改良部分迷路切除岩骨尖入路的显微解剖

目的应用锁孔理念,对部分迷路切除岩骨尖入路进行改良,并对改良后的入路进行显微解剖学研究。方法对15例30侧成人尸头采用改良部分迷路切除岩骨尖入路暴露岩斜区,测量磨除部分迷路和岩骨尖后增加的手术视野和视角,观察岩斜区解剖结构的暴露情况。结果在4cm×3cm大小的骨窗范围内可以完成所有的手术操作。磨除部分迷路和岩骨尖后,手术水平视野平均增加14·2mm,垂直视野平均增加12·5mm,手术水平视角平均增加58°,垂直视角平均增加46°,该入路可充分暴露岩斜区各解剖结构,与原入路相比无明显差别。结论改良部分迷路切除岩骨尖入路暴露充分,较原入路创伤小,脑牵拉轻,不容易损伤颈静脉球和面神经颅外段等重要结构,是一种良好的处理岩斜区病变的手术入路。     

岩段颈内动脉的显微解剖及临床意义

目的 了解岩段颈内动脉及其相关结构的显微解剖，为手术操作提供解剖学基础。方法在手术显微镜下观察15例30侧成人头部标本的岩段颈内动脉及相关结构，测量有关数据。结果 岩段颈内动脉分水平段、膝部及垂直段。岩浅大神经的走行基本和岩段颈内动脉水平段平行，是术中确定岩段颈内动脉水平段的重要标志。结论 熟悉岩段颈内动脉的显微解剖及其和相邻结构的关系，就能在相关于术中更好保护岩段颈内动脉，减少并发症，提高手术疗效。     

上颌后部截骨术相关应用解剖

目的 探讨上颌后区的解剖为临床上颌截骨提供依据。方法 选择３０具干燥成人头颅标本,通过直接测量及计算机数字化仪进行分析。结果 翼上颌联合骨性融合占１０％;翼上颌联合的高度翼上颌联合下点至上颌结节最下点的高度分别为１３．１５ｍｍ和５．２５ｍｍ;翼上颌联合上点至上颌结节下点的高度平均为１８．０５ｍｍ;颧牙槽嵴至翼上颌联合的距离平均为２５．４７ｍｍ;翼突的宽度平均为１２．３４ｍｍ;梨状孔边缘至翼腭管的距     

跟骨解剖型钢板治疗跟骨骨折

目的探讨应用跟骨解剖型钢板治疗跟骨关节内骨折的疗效。方法应用跟骨解剖型钢板治疗波及距下关节的关节内骨折23例25足,术前、术后注意局部消肿,术中注意关节面的解剖复位、Bohler＇s角及Gissane角的恢复和跟骨高度、宽度的恢复。结果 23例均获得随访,随访时间8～24个月,参照Maryland评分系统,优18例,良5例,可2例,总体优良率92%。结论应用跟骨解剖型钢板治疗跟骨关节内骨折,固定可靠,允许术后关节进行早期功能锻炼,能最大限度地减少创伤性关节炎的发生,是目前治疗跟骨关节内骨折的一种理想的方法。     

改良乙状窦前经部分骨迷路入路的显微解剖

目的 目的 研究改良乙状窦前经部分骨迷路入路的显微解剖暴露,探讨其对岩斜区的显露及在手术处理该区域病变中的优势. 方法 2012年4月至10月,对15具尸头标本进行手术人路的改良研究,在传统乙状窦前入路的基础上切除部分半规管和岩尖,详细记录岩斜区重要结构的显露情况. 结果 该入路能够提供至岩斜区和海绵窦后部宽大的操作空间,在乙状窦前显露范围(水平方向)为(19.41±1.58) mm,在颞叶下方的显露范围(垂直方向)为(14.18±1.88) mm,斜坡中心凹陷的最大暴露角度为(60.54±6.93)°,手术操作深度(55.87 4.34) mm.椎-基底动脉、小脑前下动脉、小脑上动脉、同侧第Ⅲ～X对和对侧第Ⅵ对脑神经、三叉神经腔、海绵窦后部等均显露良好. 结论 改良乙状窦前经部分骨迷路入路能够获得岩斜区深面和海绵窦后部良好暴露,具有暴露范围大、观察角度多、保留面听神经功能、早期阻断肿瘤的血供等方面的优势.     

