摘要
研究背景
目前,我国在遗体捐献和人体器官捐献方面的立法存在着不足,而且由于传统观念的束缚,大部分人在去世后很少愿意捐献器官和遗体,因此全国各地医学院校都存在缺乏医学研究用的尸体标本,而用于临床解剖教学中的标本更是严重匮乏。虽然解剖学教学大纲要求4到6个学生解剖一具尸体,随着各大医学院校扩招,学生每年逐渐增多,解剖教学经费的相对不足,现今往往是几十个学生解剖一具尸体,难以进行系统而细致的基础医学学习。目前,缺乏尸体进行教学研究是全国医学院校都面临的问题。如何解决在尸体源不足的情况下,通过开展其他途径和方法进行有效教学,从而使学生更好的掌握临床解剖学,是我们共同的目标。
随着科学技术飞速发展,多学科融合、交叉是各类学科发展的必然途径与趋势。目前数字医学已成为现代医学的重要组成部分,数字技术已经渗透到医学的各个领域,从而促使医学技术向个性化、精确化、微创化和远程化方向快速发展。采用现代影像学、电脑图形图像处理、计算医学、现代临床解剖学和骨科学相结合建立的“数字化组织瓣”可为学生提供立体、直观、动态的组织瓣解剖学基础,将单调的二维解剖图谱教学由平面变为立体,由静态变动态,由单面变多面,对在校学生无论是在课上还是课下,可系统地学习解剖学和开展临床教学训练均有较大的帮助。针对显微外科领域皮瓣的血管系统进行的解剖学研究已广泛开展,例如大体解剖、血管铸型和多层螺旋CT扫描等技术,为我们开展皮瓣血管形态学研究提供了新的手段和发展空间。
传统的皮瓣外科教学完全依赖于教科书上的两维平面图片以及尸体解剖来进行培训。但传统的解剖图谱大都是“理想化的”主观配色的模式图或半模式图,没有三维空间的立体效果和实体的真实感。而目前随着医学院校的扩招,以及尸体来源的减少,学生在尸体上的操作练习和感官体验的机会将会越来越少,从而大大影响了解剖学的教学效果。随着三维数字化重建开拓了人体解剖学研究的新领域,以及虚拟中国人工程的成功,将皮瓣的解剖结构用三维、多角度、可视化,动态地展现已成为可能,此技术大大增强人们对血管、肌肉、骨、皮肤毗邻关系的理解。这为立体的观察组织瓣营养血管情况以及临床的教学训练与模拟奠定了基础。无损伤、直观性强的多层CT,在心脑血管病变、椎管形态学研究方面取得了一些成功经验,同时在皮瓣血管形态学研究方面也提供了影像学技术手段,随着计算机处理技术手段的不断完善,使得重建皮瓣的三维解剖成为必须和可能,这为立体的观察皮瓣血供情况,提供良好的教学条件奠定了基础,从而实现了由平面解剖向立体解剖和数字解剖的发展。数字化三维重建技术不但可以丰富解剖学的教学手段,还能使在校学生无论在课上还是课下,都可随时随地的通过个人PC学习和巩固解剖学知识,大大的缩短了学习过程;三维构建的数字化组织瓣可以让年轻医师通过网络更有效的掌握和复习临床解剖知识,避免重回解剖室进行复杂的解剖工作,减轻工作压力,有利于手术的设计与模拟训练,降低手术风险,提高骨科的治疗水平。
数字化三维图像与构建的模型除了可用于临床多媒体解剖教学,还可导入虚拟仿真手术软件,进行手术培训。众所周知,传统的医疗手术训练模式和学习是按照“师傅带徒弟”的方式进行的,手术室就是教室,有经验的医生通过“作一个、看一个、学一个”的方式训练初学者,教学内容随机的依赖于病人的出现,有很大的不可预见性,难于进行系统的教学。同时这种训练方法势必延长手术时间,增加手术成本,甚至影响手术质量,因而常常遭到病人的抵制。虽然目的的多层螺旋CT可以进行三维重建并以获得很好的图像显示,但不能以其它方式导出,不方便进行临床应用和示教,而新的计算机技术可以利用动态三维图像对传统二维医学图像进行补充,用连续断层图像进行三维重建,可以精确地显示生物组织复杂的三维结构,并可进行任意旋转、剖切观察和操作;可以对重建的三维结构进行测量,获得长度、面积、体积和角度等大量精确的解剖参数;可以用于临床轴助诊断、辅助手术设计和手术模拟等方面。
虽然高速螺旋CT重建技术中已经成为临床上普遍采用的影像学检查手段。但CT及MRI等二维图像均难于反映局部解剖空间位置与毗邻关系。计算机辅助三维重建技术广泛应用于医学领域可很好的解决这个问题,其优点在于三维立体解剖结构可从任意角度、任意方向上地观察。在医学图像方面,“美国可视人计划(Visible Human Project)”(1989)在全球引起了巨大反响。数字人研究是现代计算机信息技术与医学等学科相互结合的前沿性交叉项目,对科技发展有着深远意义。1989年美国国立图书馆(NLM)举行电子图像处理特别规划工作组会议,会议通过了一个报告,认为图像为理解生物结构和机能提供便利,是医学教育、研究和保健的重要组成部分。“可视人”技术的不断完善和软、硬件技术的成熟使电脑构建的三维虚拟现实图形直接指导临床应用提供了条件,而人机交互界面及演示技术的发展为三维虚拟现实图像在临床的应用提供了一个很好的舞台。目前国外已利用“可视人”等技术设计出“虚拟现实”软件直接应用于医疗教学和临床训练。数字化和虚拟现实技术的出现为外科手术的训练和学习开辟了全新的途径。
数字化组织瓣的三维建模材料通常来源于CT、MR和人体切片,64排螺旋CT和3T-MR均能提供人体薄层端面利清晰图像,可视人体数据库为真彩色图像,能够清晰显示微细血管。医学图像重建软件Minics、Amira等均具有功能强大的高级数据可视化系统。目前数字化皮瓣的可视技术主要应用于解剖教学和临床训练。但是,数字化组织瓣虽然可以真是反映组织瓣的形态结构,血管走行,毗邻结构,但其是否能精确地进行临床手术设计和术前定位,我们还需更细化的研究。本课题在此基础上,我们选取供血动脉比较恒定的腓肠肌皮瓣和髂骨瓣进行三维数字化重建,并在Amira软件中进行解剖学测量,探讨两种不同方法重建的数字化组织瓣模型测量所得数据与尸体解剖数据是否存在差异,三维重建的组织瓣模型能否真实、准确的反映实体解剖学结构。为多媒体显微外科解剖学教学提供数据以及为三维临床手术设计和术前定位提供条件。
目的
1.探讨数字化三维重建技术在组织瓣中的构建。
2.通过虚拟解剖学测量,探讨数字化三维重建的组织瓣模型能否真实、准确的反映实体解剖学结构。
3.应用虚拟可视技术对患者进行个性化组织瓣三维重建,并指导腓肠肌皮瓣和髂骨瓣的手术设计和手术操作。
方法
