Annals of 3D printed medicine最新文献_第4页

Pelvic osteotomies for correction of sagittal imbalance of the spine: An in-silico study comparing four different osteotomies 矫正脊柱矢状不平衡的骨盆截骨术：比较四种不同截骨方法的模拟研究

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-11-20 DOI: 10.1016/j.stlm.2024.100185

A.E.A. Ochtman , M.J. Claessens , F.C. Öner , T.P.C. Schlösser , K. Willemsen , J. Magré , H.C. Nguyen , M.C. Kruyt

Three-column spinal osteotomies are common to restore sagittal balance. However, these procedures are challenging. Pelvic osteotomies may be a feasible alternative, although instability and compromised correction are concerning, which dome-shaped osteotomies may mitigate. As a possible and novel alternative for spinal osteotomies, pelvic dome and open wedge osteotomies for correction of sagittal spine balance were compared.

Four in-silico pelvic osteotomies were performed on 3D CT-reconstructions: bilateral extending pelvic osteotomy (BEPO) and dome pelvic osteotomies (DPOs) around center of the sacral endplate (SE-DPO), sacroiliac joints (SI-DPO) and centers of the acetabula (A-DPO).

We measured pelvic extension and bone contact surface (BCS) after 10°, 15° and 20° extension and the length of the sacropelvic ligaments after 20° extension. In radiographs of five samples of failed back surgery, we measured the effect on sagittal vertical axis (SVA) and Th1 pelvic angle (TPA). Pelvic extension was similar for all types of osteotomy. After 20° extension, BCS was 34.1 % (SE-DPO), 28.2 % (SI-DPO) and 30.6 % (A-DPO). Average shortening of the spinopelvic ligaments was 2.3 % after the BEPO, 22.0 % after SE-SPO, 17.0 % after SI-DPO and 11.8 % after A-DPO. After 15° correction, SVA correction was 12.6 cm and TPA correction 5.8° after BEPO. After SE-DPO, the correction was 14.5 cm and 14.1°, after SI-DPO 13.4 cm and 13.0° and after A-DPO 12.6 cm and 0.0°.

A-DPO appeared to the most predictable and reliable pelvic osteotomy. However, this is technically demanding and shortens the pelvic floor ligaments. BEPO is less demanding with minimal effect on the ligaments, however it requires more complex stabilization methods. Feasibility and safety tests are required as a next step.

三柱脊柱截骨术是恢复矢状面平衡的常见方法。然而，这些手术具有挑战性。骨盆截骨术可能是一种可行的替代方法，但不稳定性和矫正受损是令人担忧的问题，而穹隆截骨术可减轻这一问题。作为脊柱截骨术的一种可能的新型替代方法，我们对用于矫正脊柱矢状面平衡的骨盆穹隆截骨术和开放式楔形截骨术进行了比较。我们在三维 CT 重建图像上进行了四种骨盆内截骨术：双侧骨盆延长截骨术（BEPO）和围绕骶骨终板中心（SE-DPO）、骶髂关节（SI-DPO）和髋臼中心（A-DPO）的骨盆穹隆截骨术（DPO）。我们测量了骨盆10°、15°和20°伸展后的骨盆伸展度和骨接触面（BCS），以及20°伸展后的骶骨韧带长度。在 5 个背部手术失败样本的 X 光片上，我们测量了对矢状垂直轴（SVA）和 Th1 骨盆角（TPA）的影响。所有截骨类型的骨盆伸展情况相似。伸展20°后，BCS为34.1%（SE-DPO）、28.2%（SI-DPO）和30.6%（A-DPO）。BEPO 后脊柱骨盆韧带的平均缩短率为 2.3%，SE-SPO 后为 22.0%，SI-DPO 后为 17.0%，A-DPO 后为 11.8%。BEPO 15°矫正后，SVA矫正为12.6厘米，TPA矫正为5.8°。SE-DPO后的矫正为14.5厘米和14.1°，SI-DPO后的矫正为13.4厘米和13.0°，A-DPO后的矫正为12.6厘米和0.0°。A-DPO 似乎是最可预测、最可靠的骨盆截骨方法，但技术要求高，会缩短骨盆底韧带。BEPO 要求较低，对韧带的影响最小，但需要更复杂的稳定方法。下一步需要进行可行性和安全性测试。