跟骨解剖接骨板固定治疗跟骨骨折

目的探讨跟骨解剖接骨板固定治疗SandersⅡ～Ⅳ型跟骨骨折的手术方法及临床效果。方法分析2006年10月至2009年10月手术治疗的25例跟骨骨折患者,男15例,女10例;年龄18～53岁,平均34.4岁;左13例,右12例,双侧骨折2例。骨折分型：SandersⅡ型10足,Ⅲ型10足,Ⅳ型5足。结果全部获得随访,随访时间为12～24个月,平均18个月。参照Maryland评分标准,SandersⅡ型优6例,良4例;SandersⅢ型优5例,良3例,可2例;SandersⅣ型优2例,良2例,可1例。总优良率为72%。骨折愈合时间为2～4个月,平均3.2个月,均未发生皮瓣坏死。结论跟骨解剖接骨板固定治疗有移位关节内跟骨骨折,采用外侧舟状切口解剖清楚,操作难度小,可恢复患者足弓的形态和弹性,能有效提供稳定固定,减少并发症。     

准确构建个体化膝关节有限元解剖模型的方法

目的利用多模态影像数据融合和多种建模软件协同应用的方法准确构建膝关节有限元解剖模型,为研究膝关节生物力学行为奠定基础。方法采集正常膝关节CT和MRI影像数据,导入Mimics软件,提取骨、软骨、韧带和半月板,分别构建三维工程化模型。以外部标记物为参照进行模型的配准融合。将膝关节工程化模型导入SC/Tetra和Hypermesh软件,分别进行干涉面删除、网格自定义划分、局部网格优化和体网格划分,构建包含多解剖结构的膝关节有限元模型。结果基于CT和MRI影像数据构建出膝关节骨、软骨、韧带和半月板的三维工程化模型。以三维工程化模型为基础,多种建模软件协同应用构建的有限元模型充分保持了膝关节各结构的解剖学特征。结论利用CT和MRI影像数据融合和多种建模软件协同应用的方法可以构建活体膝关节有限元模型,并保持膝关节各解剖结构的解剖真实性,为准确模拟膝关节生物力学特征提供前提。     

颈内动脉岩段水平部的显微解剖及其临床意义

目的:为颞骨岩部手术提供有关颈内动脉岩段水平部(HICA)的显微解剖学资料。方法:在手术显微镜下解剖15例(30例)成人头颅湿标本,观测HICA及其毗邻结构。结果:①HICA直径为(4.84±0.57)mm,长度为(17.85±2.43)mm;②HICA外膝距耳蜗底周前内侧缘(2.48±9.23》mm;③HICA与岩大神经走行基本平行。结论:①暴露HICA入点可选择在岩大神经沟接近下颌神经外后方;②中耳及颞骨岩尖手术须注意避免损伤HICA。     

下颌骨截骨整形手术三维有限元模型的建立

目的：为研究下颌骨截骨整形手术的生物力学原理,建立了生物力学相似性较高的无牙下颌骨和颞下颌关节三维有限元模型。方法：以颅颌面系统正常的女性青年志愿者为标本,经过薄层CT断层扫描得到DICOM格式文件,经Mimics和Ansys软件建模,采用只受拉的Link10单元模拟下颌韧带和咀嚼肌约束,采用接触单元对关节窝进行约束。结果：建立了包括颞下颌关节、肌肉和韧带的正常下颌骨三维有限元模型。可根据实验设计建立实验分模型。结论：提高了模型的相似性,为进一步研究下颌角截骨整形生物力学奠定了基础。     

计算机辅助下颌骨截骨的三维显微结构模型建立

目的 探索计算机重建下颌骨三维显微结构模型及下颌角截骨手术的三维仿真操作方法 ,以减少手术操作中的组织损伤. 方法 利用螺旋CTA数据重建包含血管神经束的下颌骨三维模型并进行测量分析,使用Freeform雕刻刀及其布尔运算的切割方法 对模型进行保护血管的手术模拟.结果 利用计算机辅助技术可以精确的重建包含下牙槽动脉的下颌骨三维模型:血管从下颌孔进入下颌支.依照下颌支外缘弧度走行,下颌孔距下颌支前缘距离为(19.13±0.66)mm,孔距下颌支后缘距离为(18.96±0.64)mm,下颌角的角度为(109.70±4.67)°,下颌支的安全截骨范围和角度是平行下颌支外缘(12.62±0.28)mm宽、与下颌底成角(22.30±4.67)°;根据模型与数据,Fredorm可以模拟安全的下颌角截骨的手术操作. 结论 下颌骨显微结构的三维模型重建和测量分析技术,是增加手术安全性的一条新途径.     