1.数字化组织瓣的三维重建数据获取:①下肢血管正常成人6人(男女各3人),取得患者知情同意。螺旋CT扫描:术前碘过敏试验阴性,经肘正中静脉注射非离子型造影剂优维显300(碘普罗胺注射液,成份:碘普罗胺0.623g/ml,碘300 mg/ml,广州先灵药业有限公司)90 ml,注射速度3 ml/s,自动监测,手动触发。CT扫描参数:120 kV、200 mA;层厚5 cm(最后可拆成0.625mm的原始图像),将其数据以.DICOM格式导出。②新鲜捐献成人尸体2具,血管正常,无明显周围血管病变和瘢痕,采用Tang等改良的明胶.氧化铅灌注方法灌注,灌注前后均对全身行连续螺旋CT扫描,扫描条件:120Kv,110mA,参数:层厚0.5mm,矩阵512×512。将扫描数据以DICOM格式输入个人计算机的Amira4.1重建软件,经自动或手动阈值分割后采用表面重建方法SSD(surfaceshade display)重建血管、肌肉、骨骼以及皮肤图像。轮廓提取,利用Amira提供的画笔(Brush)、套索(Lasso)、魔术棒(Magic wand)等图像分割工具,对组织瓣各结构进行提取、生成面片,然后用“smooth label”对边界进行光滑处理,“removeislands”去除岛屿,根据计算机的配置情况对轮廓线进行适当简化,采用SDD进行三维表面重建。用同样方法对组织瓣血管、肌肉和骨骼等进行表面重建或容积重建,然后将重建的肌肉、血管、皮瓣、骨骼图像根据人体组织不同颜色给予着彩。对组织瓣血管、肌肉和骨骼等进行表面重建或容积重建并将其数据单独保存。最后制作movie进行动态观察和多媒体教学。
2.数字化组织瓣模型的解剖学测量用数字化三维重建方法将组织瓣模型构建后(方法同上),利用Amira4.1软件自带测量工具对重建模型进行测量,对氧化铅灌注和血管造影两种不同构建方法的数字化组织瓣与正常尸体解剖数据进行比较,分析各自的特点。
3.数字化组织瓣的临床初步应用选择2007年3月至2008年12月需腓肠肌皮瓣创面修复的3例患者,以及采用旋髂深血管支髂骨瓣对股骨干骨折和胫骨骨折缺损以及骨不连进行骨缺损修复的2例患者。术前经肘正中静脉注射优维显后,用螺旋CT进行扫描(参数:120 kV、200 mA;层厚5 cm)。将扫描数据以.DICOM格式输入个人计算机的Amira4.1重建软件,经自动或手动阈值分割后,采用表面重建SSD法重建组织瓣供区血管、骨骼和(或)皮肤,并显示血管与毗邻组织的关系。应用软件自带测量工具对血管蒂、骨瓣长度进行测量。依据测量结果及忠者骨缺损长度和皮肤损伤面积对重建图像进行图像切割、表面重建,构建患者的个性化组织瓣。术前手术组将重建图像仔细演示,根据重建图像于患者供区组织瓣设计出点、线、面,术中仔细校对动脉与重建血管的走行是否相符,并依重建图像大小切取组织瓣。
结果
1.数字化三维重建技术可以直观准确地显示正常组织瓣的三维解剖形态,血管走行和组织瓣的毗邻结构。特别是动脉的分支情况和体表的投影得到很好的显示。利用软件自带的Movie Maker模板创建电影文件,画面清晰流畅,可直观、立体的显示形态特征,方便临床解剖教学。
2.重建的数字化模型测量数据与尸体组织瓣的解剖学数据基本相符。腓肠肌皮瓣氧化铅灌注显示,腓肠肌内侧动脉起始处与穿支点的距离平均1.8cm,重建出的穿支血管数平均为5条,外径为0.3～0.8mm,腓肠内侧动脉主干血管外径平均为2.6 mm;影像学造影显示,腓肠肌内侧动脉起始处与穿支点的距离平均2.0 cm,重建出的穿支血管数平均为2条,外径为0.1～0.5 mm,腓肠内侧动脉干血管外径平均为2.0 mm。骼骨瓣氧化铅灌注显示,旋髂深动脉起始点距髂前上棘的距离为4.2cm,旋髂深动脉主干外径平均为3.1 mm,髂嵴内段穿支血管数平均为6条,外径为0.5～0.9 mm;影像学造影显示,旋髂深动脉起点距髂前上嵴平均5.2cm,旋髂深动脉外径平均为2.2 mm,髂嵴内段穿支血管数平均为2条,外径为0.2～0.5mm。
3.所重建个性化腓肠肌皮瓣的患者3例,均能够清晰显示血管、皮肤及其毗邻结构的三维关系。并根据术前创面缺损大小,对皮瓣进行精确设计。其中2例病人所显示的皮瓣主要穿支及主干,与术中检查相符;1例显示皮瓣主干血管,但穿支显示不清,术中探查穿支血管平均约0.5 mm,最小穿支均小于0.3 mm。术后3例皮瓣全部成活。三维重建患者个性化骨瓣2例,所重建个性化髂骨瓣,能够清晰显示血管、骨骼及其毗邻结构的三维关系。并根据术前骨缺损大小,对骨瓣进行精确设计。2例病人所显示的骨瓣主要血供主干,均与术中检查相符。术前测量旋髂深动脉起点距髂前上嵴平均4.28 cm,旋髂深动脉外径平均为2.4mm,穿支血管数平均为3条。术后2例髂骨瓣全部成活。
结论
1.采用数字化三维重建技术可以直观显示正常组织瓣的三维解剖形态,可实现更多人体解剖结构可视化,为解剖教学展示提供参考,完善和丰富显微外科临床与解剖教学手段,弥补了尸体解剖教学标本不足的问题。
2.数字化组织瓣的虚拟解剖学测量数据在实体组织瓣测量数据的范围之内,并能够准确的显示组织瓣的血供来源与血供形式,为今后大体解剖学测量提供了新的思路。
3.术前依据个性化的重建图像结果对组织瓣进行精确的设计、定位,有助于提高外科手术的质量和可靠性。
Background
At present,our country remains at donation and human organ donation legislation there is a blank,and because of the shackles of traditional concepts,most people at the death of very few are willing to donate organs and body,resulting in medical colleges throughout the country there is a lack of medical body of research,and clinical anatomy for teaching the body is a desperate shortage.Although the anatomy of the syllabus requirements of 4-6 students dissect a corpse,and with the major expansion in medical schools,students gradually increased each year,teaching anatomy of the relative shortage of funds,and now dozens of students are often dissect a corpse,difficult to carry out systematic and detailed study of the basic medicine.At present,the lack of the body to carry out teaching and research in medical colleges and universities nationwide are facing the problem.How to solve the shortage in the body of the source of cases,through other means and methods for effective teaching,thereby enabling students to better grasp the clinical anatomy,are our common goals.