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引用次数: 0

Optimal 3D printing for orthopaedics: An experience after 500 cases 矫形外科的最佳 3D 打印技术：500 个病例的经验总结

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.stlm.2024.100179

Shirong Huang, Muhammad Farhan Bin Mohd Fadil, Michael Gui Jie Yam

There has been a surge in the use of 3D printing in modern medicine due to the plethora of benefits that it brings - shorter operative times with reduced operating room costs, along with higher quality patient and medical student education. Despite its undeniable benefits, there remains challenges left unaddressed. How can a centre start and maintain an efficient 3D printing centre? In our paper, we aim to share our set of recommendations for optimal 3D printing in Orthopaedics, leveraging on our experience after more than 500 cases.

3D打印技术在现代医学中的应用激增，因为它能带来诸多好处--缩短手术时间、降低手术室成本、提高病人和医学生的教育质量。尽管3D打印技术的好处毋庸置疑，但仍有一些挑战尚未解决。一个中心如何才能建立并维持一个高效的 3D 打印中心？在本文中，我们将分享我们根据 500 多个病例的经验提出的骨科最佳 3D 打印建议。

引用次数: 0

Reviewing the literature of 3D printing of bones and cartilage: Evidence and practice 回顾有关骨骼和软骨 3D 打印的文献：证据与实践

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.stlm.2024.100180

Arunkumar Subramanian , Jaishree Mohanbabu , Trisha Srinivasan , Tamilanban T , Vetriselvan Subramaniyan , Manimaran V , Mahendran Sekar , Ling Shing Wong

The cutting-edge innovations offer diverse opportunities in medicine; one such inductive approach is 3D bio-printing, in which cells and desired biomaterials cohesively synthesize living macro tissues. The rapidly increasing demand for reconstruction and restoration of highly intricate and responsive bone implants has encouraged bone tissue engineering to yield implants that substitute the native bone, both physically and biologically. As this technology is still in its infancy, different limitations can be encountered, such as the lack of in-depth characterization of scaffolds and limited visualization of a general framework, which can be overcome with further explorative studies. With computerized bio-fabrication, 3D printing aims to perfectly adapt implants, individually analyzing data at the level of cells, tissues, organs, and organic systems, ending this entire process under pre-bioprinting. The locus and susceptibility to bare load are primary considerations in selecting among widely available biomaterial options and printing techniques, including bio-ceramics, metals, bioinks, selective laser melting, directed energy deposition (laser or e-beam), and drop-on-powder printing. The addition of growth factors and mesenchymal stem cells allows the maintenance of the balance between osteoclasts and osteoblasts, the cartilage tissue formation, and contributes to the overall bone remodeling and regeneration processes. This review address and highlights relevant aspects on pre-bioprinting procedures, bio-materials selection, bio-printers, bone remodeling mechanism, and in-vivo responses of fibrin scaffold.

最前沿的创新为医学提供了各种机会；其中一种归纳方法是三维生物打印，细胞和所需的生物材料在其中凝聚合成活的宏观组织。人们对重建和修复高度复杂、反应灵敏的骨植入物的需求迅速增加，这促使骨组织工程产生了能在物理和生物两方面替代原生骨的植入物。由于这项技术仍处于起步阶段，可能会遇到不同的限制，如缺乏对支架的深入表征和总体框架的有限可视化，这些限制可以通过进一步的探索研究来克服。通过计算机化生物制造技术，3D 打印技术旨在完美调整植入物，单独分析细胞、组织、器官和有机系统层面的数据，在预生物打印下结束整个过程。在从生物陶瓷、金属、生物墨水、选择性激光熔化、定向能沉积（激光或电子束）和粉末滴注打印等广泛可用的生物材料选项和打印技术中进行选择时，首要考虑的是位置和对裸负载的敏感性。生长因子和间充质干细胞的加入可维持破骨细胞和成骨细胞之间的平衡，促进软骨组织的形成，并有助于整个骨重塑和再生过程。这篇综述探讨并强调了生物打印前程序、生物材料选择、生物打印机、骨重塑机制以及纤维蛋白支架的体内反应等相关方面。