虚拟现实技术在神经外科术前计划中的应用

目的探讨虚拟现实（virtual reality，VR）技术在神经外科术前计划中的临床应用价值。方法对拟采用手术治疗的颅脑疾病26例，分别采集磁共振成像（MRI）、磁共振动脉成像（MRA）、磁共振静脉成像（MRV），计算机体层摄影（CT）等多种医学影像数据，输入Dextroscope术前计划系统，运用Radiodexter软件在VR环境中进行融合、提取、切割等处理显示为一个三维立体物像。同时运用软件内的三维处理工具对病灶及其局部解剖结构进行观察测量、手术模拟。制定术前计划，并与真正手术中情况进行对照比较。结果26例病例均成功地实现了三维立体虚拟现实影像的重建，术前计划中对于病灶及其局部解剖学特征的判定与术中实际情况吻合。结论Dextroscope系统的虚拟现实技术能快速、直观、全面地整合多种医学影像数据，以提供病灶及其局部解剖结构的综合信息，在神经外科手术前为制定和优化手术方案提供帮助，有可能有助于提高手术的安全性与病灶的全切除率。     

Toward the development of 3-dimensional virtual reality video tutorials in the French neurosurgical residency program. Example of the combined petrosal approach in the French College of Neurosurgery

BackgroundThe present study developed 3D video tutorials with commentaries, using virtual reality headsets (VRH). VRHs allow 3D visualization of complex anatomy from the surgeon's point of view. Students can view the surgery repeatedly without missing the essential steps, simultaneously receiving advice from a group of experts in the field.MethodsA single-center prospective study assessed surgical teaching using 3D video tutorials designed for French neurosurgery and ENT residents participating in the neuro-otology lateral skull-base workshop of the French College of Neurosurgery. At the end of the session, students filled out an evaluation form with 5-point Likert scale to assess the teaching and the positive and negative points of this teaching tool.ResultsTwenty-two residents in neurosurgery (n = 17, 81.0%) and ENT (n = 5) were included. Eighteen felt that the 3D video enhanced their understanding of the surgical approach (81.8%). Fifteen (68.2%) thought the video provided good 3D visualization of anatomical structures and 20 that it enabled better understanding of anatomical relationships (90.9%). Most students had positive feelings about ease of use and their experience of the 3D video tutorial (n = 14, 63.6%). Twenty (90.9%) enjoyed using the video. Twelve (54.5%) considered that the cadaver dissection workshop was more instructive.Conclusions3D video via a virtual reality headset is an innovative teaching tool, approved by the students themselves. A future study should evaluate its long-term contribution, so as to determine its role in specialized neurosurgery and ENT diploma courses.     

虚拟现实互动技术在交叉韧带等长重建计算机辅助设计中的应用

目的 利用虚拟现实技术还原膝关节骨性结构在屈伸运动过程中的三维空间形态，为观测膝关节面交叉韧带附丽区的相对位置变化和进一步研究前、后交叉韧带等长重建最佳等长点提供计算机辅助设计新方法。方法 采用实验与计算机仿真相结合的方法，对新鲜人体膝关节标本进行屈伸运动实验，并通过激光三维扫描方法记录、计算膝关节的空间活动指标，然后重建膝关节计算机三维模型。通过实验中的空间活动指标控制此模型虚拟运动，再现膝关节各屈伸角度下股骨、胫骨和腓骨的空间位置。结果 计算机还原出各运动角度下膝关节骨性结构（股骨、胫骨及关节面）的空间形态，利用软件Geomagic的几何计算功能可分别测量模型中各个运动状态交叉韧带附丽区两点间的三维空间距离。讨论本研究方法可以真实地记录和再现膝关节三维运动过程，从空间结构上更精确、合理地寻找重建等长点，对膝关节交叉韧带手术重建有重要临床意义。     

Challenges to the development of complex virtual reality surgical simulations

Virtual reality simulation in surgical training has become more widely used and intensely investigated in an effort to develop safer, more efficient, measurable training processes. The development of virtual reality simulation of surgical procedures has begun, but well-described technical obstacles must be overcome to permit varied training in a clinically realistic computer-generated environment. These challenges include development of realistic surgical interfaces and physical objects within the computer-generated environment, modeling of realistic interactions between objects, rendering of the surgical field, and development of signal processing for complex events associated with surgery. Of these, the realistic modeling of tissue objects that are fully responsive to surgical manipulations is the most challenging. Threats to early success include relatively limited resources for development and procurement, as well as smaller potential for return on investment than in other simulation industries that face similar problems. Despite these difficulties, steady progress continues to be made in these areas. If executed properly, virtual reality offers inherent advantages over other training systems in creating a realistic surgical environment and facilitating measurement of surgeon performance. Once developed, complex new virtual reality training devices must be validated for their usefulness in formative training and assessment of skill to be established.     