With the rapid development of science and technology,multi-disciplinary integration,cross-discipline is all kinds of ways and the necessity of the development trend.The current figure of modern medical science has become an important part of medicine,digital technology has penetrated into all fields of medicine and thereby facilitate the medical technology to the personalization,precision,minimally invasive and long-range direction of rapid development.The use of modern imaging,computer graphics image processing,calculation of medical,clinical anatomy and bone of modern science and set up a combination of the "digital tissue flap" could be to provide students with three-dimensional,intuitive,dynamic tissue flap basic anatomy will be two-dimensional Monotony teaching anatomy from two-dimensional map into three-dimensional,by the static variable dynamics,changing from single-sided multi-faceted,and are at school,whether in the classroom or on class,it can be systematic study of anatomy and clinical teaching and training both assist the larger. Microsurgical flaps for the area of the vascular system of the anatomical study has been widely carried out,such as Gross Anatomy,vascular casting and multi-slice spiral CT scanning technology,for us to carry out morphological study of vascular flap provides a new means and space for development.
Teaching traditional flap surgery is totally dependent on the textbook on the two-dimensional picture plane,as well as to conduct training autopsy.However,the traditional anatomic maps are "Idealized" subjective color pattern or semi-pattern, there is no three-dimensional space of three-dimensional effects and realistic entities. With the current expansion of medical colleges,as well as the body of source reduction,students at the body on the operation of exercises and sensory experiences will be fewer and fewer opportunities,thereby greatly affecting the anatomy teaching effectiveness.With the three-dimensional digital reconstruction of human anatomy has opened up new areas of research,as well as the virtual Chinese works successfully,they will flap anatomy using three-dimensional,multi-angle visualization,dynamic display has become possible,this technology greatly enhance people's blood vessels,muscle,bone,skin adjacent to the understanding of the relationship.This three-dimensional observation of vascular tissue flap nutrition,as well as clinical teaching and training and simulation foundation.No damage,intuitive and strong multi-layer CT,cardiovascular and cerebrovascular disease,spinal morphological study has made some successful experiences,while at flap vascular morphological study also provides a means of imaging technology,with computer processing technology means of continuous improvement,making the three-dimensional anatomical reconstruction of skin become necessary and possible, which for three-dimensional observation of flap blood supply,providing good teaching conditions laid a foundation,thereby achieving the anatomy from two-dimensional to three-dimensional anatomy and figure anatomy development. Three-dimensional reconstruction of digital technology not only can enrich the teaching of anatomy,but also to enable students,whether in the classroom or on the next lesson can be anytime,anywhere through Personal PC anatomical study and consolidation of knowledge,greatly shorten the learning process;Construction of three-dimensional digital flap allows young physicians through the network more effectively grasp and review of clinical anatomy knowledge,to avoid a return to the complex anatomy of the dissection room job,reducing job stress and is conducive to the operation of the design and simulation training,lower surgical risk,improve the level of orthopedic treatment.
Digital three-dimensional image and the construction of the model can be used apart from clinical multimedia anatomy teaching,surgery can also import virtual simulation software,surgical training.As we all know,the traditional medical model of surgical training and study are in accordance with the "masters train an apprentice" method,and the operating room is the classroom,there is the experience of doctors through "one do,and watch,and learn" way of training for beginners,teaching content dependent on the random appearance of patients,there is a lot of unpredictability,the system of teaching difficult.At the same time,this training method is bound to extend the operation time,increased surgical costs,and even affect the quality of surgery,which was usually the patient's boycott.Although the current multi-slice spiral CT and three-dimensional reconstruction can be carried out to obtain a good image display,but otherwise should not export,is not convenient for clinical application and teaching,and new computer technology can make use of dynamic three-dimensional image of the traditional two dimensional medical images added,using a row of three-dimensional tomography image reconstruction,can accurately show the complexity of biological tissue of the three-dimensional structure, and arbitrary rotation,cutting the observation and operation;can the reconstruction of three-dimensional structure measured was the length of,area,volume and angle of such a large number of precise anatomical parameters;can be used for clinical diagnosis,surgery and surgical simulation of the design and so on.
Although the high-speed spiral CT reconstruction technique in clinical practice has become a commonly used means of imaging examinations.However, two-dimensional CT and MRI images,etc.are difficult to reflect the local anatomical relationship with the adjacent spatial location.Computer-aided three-dimensional reconstruction technique is widely used in the medical field can be a very good solution to this problem,and its advantage is three-dimensional anatomical structure from any angle,any direction on observation.In medical images,"The United States plans to visual person(Visible Human Project)"(1989) attracted a huge global repercussion.Human research is a figure of modern computer information technology and medical disciplines,such as integration of cross-frontier projects,the development of science and technology has far-reaching significance.1989 United States National Library(NLM) held in electronic image processing special planning meeting of the Working Group,the Conference adopted a report,consider the image for the understanding of biological structure and function to facilitate medical education,research and an important component of health care."Visual person" technology continuously improved and the software and hardware technology to build sophisticated computer graphics three-dimensional virtual reality applications in the direct supervision of clinical conditions,and human-computer interaction interface and demonstration of technology development for the three-dimensional virtual reality images in clinical application provides an excellent arena.Currently abroad had used "visual person" and other technical design of "virtual reality" software directly applied to medical teaching and clinical training.Digitization and the emergence of virtual reality technology for surgical training and the study have opened up a whole new way.