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引用次数: 0

3D printed collagen scaffold for heart valve repair 用于心脏瓣膜修复的 3D 打印胶原支架

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.stlm.2024.100181

Henrique Luis Piva, Vitoria Olegario Leite, Antonio Claudio Tedesco

Three-dimensional (3D) bioprinting has emerged as a promising approach for the development of functional tissues and organs, including the heart valves. In this study, we investigated the interaction of 3D printed collagen scaffolds with H9c2(2–1) and NIH/3T3 cells to improve heart-valve repair strategies. Type I collagen was extracted from rat tails, characterized using SDS-PAGE and Raman spectroscopy, and used as a biomaterial ink for 3D printing. The rheological properties were evaluated. The FRESH technique was used to support the printed construct. In vitro assessments were performed to determine the cell viability and distribution within the scaffold. These results demonstrated the successful extraction and characterization of Type I collagen, which exhibited suitable rheological properties for 3D bioprinting. The printed collagen scaffolds supported the growth and distribution of H9c2(2–1) and NIH/3T3 cells, indicating their potential application in heart valve repair. This study highlights the importance of collagen as a biomaterial in 3D bioprinting and provides insights into the development of advanced strategies for heart valve repair.

三维（3D）生物打印已成为开发包括心脏瓣膜在内的功能性组织和器官的一种前景广阔的方法。在本研究中，我们研究了三维打印胶原支架与 H9c2(2-1) 和 NIH/3T3 细胞的相互作用，以改进心脏瓣膜修复策略。我们从大鼠尾部提取了 I 型胶原蛋白，使用 SDS-PAGE 和拉曼光谱对其进行了表征，并将其用作三维打印的生物材料墨水。对其流变特性进行了评估。FRESH 技术用于支持打印的构建体。还进行了体外评估，以确定支架内的细胞活力和分布情况。这些结果表明，I 型胶原蛋白的提取和表征取得了成功，其流变特性适合用于三维生物打印。打印出的胶原支架支持 H9c2（2-1）和 NIH/3T3 细胞的生长和分布，这表明它们在心脏瓣膜修复中具有潜在的应用价值。这项研究强调了胶原蛋白作为一种生物材料在三维生物打印中的重要性，并为开发先进的心脏瓣膜修复策略提供了启示。

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引用次数: 0

Novel 3D printed capsule to work as an auxiliary for enteric-coating for gastroprotective drug delivery system. 新型 3D 打印胶囊可作为胃保护给药系统的肠道包衣辅助剂。

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-10-06 DOI: 10.1016/j.stlm.2024.100176

Saniya Jawed, Satish CS

In the current research work, 3d printed capsules were printed by using FDM based 3D printer. A model drug punched into matrix tablets was put inside and encapsulated in the capsule. It was compared with the highly advanced ready-to-fill enteric-coated capsule Eudracap™ capsule. Solid Works and slicing software were used to design and cast off the shape of the capsule shell. The design of the cap and body was made and capsules were printed accordingly. All were evaluated for acid uptake and disintegration tests. In an acidic medium at pH 1.2, it has not been disintegrated or opened. While in the intestinal pH at 6.8 body and cap got separated after 45 ± 05 min. All sizes of capsules were also assessed for dosage form they can uphold. This could be a good option for customized drug delivery for human and animal studies.

在当前的研究工作中，使用基于 FDM 的 3D 打印机打印出了 3D 打印胶囊。将模型药物打入基质片中并封装在胶囊中。该胶囊与先进的即装型肠溶胶囊 Eudracap™ 胶囊进行了比较。使用 Solid Works 和切片软件来设计和铸造胶囊外壳的形状。然后设计了胶囊帽和囊体，并据此打印了胶囊。所有胶囊都进行了酸吸收和崩解试验。在 pH 值为 1.2 的酸性介质中，胶囊未被崩解或打开。而在肠道 pH 值为 6.8 的条件下，45 ± 05 分钟后胶体和胶帽分离。此外，还对各种规格的胶囊进行了评估，以确定它们所能支持的剂型。这可能是为人类和动物研究定制给药的良好选择。