Extended,virtual and augmented reality in thoracic surgery: a systematic review

 Open in a separate windowOBJECTIVESExtended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery.METHODSA systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020.RESULTSOur search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient’s anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy.CONCLUSIONXR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.     

The virtual nose: a 3-dimensional virtual reality model of the human nose

BACKGROUND: The 3-dimensionally complex interplay of soft tissue, cartilaginous, and bony elements makes the mastery of nasal anatomy difficult. Conventional methods of learning nasal anatomy exist, but they often involve a steep learning curve. Computerized models and virtual reality applications have been used to facilitate teaching in a number of other complex anatomical regions, such as the human temporal bone and pelvic floor. We present a 3-dimensional (3-D) virtual reality model of the human nose. METHODS: Human cadaveric axial cross-sectional (0.33-mm cuts) photographic data of the head and neck were used. With 460 digitized images, individual structures were traced and programmed to create a computerized polygonal model of the nose. Further refinements to this model were made using a number of specialized computer programs. This 3-D computer model of the nose was then programmed to operate as a virtual reality model. RESULTS: Anatomically correct 3-D model of the nose was produced. High-resolution images of the "virtual nose" demonstrate the nasal septum, lower lateral cartilages, middle vault, bony dorsum, and other structural details of the nose. Also, the model can be combined with a separate virtual reality model of the face and its skin cover as well as the skull. The user can manipulate the model in space, examine 3-D anatomical relationships, and fade superficial structures to reveal deeper ones. CONCLUSIONS: The virtual nose is a 3-D virtual reality model of the nose that is accurate and easy to use. It can be run on a personal computer or in a specialized virtual reality environment. It can serve as an effective teaching tool. As the first virtual reality model of the nose, it establishes a virtual reality platform from which future applications can be launched.     

不同现实可视化系统在麻醉领域中的应用

随着全息影像技术的高速发展,其提供的高级可视化技术和交互式医疗体验使得不同的现实可视化系统在医学上的应用日益广泛。文章综述了不同现实可视化系统,如虚拟现实（virtual reality, VR）系统、增强现实（augmented reality, AR）系统及混合现实（mixed reality, MR）系统的定义及...     

3D virtual reality and selective vascular control for laparoscopic left hepatic lobectomy

Background

Careful control of haemostasis is particularly important in laparoscopic hepatic surgery, since a bloodless operative field results in safer and smoother procedures. A selective vascular control for a left lateral segmentectomy may be facilitated by the use of three-dimensional (3D) virtual reality.

Materials and methods

A 67-year-old male patient presenting with a 3.5-cm hepatocellular carcinoma (HCC) located between segment II and III of the liver was referred for hepatic resection. Transplant was contraindicated due to previous head and neck cancer surgery. Preoperative 3D reconstruction was used for preoperative planning and allowed a virtual resection to be done as well as peroperative simulation.

Results

Five ports were used. The first step was primary control of the hepatic pedicle. 3D virtual-reality reconstruction demonstrated the position of the tumor in the segment and regarding the vessels. The left hepatic artery and the portal vein were successively dissected and controlled. The real anatomy was compared to the virtual-reality reconstruction. Both demonstrated the same anatomy. Vascular section was completed and this resulted in a typical color change of the left lateral segment as well as a small decrease in size. The bisegmentectomy was performed using harmonic dissectors (Autosonix®, Tyco Healthcare), bipolar cautery, clips, and application of Endo GIA vascular staples (Tyco Healthcare) on the portal pedicles. The procedure was completed following isolation and control of the left hepatic vein. After section, the specimen was placed in a bag and extracted following enlargement of the camera port. Follow-up was uneventful and there was no elevation of hepatic enzymes or postoperative ascites. The patient left the hospital on the fifth postoperative day.

Conclusion

3D reconstruction allowed the procedure to be simulated preoperatively. This facilitated the intraoperative identification of the vascular anatomy and the control of the left lateral segment arteries and veins, thus preventing intraoperative bleeding. The use of this approach in preoperative planning is recommended.