Digital three-dimensional modeling of the flap material is usually derived from CT,MR and human slices,64-slice spiral CT and 3T-MR can provide the human face thin and clear images,visible human database for true color images can clearly show the micro-blood vessels.Medical image reconstruction software Minics,Amira,etc. with powerful advanced data visualization system.The current figure of flap anatomy visualization technique is mainly used in teaching and clinical training.However,the figure of tissue flap can really reflect the morphological structure of tissue flaps, blood vessels running adjacent to the structure,but whether it can accurately design and conduct of clinical surgery preoperative localization,we need a more detailed study.The topics on this basis,we select the relatively constant arterial blood supply to the gastrocnemius muscle flap and bone flap reconstruction of three-dimensional figure,and at Amira software for anatomical measurements,the reconstruction of two different methods to explore the digital measurement of tissue flap model the data with the autopsy data are different,three-dimensional reconstruction of the tissue flap can model true,accurate reflection of anatomical structure entity.Microsurgical anatomy for multimedia data,as well as teaching clinical operations for three-dimensional design and provide the conditions for preoperative localization.
Objective
1.Explore three-dimensional reconstruction of digital technology in the tissue flap Construction and clinical application of anatomy teaching.
2.Through the anatomical measurements to explore the figure of three-dimensional reconstruction of the tissue flap can model true,accurate reflection of anatomical structure entity.
3.Application of virtual visualization technology on patients with personalized three-dimensional tissue flap reconstruction,and to provide guidance to the gastrocnemius muscle flap and bone flap design and surgical operation.
Methods
1.Tissue flap reconstruction of the digital three-dimensional data acquisition:①lower limb blood vessels in normal adults 6 people(3 men and women of all people),to obtain informed consent of patients.Spiral CT scan:preoperative iodine allergy tests negative,the median cubital intravenous non-ionic contrast agent Ultravist 300(iopromide injection,ingredients:Iopromide 0.623 g/ml,iodine 300 mg/ml,Canton first Ling Pharmaceutical Ltd.) 90 ml,injection rate of 3 ml/s, automatic monitoring,manual trigger.CT scan parameters:120 kV,200 mA;slice thickness 5 cm(Finally removable 0.625mm into the original image) to its data.DICOM format to export.②fresh cadavers donated two blood vessels to normal,no significant peripheral vascular lesions and scars,the use of modified gelatin Tang,etc.Lead oxide perfusion method of perfusion,before and after perfusion of systemic continuous spiral CT scan,scan conditions:120 Kv,110 mA, parameters:slice thickness 0.5mm,matrix 512×512.Will scan input data to DICOM format for personal computers Amira4.1 reconstruction software,by automatically or manually after threshold segmentation method of surface reconstruction using SSD (surface shade display) the reconstruction of blood vessels,muscles,bones and skin images.Contour extraction,the use of Amira to provide the brush(Brush),Lasso (Lasso),magic wand(Magic wand),such as image segmentation tools,the structure of the tissue flap to be collected,generated surfaces,and then use the "smooth label" on the border smooth deal,"remove islands" Removal of the island,according to the configuration of the computer on an appropriate simplification of contour lines,using three-dimensional surface reconstruction SDD.With the same method of flap blood vessels,muscles and bones,such as surface reconstruction or volume rendering,and then rebuild the muscles,blood vessels,skin,skeletal images of human tissues in accordance with different colors to give a prize.Tissue flap to blood vessels,muscles and bones,such as surface reconstruction or volume reconstruction and preservation of data alone.Finally the production of dynamic observation of Movie and multimedia teaching.
2.Digital model of tissue flap Anatomical measurement of digital three-dimensional reconstruction method to model after the tissue flap(Ways ibid.), using its own software Amira4.1 measuring instrument to measure the reconstruction model of lead oxide perfusion and angiography in two Different Ways to build the digital tissue flap with normal autopsy data,analyze their characteristics.
3.Digital flap preliminary application of clinical selection from March 2007 to December 2008 required gastrocnemius flap in 3 cases of wound healing in patients, and the use of iliac bone flap vascular branch of femoral shaft fractures and tibial fractures and nonunion defect for bone defect repair in patients with Example 2.After preoperative median cubital vein after injection of Ultravist,using spiral CT scan (parameters:120 kV,200 mA;slice thickness 5 cm).To scan data.DICOM format input Amira4.1 reconstruction personal computer software,by automatically or manually after threshold segmentation,surface reconstruction using tissue flap reconstruction SSD for the District of vascular,skeletal and(or) the skin,and show blood vessels and adjacent organizations.Bring their application software on the vascular pedicle measuring instrument,bone length measurement.Based on the measurement results and the patients bone defect length and area of skin lesions on the reconstructed image image cutting,surface reconstruction,building a patient's personalized tissue flap.Preoperative surgical group will be carefully reconstructed image presentation,according to the reconstructed image for the area in the patients with tissue flap design point,line,face,carefully proofread artery surgery and reconstruction of blood vessels running in line,and according to the reconstructed image size cut tissue flap.
Results
1.Three-dimensional reconstruction of digital technology can accurately show the intuitive normal three-dimensional tissue flap anatomy,vascular tissue flap Traveling and the adjacent structures.Especially the branch artery and the projection surface to be well displayed.Use of the software comes with templates to create a Movie Maker movie file,smooth and clear picture quality can be intuitive, three-dimensional display morphological characteristics,to facilitate the teaching of clinical anatomy.
