirira kuti chaka chachiwiri cha maphunziro chinali nthawi yabwino kwambiri yogwiritsira ntchito 3DPAM [84]. Zotsatira za Tanner ndi anzake zinawonetsanso kuti ophunzira adachita bwino ngati sanaphunzirepo za ntchitoyi [46]. Deta iyi ikusonyeza kuti chaka choyamba cha sukulu ya zamankhwala ndi nthawi yabwino kwambiri yophatikizira 3DPAM mu kuphunzitsa anatomy. Kusanthula kwa Ye kwa meta kunathandizira lingaliro ili [18]. Mu nkhani 27 zomwe zaphatikizidwa mu kafukufukuyu, panali kusiyana kwakukulu pakati pa mayeso pakati pa 3DPAM ndi mitundu yachikhalidwe ya ophunzira azachipatala, koma osati kwa okhalamo.
3DPAM ngati chida chophunzirira chimathandizira kupambana pamaphunziro [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 kuti mitundu iyi ndi yothandiza [37, 42, 49, 81, 82], ndipo maphunziro awiri adapeza kukhutira kwa aphunzitsi ndi 3DPAM [25, 63]. Mwa magwero onse, Backhouse ndi anzake amaona kusindikiza kwa 3D kukhala njira yabwino kwambiri m'malo mwa mitundu yachikhalidwe ya anatomical [49]. Mu meta-analysis yawo yoyamba, Ye ndi anzake adatsimikiza kuti ophunzira omwe adalandira malangizo a 3DPAM anali ndi zigoli zabwino pambuyo pa mayeso kuposa ophunzira omwe adalandira malangizo a 2D kapena mtembo [10]. Komabe, adasiyanitsa 3DPAM osati ndi zovuta, koma ndi mtima, mitsempha, ndi m'mimba. Mu maphunziro asanu ndi awiri, 3DPAM sinachite bwino kuposa mitundu ina kutengera mayeso a chidziwitso omwe amaperekedwa kwa ophunzira [32, 66, 69, 77, 78, 84]. Mu meta-analysis yawo, Salazar ndi anzake adatsimikiza kuti kugwiritsa ntchito 3DPAM kumathandizira kumvetsetsa bwino kapangidwe ka thupi kovuta [17]. Lingaliroli likugwirizana ndi kalata ya Hitas kwa mkonzi [88]. Madera ena a thupi omwe amaonedwa kuti ndi ovuta kwambiri safuna kugwiritsa ntchito 3DPAM, pomwe madera ovuta kwambiri a thupi (monga khosi kapena dongosolo la mitsempha) angakhale chisankho chanzeru cha 3DPAM. Lingaliroli likhoza kufotokoza chifukwa chake ma 3DPAM ena saonedwa kuti ndi apamwamba kuposa mitundu yachikhalidwe, makamaka pamene ophunzira alibe chidziwitso m'dera lomwe magwiridwe antchito a chitsanzo amapezeka kuti ndi apamwamba. Chifukwa chake, kupereka chitsanzo chosavuta kwa ophunzira omwe ali kale ndi chidziwitso china pankhaniyi (ophunzira azachipatala kapena okhala) sikuthandiza pakukweza magwiridwe antchito a ophunzira.
Pa maubwino onse a maphunziro omwe atchulidwa, maphunziro 11 adagogomezera mawonekedwe owoneka kapena ogwira a zitsanzo [27,34,44,45,48,50,55,63,67,72,85], ndipo maphunziro atatu adawongolera mphamvu ndi kulimba (33, 50 -52, 63, 79, 85, 86). Ubwino wina ndi wakuti ophunzira amatha kusintha kapangidwe kake, aphunzitsi amatha kusunga nthawi, ndi osavuta kusunga kuposa mitembo, polojekitiyi imatha kumalizidwa mkati mwa maola 24, ingagwiritsidwe ntchito ngati chida chophunzitsira kunyumba, ndipo ingagwiritsidwe ntchito kuphunzitsa zambiri. magulu [30, 49, 60, 61, 80, 81]. Kusindikiza mobwerezabwereza kwa 3D pophunzitsa kwambiri za anatomy kumapangitsa kuti zitsanzo zosindikizira za 3D zikhale zotsika mtengo kwambiri [26]. Kugwiritsa ntchito 3DPAM kumatha kusintha luso lozungulira maganizo [23] ndikuwongolera kutanthauzira kwa zithunzi zodutsa [23, 32]. Kafukufuku awiri adapeza kuti ophunzira omwe adakumana ndi 3DPAM anali ndi mwayi waukulu wochitidwa opaleshoni [40, 74]. Zolumikizira zachitsulo zitha kuyikidwa kuti zipange kayendedwe kofunikira pophunzira kapangidwe ka thupi [51, 53], kapena zitsanzo zitha kusindikizidwa pogwiritsa ntchito mapangidwe a trigger [67].