引用次数: 0

Additive manufacturing of personalized scaffolds for vascular cell studies in large arteries: A case study on carotid arteries in sickle cell disease patients 用于大动脉血管细胞研究的个性化支架的增材制造：镰状细胞病患者颈动脉案例研究

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-10-05 DOI: 10.1016/j.stlm.2024.100178

Saskia Eckert , Christian Kassasseya , Weiqiang Liu , Eliott Benichou , Irène Vignon-Clementel , Smaïne Kouidri , Kim-Anh Nguyen-Peyre , Pablo Bartolucci , Frédéric Segonds

Patient-specific models have increasingly gained significance in medical and research domains. In the context of hemodynamic studies, computational fluid dynamics emerges as a highly innovative and promising approach. We propose to augment these computational studies with cell-based experiments in individualized artery geometries using personalized scaffolds and vascular cell experiments. Previous research has demonstrated that the development of Sickle Cell Disease (SCD)-Related Vasculopathy is dependent on personal geometries and flow characteristics of the carotid artery. This fact leaves conventional animal experiments unsuitable for gaining patient-specific insights into cellular signaling, as they cannot replicate the personalized geometry. These personalized dynamics of cellular signaling may further impact disease progression, yet remains unclear. This paper presents a six-step methodology for creating personalized large artery scaffolds, focusing on high-precision models that yield biologically interpretable patient-specific results. The methodology outlines the creation of personalized large artery models via Additive Manufacturing suitably for supporting cell culture and other cellular experiments. Additionally, it discusses how different Computer-Aided-Design (CAD) construction modes can be used to obtain high-precision personalized models, while simplifying model reconfigurations and facilitating adjustments to general designs such as system connections to bioreactors, fluidic systems and visualization tools. A proposal for quality control measures to ensure geometric congruence for biological relevance of the results is added. This innovative, interdisciplinary approach appears promising for gaining patient-specific insights into pathophysiology, highlighting the importance of personalized medicine for understanding complex diseases.

患者特异性模型在医疗和研究领域的重要性日益凸显。在血液动力学研究中，计算流体动力学是一种极具创新性且前景广阔的方法。我们建议利用个性化支架和血管细胞实验，在个性化动脉几何结构中进行基于细胞的实验，以增强这些计算研究。先前的研究表明，镰状细胞病（SCD）相关血管病变的发展取决于颈动脉的个性化几何形状和流动特性。由于无法复制个性化的几何形状，传统的动物实验无法深入了解患者的细胞信号传导。这些个性化的细胞信号动态可能会进一步影响疾病的进展，但目前仍不清楚。本文介绍了创建个性化大动脉支架的六步方法，重点是建立高精度模型，以产生可从生物学角度解释的患者特异性结果。该方法概述了通过快速成型制造技术创建个性化大动脉模型，以支持细胞培养和其他细胞实验。此外，它还讨论了如何利用不同的计算机辅助设计（CAD）构建模式来获得高精度的个性化模型，同时简化模型的重新配置并促进对一般设计的调整，如与生物反应器、流体系统和可视化工具的系统连接。此外，还提出了质量控制措施建议，以确保结果的几何一致性和生物学相关性。这种创新的跨学科方法似乎很有希望获得针对病人的病理生理学见解，突出了个性化医学对理解复杂疾病的重要性。

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引用次数: 0

3D printable customized drug delivery system for the vaginal delivery of therapeutics: Unlocking potential prospects for women care 用于阴道给药的 3D 可打印定制给药系统：打开妇女护理的潜在前景

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-10-05 DOI: 10.1016/j.stlm.2024.100177

Suraj Kumar , Rishabha Malviya , Sathvik Belagodu Sridhar

The current traditional medication administration method is characterized by a prevalent "one-size-fits-all" approach poses challenges in tailoring medications to individual pharmacokinetic profiles, limiting its applicability in the pharmaceutical sector. In response to this, three-dimensional (3D) printable medical devices for vaginal drug delivery are gaining popularity, due to advancements in Fused Deposition Modeling (FDM) or additive manufacturing (AM) technology. These devices offer distinct Strengths over conventional medication delivery methods, enabling the customization of drugs and the creation of intricate three-dimensional structures with personalized designs. In an additional point of interest, the development of multi-material printing integrates the beneficial properties of a variety of functional substances, presenting diverse opportunities to enhance the efficacy of vaginal drug delivery. Although there have been substantial advancements in manufacturing processes, challenges such as cost-effectiveness, scalability, and compliance with regulations remain substantial hurdles. This review focuses on the recent progress made in the field of printed using three-dimensional technology for vaginal medication delivery devices, addresses the primary challenges that need to be overcome, and explores the potential of manufacturing techniques in shaping the future of dosage forms and drug administration systems.