2.Reconstruction of the digital model of measurement data with the anatomy of the body flap basic line data.PbO gastrocnemius flap perfusion showed that the medial gastrocnemius artery with an average distance from the fulcrum wear 1.8cm, the reconstruction of the perforator vessels an average of 5,external diameter of 0.3-0.8mm,the medial sural artery The average diameter of the trunk vascular 2.6mm; images imaging study showed that the medial gastrocnemius artery with an average distance from the fulcrum wear 2.0cm,the reconstruction of the perforator vessels an average of 2,external diameter of 0.1-0.5mm,the medial sural artery vascular diameter of the average do 2.2mm.PbO bone flap perfusion showed iliac artery of anterior superior iliac spine distance of the distance of 4.2cm,iliac artery diameter of an average of 3.1mm,with the iliac crest above the average number of perforator vessels for 6,external diameter of 0.5-0.9 mm;images imaging study showed that iliac artery distance from anterior superior iliac crest on average 5.2cm,iliac artery diameter of an average of 2.7mm,with the iliac crest above the average number of perforator blood vessels for the two,external diameter of 0.2-0.5mm.
3.The gastrocnemius muscle flap reconstruction of personalized three cases of patients is able to clearly indicate that blood vessels,skin and adjacent structures of three-dimensional relations.And in accordance with pre-operative wound defect size, the precise design of the flap.One of two cases of patients shown in the main perforator flap and trunk,and intraoperative inspection line;Example 1 shows that the backbone of vascular flap,but shows perforator unclear,intraoperative vascular exploration perforator average of about 0.5 mm,the smallest perforator were less than 0.3 mm.All postoperative flaps were survival.Three-dimensional reconstruction of patients with individualized two cases of bone,the bone flap reconstruction of personalized,is able to clearly show blood vessels,bone and adjacent structures of three-dimensional relations.And in accordance with pre-operative bone defect size, the precise design of the bone flap.Patient Example 2 shown in the main blood supply of bone backbone,are in line with the intraoperative inspection.Preoperative measurement of iliac artery from distance before the iliac crest on the average 4.28 cm,deep circumflex iliac artery diameter of an average of 2.4 mm,the average number of perforator blood vessels for the three.2 cases of postoperative bone flap all survived.
Conclusions
1.Three-dimensional reconstruction using digital technology can show the normal tissue flap intuitive three-dimensional anatomical shape,can achieve more human anatomy visualization,for the display of anatomy teaching to provide reference,to improve and enrich the microsurgical anatomy of the clinical and teaching methods,to make up for the autopsy specimens of the problem of inadequate teaching.
2.Digital virtual anatomy flap measurement data in the physical measurement of tissue flap within the scope of data and be able to accurately display the flap blood supply and blood source for the form of measurement for the future provision of the general anatomy of a new way of thinking.
3.Preoperative personalized based on the results of the reconstructed image of the tissue flap to carry out precise design,positioning,help to improve surgical quality and reliability.
引文
1 Taylor GI,Pan WR.Angiosomes of the Leg:Anatomic Study and Clinical Implications.Plast Reconstr Surg.1998 Sep;102(3):599-618.
2 Ackerman MJ,Spitzer VM,Scherzinger Al,et al.The Visible Human data set:An image resource for anatomical visualization[J].Medinfo.1995;8(2):1195-1198.
3 原林,黄文华,唐雷,等.数字化VCHF1数据图像处理[J].中国临床解剖学杂志,2003;21(3):193-196.
4 Zhang YZ,Li YB,Tang ML,et al.Application of three-dimensional digitalized reconstruction of an anterolateral thigh flap and an arterial dorsalis pedis flap.Microsurgery.2007;27(6):553-559.
5 张元智,李严兵,唐茂林,裴国献.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志[J].2006,8(6):501-504.
6 Tang M,Geddes CR,Yang D,et al.Modified lead oxide-gelatin injection technique for vascular studies.J Clin Anat.2002,1(1):73-78.
7 楼新法,梅劲,Christopher R.Geddes,等.明胶-氧化铅血管造影术的优化[J].中国临床解剖学杂志.2006,24(2):259-262.
8 Spitzer VM,AcKerman MJ,Scherzinger AL,et al.The visible human male:a technical report[J].J Am Med Inform Assoc.1996,3(2):118-130.
9 Karl Heinz H(o|¨)hne,Bernhard Pflesser,Andreas Pommert,et al.A realistic model of human structure from the Visible Human data.Meth.Inform.Med.40,2(2):83-89.
10 Satava RM,Fried MP.A methodology for objective assessment of errors:an example using an endoscopic sinus surgery simulator.Otolary clin north am.2002 35(6):1289-1301.
11 Efimov IR.Virtual electrodes in virtual reality of defibrillation.J Cardiovasc Electrophysiol.2002,13(7):680-681.
12 Schiemann T,Freudenberg J,Pflesser B,et al.Exploring the visible human using the voxel-man framework.Comput Med Imaging Graph.2000(3):127-132.
13 Taylor GI,Gianoutsos MP,Morris SF.The neurovascular territories of the skin and muscles:anatomic study and clinical implications.Plast Reconstr Surg.1994,94(1):1-36.
14 Rees MJ,Taylor GI.A simplified lead oxide cadaver injection technique.Plast Reconstr Surg.1986,77(1):141-145.
15 Wu WC,Chang YP,So YC,et al.The combined use of flaps based on the subscapular vascular system for limb reconstruction.Brit J Plast Surg.1997,50(2):73-80.
16 Angrigiani C,Grilli D,Siebert J.Latissimus dorsi musculocutaeous flap without muscle.Plast Reconstr Surg.1995,96(7):1608-1614.
17 Heitmann C,Guerra A,Metzinger SW,et al.The thoracodorsal artery perforator flap:Anatomic basis and clinical application.Ann Plast Surg.2003,51(1):23-29.
18 钟世镇.“虚拟中国人”(VCH)切片建模研究进展.中国临床解剖学杂志.2002,20(5):323.
19 张元智,顾立强,原林,等.腰骶丛神经的断层解剖学及可视化初步研究.中华创伤骨科杂志.2004,6(12):1362-1364.
20 张元智,顾立强,原林,等.虚拟中国人女1号臂丛神经可视化初步研究.中华手外科杂志.2005,21(5):277-279.
21 张元智,李严兵,唐茂林,等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志.2006,8(6):501-504.
22 关晓伟,李敏.CAI课件在解剖教学中的应用体[J]解剖学杂志.2005,28(1):118-119.
23 解大龙.解剖实验课中多媒体教学与传统教学方法的教学效果比较[J].解剖科学进展.2005,11(2):189-189.
24 Krosshaug T,Slauterbeck JR,Engebretsen L,et al.Biomechanical analysis of anterior cruciate ligament injury mechanisms:three-dimensional motion reconstruction from video sequences.Scand J Med Sci Sports.2007,17(5):508-519.