Kusindikiza kwa 3D kumalola kupanga mitundu yosinthika ya anatomical mwa kukonza zinthu zina panthawi yopangira chitsanzo, [48, 80] kupanga maziko oyenera, [59] kuphatikiza mitundu yambiri, [36] pogwiritsa ntchito kuwonekera bwino, (49) mtundu, [45] kapena kupangitsa kuti mapangidwe ena amkati awonekere [30]. Tripodi ndi anzake adagwiritsa ntchito dongo losema kuti ligwirizane ndi mitundu yawo ya mafupa osindikizidwa a 3D, kugogomezera kufunika kwa mitundu yopangidwa pamodzi ngati zida zophunzitsira [47]. Mu maphunziro 9, utoto unagwiritsidwa ntchito pambuyo posindikiza [43, 46, 49, 54, 58, 59, 65, 69, 75], koma ophunzira adagwiritsa ntchito kamodzi kokha [49]. Mwatsoka, kafukufukuyu sanawunikenso ubwino wa maphunziro a chitsanzo kapena ndondomeko ya maphunziro. Izi ziyenera kuganiziridwa pankhani ya maphunziro a anatomy, chifukwa ubwino wa kuphunzira kophatikizana ndi kupanga pamodzi ndi wodziwika bwino [89]. Pofuna kuthana ndi ntchito yotsatsa yomwe ikukula, kudziphunzira wekha kwagwiritsidwa ntchito nthawi zambiri poyesa zitsanzo [24, 26, 27, 32, 46, 69, 82].
Kafukufuku wina adatsimikiza kuti mtundu wa zinthu zapulasitiki unali wowala kwambiri [45], kafukufuku wina adatsimikiza kuti chitsanzocho chinali chofooka kwambiri [71], ndipo maphunziro ena awiri adawonetsa kusowa kwa kusiyana kwa kapangidwe ka mitundu yosiyanasiyana [25, 45]. . Kafukufuku asanu ndi awiri adatsimikiza kuti tsatanetsatane wa kapangidwe ka 3DPAM sikokwanira [28, 34, 45, 48, 62, 63, 81].
Kuti mudziwe zambiri zokhudza mitundu ya anatomical ya madera akuluakulu komanso ovuta, monga retroperitoneum kapena msana wa chiberekero, nthawi yogawa magawo ndi kupanga chitsanzo imaonedwa kuti ndi yayitali kwambiri ndipo mtengo wake ndi wokwera kwambiri (pafupifupi US$2000) [27, 48]. Hojo ndi anzake adati mu kafukufuku wawo kuti zidatenga maola 40 kuti apange chitsanzo cha anatomical cha pelvis [42]. Nthawi yayitali kwambiri yogawa magawo inali maola 380 mu kafukufuku wa Weatherall ndi anzake, momwe mitundu ingapo idaphatikizidwa kuti apange chitsanzo chokwanira cha mpweya wa ana [36]. Mu maphunziro asanu ndi anayi, nthawi yogawa magawo ndi kusindikiza idaonedwa kuti ndi yoyipa [36, 42, 57, 58, 74]. Komabe, maphunziro 12 adatsutsa mawonekedwe enieni a mitundu yawo, makamaka kusinthasintha kwawo, [28, 62] kusowa kwa kuwonekera bwino, [30] kufooka ndi monochromaticity, [71] kusowa kwa minofu yofewa, [66] kapena kusowa kwa tsatanetsatane [28, 34]. , 45, 48, 62, 63, 81]. Zovuta izi zitha kuthetsedwa powonjezera nthawi yogawa kapena kuyerekezera. Kutaya ndi kupeza chidziwitso chofunikira chinali vuto lomwe magulu atatu adakumana nalo [30, 74, 77]. Malinga ndi malipoti a odwala, mankhwala otsutsana ndi ayodini sanapereke mawonekedwe abwino a mitsempha yamagazi chifukwa cha kuchepa kwa mlingo [74]. Kubayidwa kwa chitsanzo cha mtembo kumawoneka ngati njira yabwino kwambiri yomwe imasiya mfundo ya "zochepa momwe zingathere" ndi zofooka za mlingo wa mankhwala otsutsana omwe adabayidwa.