当前传统给药方法的特点是普遍采用 "一刀切 "的方法，这给根据个体药代动力学特征定制药物带来了挑战，限制了其在制药领域的适用性。为此，随着熔融沉积建模（FDM）或增材制造（AM）技术的发展，用于阴道给药的三维（3D）可打印医疗器械越来越受欢迎。与传统的给药方法相比，这些设备具有明显的优势，可以实现药物的定制，并创造出具有个性化设计的复杂三维结构。另一个值得关注的问题是，多材料打印技术的发展整合了多种功能物质的有益特性，为提高阴道给药的疗效提供了多种机会。虽然制造工艺有了长足的进步，但成本效益、可扩展性和法规遵从性等挑战仍然是巨大的障碍。本综述重点介绍了利用三维技术印制阴道给药装置领域的最新进展，探讨了需要克服的主要挑战，并探讨了制造技术在塑造未来剂型和给药系统方面的潜力。

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引用次数: 0

A novel approach to hallucal sesamoid pathology utilizing a 3D printed patient specific total sesamoid replacement implant: Case series 利用 3D 打印的患者专用全芝麻状替代假体治疗幻觉芝麻状病变的新方法：病例系列

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-09-14 DOI: 10.1016/j.stlm.2024.100174

Tyler R. Rodericks , Adam D. Perler , Hans C. Humrick

Background

Sesamoidectomy can be associated with multiple complications secondary to loss of the intrinsic function of the excised sesamoid. We sought to mitigate these complications by preserving sesamoid function with a total sesamoid replacement (TSR) in lieu of sesamoidectomy.

Method

Patient specific 3D printed TSR implants were designed and implanted for three patients who had exhaustively failed conservative measures. Follow up ranges from 7-36 months during which we evaluated for complications, symptom resolution, and patient satisfaction.

Result

All patients had complete resolution of pain between 3.5-12 months postop and have remained satisfied with their outcome. No evidence of the aforementioned complications was observed.

Conclusion

TSR may represent a viable alternative treatment option for most cases in which sesamoidectomy would otherwise be considered.

Level of evidence

IV, case series.

背景芝麻状骨切除术可能会继发多种并发症，因为切除的芝麻状骨会丧失固有功能。我们试图用全芝麻假体置换术（TSR）来代替芝麻切除术，以保留芝麻功能，从而减少这些并发症的发生。结果所有患者在术后 3.5-12 个月内疼痛完全缓解，并对治疗效果表示满意。结果所有患者在术后3.5-12个月期间疼痛完全缓解，并对疗效表示满意，没有发现上述并发症。

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引用次数: 0

Selective laser sintering at the Point-of-Care 3D printing laboratory in hospitals for cranio-maxillo-facial surgery: A further step into industrial additive manufacturing made available to clinicians 用于颅颌面外科手术的医院护理点 3D 打印实验室的选择性激光烧结技术：向临床医生提供工业增材制造技术又迈进了一步

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-09-12 DOI: 10.1016/j.stlm.2024.100175

Alessandro Tel , Erik Kornfellner , Enikő Molnár , Shiden Johannes , Francesco Moscato , Massimo Robiony

Additive manufacturing has developed rapidly in recent years and has many useful applications in the clinical field. In particular, cranio-maxillo-facial (CMF) surgery requires high precision, which can be obtained with 3D printed patient-specific surgical guides and anatomical models. Among the many different printing options, selective laser sintering (SLS) seems to be rarely used in point-of-care applications, considering its apparent characteristics.

This article examines the advantages and disadvantages of SLS printers for CMF point-of-care (PoC) by reviewing the literature and comparing in-house printed SLS and stereolithography (SLA) prints.