25 Cargill SC,Pearcy M,Barry MD.Three-dimensional lumbar spine postures measured by magnetic resonance imaging reconstruction.Spine.2007,32(11):1242-1248.
26 Heng PA,Cheng CY,Wong TT,et al.A Virtual-Reality Training System for Knee Arthroscopic Surgery[J].IEEE Trans InfTechnol Biomed.2004,8(2):217-227.
27 Nishihara S,Sugano N,Nishii T,et al.Clinical accuracy evaluation of femoral canal preparation using the ROBODOC system[J].J Orthop Sci.2004,9(5): 452-461.
28 Hagemeister N,Duval N,Yahia L,et al.Comparison of two methods for reconstruction of the posterior cruciate ligament using a computer based method:quantitative evaluation of laxity,three-dimensional kinematics and ligament deformation measurement in cadaver knees[J].Knee.2002,9(4):291-299.
29 Taylor RH,Joskowicz L,Williamson B,et al.Computer-integrated revision total hip replacement surgery:concept and preliminary results[J].Med Image Anal.1999,3(3):301-319.
30 Park S.H.,Yoon Y.S.,Kim L.H.,et al.Virtual Knee Joint Replacement Surgery System.2007 Geometric Modeling and Imaging:New Advances,2007,79-84.
31 Zhang TY,Dai PD,Wang ZM,et al.A contour map of the ear's vestibular apparatus based on 3D reconstruction[J].Computing Science & Engineering.2007,9:26-31.
32 徐凯,裴国献,张元智,等.基于个人计算机对足背供区移植皮瓣的三维可视化设计.中国组织工程研究与临床康复.2007,25:4879-4882.
33 裴国献,张元智.数字骨科学:一门骨科学新分支的萌生.中华创伤骨科杂志.2007,9(7):601-603.
34 张元智,李严兵,金丹,等.数字化三维重建技术在股前外侧皮瓣血供及其可视化中的应用.中华创伤骨科杂志.2007,9(7):650-653.
35 金丹,张元智,徐凯,等.数字化虚拟可视重建在显微外科骨瓣、肌骨瓣教学中的初步应用.中国医学教育技术.2008,22(3):432-435.
36 任义军,任高宏,金丹,等.数字化股前外侧骨瓣的可视技术在临床中的初步应用.中华创伤骨科.2008,10(5):227-229.
1 Friedl R,Preisack MB,Klas W,et al.Virtual reality and 3D visualizations in heart surgery education.Heart Surg Forum.2002,5(3):17-21.
2 Haluck RS,Krummel TM.Computers and virtual reality for surgical education in the 21st century.Arch Surg.2000,135(7):786-792.
3 Warrick PA,Funnell WR.A VRML-based anatomical visualization tool for medical education.IEEE Trans Inf Technol Biomed,1998,2(2):55-61.
4 胥少汀,葛宝丰,徐印坎.实用骨科学(第三版).北京:人民军医出版社.2004:1932-1935.
5 侯春林.带血管蒂组织瓣移位手术图解.上海:上海科学技术出版社.1991: 239-300.
6 王庭家,丁自海,张敬良,等.腓肠肌血管在小腿部游离皮瓣移植术中的应用解剖.前卫医药杂志.1999,16(1):20-21.
7 杨军,徐永清.双蒂腓肠肌皮瓣下滑修复跟腱及皮肤缺损的应用解剖学.中国临床解剖学杂志.2005,23(1):31-34.
8 郑和平,康庆林,张发惠.旋髂深动脉嵌合组织瓣的解剖学基础.中国临床解剖学杂志.2008,26(1):3-7.
9 G(o|¨)tze C,Vieth V,Meier N,et al.CT-based accuracy of implanting custom-made endoprostheses.Clin Biomech.2005,20(8):856-862.
10 Adam F,Hammer DS,Pape D,et al.Femoral anatomy,computed tomography and computer-aided desin of prosthetic implants.Arch Orthop Trauma Surg.2002,122(5):262-268.
11 袁本祥,刘祖德,张琳琳,等.国人肱骨近端三维解剖研究及其对假体设计与植入的影响.中华骨科杂志.2007,27(2):120-124.
12 Lo LJ,Chen YR.Computer-aided reconstruction of traumatic fronto-orbital osseous defects:aesthetic considerations.Chang Gung Med J.2004,27(4):283-291.
13 李鉴轶,张美超,赵卫东,等.激光三维扫描重建骨形态在解剖学教学中的应用.四川解剖学杂志,2005,13(3):30-31.
14 刘怡,张洪定,崔欣,等.虚拟现实VRML程序设计.天津:南开大学出版社,2007:1-3.
15 王岩,周飞虎,周勇刚,等.国人正常膝关节三维几何形态测量及相关研究.中国矫形外科杂志.2004,12(8):617-628.
16 Thomas GF,Schaller S,Stierstorfer K,et al.Multi-detector CT systems and image-reconstruction techniques[J].Radiology,2005,235(3):756-773.
17 陆晴友,吴岳嵩,王成焘.股骨近端解剖形态的CT三维重建与分析.第二军医大学学报.2005,26(9):1029-1033.
18 Kaneuji A,Matsumoto T,Nishino M,et al.Three-dimensional morphological analysis of the proximal femoral canal,using computer-aided design system,in Japanese patients with osteoarthrosis of the hip.J Orthop Sci.2000,5(4):361-368.
19 Villain N,Goussard Y,Idier J,et al.Three-dimensional edge-preserving image enhancement for computed tomography.IEEE Trans Med Imaging.2003,22(10):1275-1287.
20 M Cimerman,A Kristan.Preoperative planning in pelvic and acetabular surgery:The value of advanced computerised planning modules.Pelvic and Acetabular Surgery,2007,38(4):442-449.
21 钟世镇.数字化虚拟人体的科学意义及应用前景.第一军医大学学报,2003,23(3):193-195.
22 单锦露,张绍祥,谭立文.虚拟现实技术在人体解剖学教学中的应用.局解手术学杂志,2008,17(1):45.
23 王平安.虚拟人在医学上的应用.首届国际医学影像学暨介入医学学术会议论文汇编.北京:中国医学影像技术编辑部,2005.
24 谢叻,张绍祥,王友,等.数字化制造技术在外科中的应用.中华创伤骨科杂志,2008,10(2):109-110.