Mwatsoka, nkhani zambiri sizitchula zinthu zina zofunika kwambiri za 3DPAM. Zochepera theka la nkhanizo zinanena momveka bwino ngati 3DPAM yawo inali ndi utoto. Kufalikira kwa nkhani zosindikizidwa kunali kosagwirizana (43% ya nkhani), ndipo 34% yokha ndi yomwe inatchula za kugwiritsa ntchito njira zosiyanasiyana zosindikizira. Magawo osindikizira awa ndi ofunikira chifukwa amakhudza luso lophunzirira la 3DPAM. Nkhani zambiri sizipereka chidziwitso chokwanira chokhudza zovuta zopezera 3DPAM (nthawi yopangira, ziyeneretso za ogwira ntchito, ndalama za mapulogalamu, ndalama zosindikizira, ndi zina zotero). Chidziwitsochi ndi chofunikira kwambiri ndipo chiyenera kuganiziridwa musanaganize zoyambitsa pulojekiti yopanga 3DPAM yatsopano.
Kuwunika kumeneku kwadongosolo kukuwonetsa kuti kupanga ndi kusindikiza mitundu ya anatomical ya 3D ndikothekera pamtengo wotsika, makamaka pogwiritsa ntchito ma printers a FDM kapena SLA komanso zinthu zotsika mtengo za pulasitiki zamtundu umodzi. Komabe, mapangidwe oyambira awa amatha kuwonjezeredwa powonjezera mitundu kapena kuwonjezera mapangidwe m'zinthu zosiyanasiyana. Mitundu yeniyeni (yosindikizidwa pogwiritsa ntchito zipangizo zingapo zamitundu yosiyanasiyana ndi mawonekedwe kuti itsatire bwino makhalidwe ogwira a chitsanzo chofotokozera mtembo) imafuna ukadaulo wosindikiza wa 3D wokwera mtengo komanso nthawi yayitali yopangira. Izi zidzawonjezera kwambiri mtengo wonse. Kaya njira yosindikizira yasankhidwa, kusankha njira yoyenera yojambulira ndikofunikira kwambiri kuti 3DPAM ipambane. Kuchuluka kwa malo, mtunduwo umakhala weniweni ndipo ungagwiritsidwe ntchito pa kafukufuku wapamwamba. Kuchokera pamalingaliro ophunzitsira, 3DPAM ndi chida chothandiza pophunzitsa anatomy, monga momwe zikuwonekera ndi mayeso a chidziwitso omwe amaperekedwa kwa ophunzira ndi kukhutira kwawo. Zotsatira zophunzitsira za 3DPAM zimakhala zabwino kwambiri zikaberekanso madera ovuta a anatomical ndipo ophunzira amazigwiritsa ntchito koyambirira kwa maphunziro awo azachipatala.
Ma data omwe apangidwa ndi/kapena kufufuzidwa mu kafukufukuyu wapano sapezeka pagulu chifukwa cha zopinga za chilankhulo koma akupezeka kwa wolemba woyenerera ngati pakufunika kutero.
Drake RL, Lowry DJ, Pruitt CM. Kuwunikanso maphunziro a anatomy, microanatomy, neurobiology, ndi embryology mu maphunziro a zachipatala aku US. Anat Rec. 2002;269(2):118-22.
Kuduladula kwa Ghosh SK Cadaveric ngati chida chophunzitsira sayansi ya anatomical m'zaka za m'ma 2000: Kuduladula ngati chida chophunzitsira. Kusanthula kwa maphunziro a sayansi. 2017;10(3):286–99.
Nthawi yotumizira: Epulo-09-2024