The investigation showed that the easily sterilizable and robust materials processed by SLS printing are well suited for CMF surgical guides and have clear advantages over SLA parts.

Some barriers to the use of SLS printers in PoC are likely to be the slightly higher complexity and cost.

However, these will decrease as 3D printing technology advances and surgeon acceptance increases, making SLS a practical PoC tool.

快速成型制造技术近年来发展迅速，在临床领域有许多有用的应用。尤其是颅颌面（CMF）手术需要高精度，而这可以通过三维打印的患者专用手术导板和解剖模型来实现。在众多不同的打印选项中，考虑到选择性激光烧结（SLS）的明显特点，它似乎很少用于护理点应用。本文通过回顾文献并比较内部打印的 SLS 和立体光刻（SLA）打印件，研究了用于 CMF 护理点（PoC）的 SLS 打印机的优缺点。调查显示，SLS 打印加工的材料易于消毒且坚固耐用，非常适合用于 CMF 手术导板，与 SLA 零件相比具有明显的优势。

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引用次数: 0

Evaluation of a pilot regional neurotrauma workshop using 3D printed simulation models 使用 3D 打印模拟模型对区域神经创伤试点研讨会进行评估

Q3 Medicine

Annals of 3D printed medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.stlm.2024.100169

Nalinda Dissanayaka , Hamish Alexander , Michael Redmond , Patrick Pearce , Andrew Hobbins-King , Kate Lee , Danilo Carluccio , Roozbeh Fakhr , Luigi-Jules Vandi , James I. Novak

Objective

Non-neurosurgeons in regional and rural hospitals may be required to operate on patients presenting with a traumatic brain injury where timely transfer to a tertiary hospital is not possible. Confidence and experience can vary significantly due to limited access to hands-on training. Increasing availability to advanced 3D printed models opens new opportunities to provide accurate head models suitable for this purpose. This study evaluated the experience of regional clinicians and nurses following a neurotrauma workshop where 3D printed head models were used to provide training in burr hole and craniotomy procedures.

Methods

A neurotrauma seminar and workshop was hosted at the Sunshine Coast Health Institute, in the state of Queensland, Australia. The workshop component allowed 26 local clinicians and nurses to gain hands-on experience with a 3D printed head model, guided by neurosurgeons from the closest tertiary hospital. Following training, participants completed a short survey.

Results

Prior to this workshop, most participants had never performed a burr hole (58 %, n=15) or interacted with a 3D printed model (69 %, n=18). Overall, most participants indicated that the 3D printed model performed better (58 %, n=15) and much better (15 %, n=4) than their expectations. 81 % (n=21) left the workshop with improved confidence in performing burr hole and craniotomy procedures. Despite some melting of the plastic, 96 % (n=25) of participants would recommend this model to their colleagues.

目的地区和农村医院的非神经外科医生可能需要为脑外伤患者进行手术，而这些患者不可能及时转到三级医院。由于获得实践培训的机会有限，他们的信心和经验会有很大差异。先进 3D 打印模型的日益普及为提供适用于这一目的的精确头部模型带来了新的机遇。本研究评估了地区临床医生和护士在神经创伤研讨会后的经验，在研讨会上，3D 打印的头部模型被用来提供毛刺孔和开颅手术的培训。方法在澳大利亚昆士兰州的阳光海岸卫生研究所举办了神经创伤研讨会和讲习班。研讨会上，26 名当地临床医生和护士在最近的三甲医院神经外科医生的指导下，亲身体验了 3D 打印头部模型。培训结束后，参与者填写了一份简短的调查问卷。结果在参加此次研讨会之前，大多数参与者从未进行过毛刺孔操作（58%，人数=15）或与 3D 打印模型进行过互动（69%，人数=18）。总体而言，大多数参与者表示 3D 打印模型的性能比他们的预期要好（58%，人数=15）或好得多（15%，人数=4）。81% 的学员（21 人）在离开讲习班时表示，他们对实施毛刺孔和开颅手术的信心有所增强。尽管塑料有些融化，但仍有 96% （人数=25）的学员会向同事推荐该模型。

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引用次数: 0