25 孙宏卫.应用VRML建设虚拟医学教学环境的构想.中国医学教育技术,2006,20(5):408-410.
26 楼新法,梅劲,Christopher R.Geddes,等.明胶-氧化铅血管造影术的优化[J].中国临床解剖学杂志.2006,24(2):259-262.
27 原林,黄文华,唐雷,等.数字化VCH-F1数据图像处理.中国临床解剖学杂志.2003.21:193-196.
28 Zhang YZ,Li YB,Tang ML,et al.Application of three-dimensional digitalized reconstruction of an anterolateral thigh flap and an arterial dorsalis pedis flap.Microsurgery.2007;27(6):553-559.
29 徐凯,裴国献,张元智,等.基于个人计算机对足背供区移植皮瓣的三维可视化设计.中国组织工程研究与临床康复.2007,25:4879-4882.
30 裴国献,张元智.数字骨科学:一门骨科学新分支的萌生.中华创伤骨科杂志. 2007,9(7):601-603.
31 张元智,李严兵,金丹,等.数字化三维重建技术在股前外侧皮瓣血供及其可视化中的应用.中华创伤骨科杂志.2007,9(7):650-653.
32 金丹,张元智,徐凯,等.数字化虚拟可视重建在显微外科骨瓣、肌骨瓣教学中的初步应用.中国医学教育技术.2008,22(3):432-435.
33 任义军,任高宏,金丹,等.数字化股前外侧骨瓣的可视技术在临床中的初步应用.中华创伤骨科.2008,10(5):227-229.
34 张元智,李严兵,唐茂林,等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志,2006,8(6):501-504.
35 杜浩,张元智,王钢,等。三维重建与逆向工程技术设计半髋关节表面置换定位导航模板[J]。中华创伤骨科杂志,2008,10(2):132-134。
36 扈延龄,金丹,苏秀云,等.基于三维CT数据的髋臼骨折计算机辅助虚拟手术设计[J].中华创伤骨科杂志.2008,10(2):135-137.
37 苏秀云,裴国献,李鉴轶,等.中国数字人男一号上肢解剖结构的三维可视化重建[J].中华创伤骨科杂志.2008,10(2):142-145.
38 裴国献.数字骨科学概念与临床初步应用.中华创伤骨科杂志,2008,10:101-102.
39 周飞虎,王岩,周勇刚.国人正常股骨远端三维模型及骨形态测量研究.中国临床康复.2005,9(6):62-65.
1 Feldman JJ,Cohen BE,May JW Jr.The medial gastrocnemius myocutaneous flap.Plast Reanstr Surg.1978,61(4):531-539.
2 Taylor GI,Townsend P,Corlett R.Superiority of the deep circumflex iliac vessels as the supply for free groin flaps.Clinical work.Plast Reconstr Surg,1979,64:745-759.
3 黄恭康.吻合旋髂深血管的游离髂骨移植.中华外科杂志,1982,20:23-26.
4 康庆林,曾炳芳,柴益民,等.旋髂深动脉供应的髂骨穿支皮瓣设计与应用.中华骨科杂志,2007,27:442-445.
5 张元智,李严兵,唐茂林,等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志,2006,8(6):501-504.
6 徐凯,裴国献,张元智,等.基于个人计算机对足背供区移植皮瓣的三维可视化设计.中国组织工程研究与临床康复,2007,11:4879-4882.
7 张元智,李严兵,金丹,等.数字化三维重建技术在股前外侧皮瓣血供及其可视化中的应用.中华创伤骨科杂志,2007,9(7):650-653.
8 胥少汀,葛宝丰,徐印坎.实用骨科学(第三版).北京:人民军医出版社.2004:1932-1935.
9 侯春林.带血管蒂组织瓣移位手术图解.上海:上海科学技术出版社.1991:259-306.
10 郭世绂著.临床骨科解剖学(第1版).天津:天津科学技术出版社.1988:881-884.
11 杨军,徐永清.双蒂腓肠肌皮瓣下滑修复跟腱及皮肤缺损的应用解剖学.中 国临床解剖学杂志,2005,23(1):31-34.
12 Lin CH,Wei FC,Chen HC,et al.Outcome comparison in traumatic lowerextremity reconstruction by using various composite vascularized bone transplantation.Plast Reconstr Surg,1999,104(4):984-992.
13 Yazar S,Lin CH,Wei FC.One-stage reconstruction of composite bone and soft -tissue defects in traumatic lower extremities.Plast Reconstr Surg,2004,114(6):1457-1466.
14 潘慧琪,胡清潭,苏国礼,等.旋髂深动脉对髂骨嵴血供的应用解剖和临床应用.中国临床解剖学杂志,1985,3:24-26.
15 苗华,尹正银,黄恭康.髂嵴前部的血液供应[J].解剖学报,1981,12(4):376-3 80.
16 范启申.腓肠肌皮瓣V-Y推进修复小腿下端软组织缺损。人民军医杂志,1987:10:45.
17 侯春林,等:轴型皮瓣肌皮瓣转移治疗四肢软组织缺损。中华外科杂志,1985:23(11):648.
18 方绍孟,等:双蒂腓肠肌肌皮瓣治疗小腿下1/3软组织缺损。中华骨科杂志,1986:1:24.
19 孙弘,侯春林,主编.带血管蒂皮瓣肌皮瓣转移术.第1版.江苏科学技术出版社.1998:194-1951
20 王成琪.皮瓣和肌皮瓣修复创伤性组织缺损的作用.中华显微外科杂志.1999,22:11-12.
21 范启申,郭德亮,魏长月,等.跟腱及皮肽同时缺损的显微外科修复.中华显微外科杂志.1994,2:94-95.
22 毛宾尧,主编.足外科学.第1版.北京:人民卫生出版社,1992:566.
23 McCraw JB,Fishman JH,Sharzer LA.The versatile gastrocnemius myocutaneous flap.Plast Reconstr Surg.1978,62(1):15-23.
24 Salibian AH,Menick FJ.Bipedicle gastrocnemius musculocutaneous flap for defects of the distal one-third of the leg.Plast Reconstr Surg.1982,70(1):17-23.
25 高建中,邢建峰,王培.22例腓肠肌皮瓣临床应用体会.临床医学.2004,24(10):32.
26 Minami A,Ogino T,Itoga H.Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels:experience in 13 cases.Microsurgery,1989,10(2):99-102.
27 姚忠军,胡军,严永祥,等.髂骨皮瓣移植加外固定器固定修复胫骨缺损伴小腿软组织缺损.中华骨科杂志,2002,22(8):492-495.
28 Yamamoto Y,Sugihara T,Kawashima K,et al.An anatomic study of the latissimus dorsi-rib flap:an extension of the subscapular combined flap.Plast Reconstr Surg,1996,98(5):811-816.
29 Lin CH,Wei FC,Levin LS,et al.Free composite serratus anterior and rib flaps for tibial composite bone and soft- tissue defect.Plast Reconstr Surg,1997,99(6):1656-1665.
30 王树锋,吕占辉,陆培发,等.肩胛骨背阔肌复合组织瓣移植一期修复小腿外伤后胫骨伴软组织缺损.中华骨科杂志,2000,20(3):170-172.
31 潘峰,陈振光,林海滨,等.髂腹股沟区血供的应用解剖研究及其临床意义.医学新知杂志.2004,14(3)175-177.
32 周训银,刘亚国.吻合两组血管的髂骨瓣移植一期修复下颌骨缺损.中华显微外科杂志.1989,12(2):72.
33 郑和平,康庆林,张发惠.旋髂深动脉嵌合组织瓣的解剖学基础.中国临床解剖学杂志.2008,26(1):3-7.
34 姚忠军,胡军,严永祥,等.髂骨皮瓣移植加外固定器固定修复胫骨缺损伴小腿软组织缺损.中华骨科杂志,2002,22(8):492-495.
35 康庆林,曾炳芳,柴益民,等.旋髂深动脉供应的髂骨穿支皮瓣设计与应用.中华骨科杂志.2007,27(6):442-445.
36 王栓科,张凤岗,张祥生等.旋髂深血管髂骨瓣的临床应用.中华显微外科杂志.1996,19(4):267.
37 李志辉,王栓科,任向春.吻合血管的髂骨骨膜瓣移植治疗胫骨骨不连.中 国骨与关节损伤杂志.2005,20(4):272.
38 刘兴炎,葛宝丰,甄平等.吻合血管的骨膜皮质骨瓣移植修复肱骨骨不连.中华手外科杂志.1997,13(3):169.
39 赵金廷,张培勋,贾思明等.带旋髂深血管髂骨-蝶形骨膜瓣复合移植治疗四肢骨不连.骨与关节损伤杂志.2003,18(10):681.
40 路青林,韩建波,李树锋等.交锁髓内钉联合骨瓣、骨膜瓣治疗四肢骨不连及骨缺损.骨与关节损伤杂志.2004,19(2):99.
41 Yang WG,Chiang YC,Wei FC,et al.Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing.Plast Reconstr Surg.2006,117(3):1004-1008.
42 Iida T,Nakagawa M,Asano T,et al.Free vascularized lateral femoral cutaneous nerve graft with anterolateral thigh flap for reconstruction of facial nerve defects.J Reconstr Microsurg.2006,22(5):343-348.
43 Smith DM,Aston SJ,Cutting CB,et al.Designing a virtual reality model for aesthetic surgery.Plast Reconstr Surg.2005,116(3):893-897.
44 Chou B,Handa VL.Simulators and virtual reality in surgical education.Obstet Gynecol Clin North Am.2006,33(2):283-296.
45 Heegaard JH,Leyvraz PF,Hovey CB.A computer model to simulate patellar biomechanics following total knee replacement:the effects of femoral component alignment.Clin Biomech(Bristol,Avon).2001,16(5):415-423.
46 Fink C,Rosenberger RE,Bale RJ,et al.Computer-assisted retrograde drilling of osteochondral lesions of the talus.Orthopade.2001,30(1):59-65.
47 张峻,王友,等.三维CT重建在胫骨平台骨折中的应用.中华骨科杂志.1998,18(7):387-390.
48 Messmer P,Long G,Suhm N,et al.Volumetric model determination of the tibia based on 2D radiographs using a 2D/3D database.Comput Aided Surg.2001,6(4):183-194.
49 Tonus C,Debertshauser D,Strassmann G,et al.CT-based navigation systmes for intraoperative radiotherapy using the afterloading-flab technique.Dig Surg,2001, 18(6):470-474.
50 Heegaard JH,Leyvraz PF,Hovey CB.A computer model to simulate patellar biomechanics following total knee replacement:the effects of femoral component alignment.Clin Biomech(Bristol,Avon),2001,16(5):415-423.
51 Fink C,Rosenberger RE,Bale RJ,et al.Computer-assisted retrograde drilling of osteochondral lesions of the talus.Orthopade,2001,30(1):59-65.
52 Zhang YZ,Li YB,Tang ML,et al.Application of three-dimensional digitalized reconstruction of an anterolateral thigh flap and an arterial dorsalis pedis flap.Microsurgery.2007;27(6):553-559.
53 徐凯,裴国献,张元智,等.基于个人计算机对足背供区移植皮瓣的三维可视化设计.中国组织工程研究与临床康复.2007,25:4879-4882.
54 裴国献,张元智.数字骨科学:一门骨科学新分支的萌生.中华创伤骨科杂志.2007,9(7):601-603.
55 张元智,李严兵,金丹,等.数字化三维重建技术在股前外侧皮瓣血供及其可视化中的应用.中华创伤骨科杂志.2007,9(7):650-653.
56 金丹,张元智,徐凯,等.数字化虚拟可视重建在显微外科骨瓣、肌骨瓣教学中的初步应用.中国医学教育技术.2008,22(3):432-435.
57 任义军,任高宏,金丹,等.数字化股前外侧骨瓣的可视技术在临床中的初步应用.中华创伤骨科.2008,10(5):227-229.
58 张元智,李严兵,唐茂林,等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志,2006,8(6):501-504.
59 杜浩,张元智,王钢,等。三维重建与逆向工程技术设计半髋关节表面置换定位导航模板[J]。中华创伤骨科杂志,2008,10(2):132-134。
60 扈延龄,金丹,苏秀云,等.基于三维CT数据的髋臼骨折计算机辅助虚拟手术设计[J].中华创伤骨科杂志.2008,10(2):135-137.
61 裴国献.数字骨科学概念与临床初步应用.中华创伤骨科杂志,2008,10:101-102.
1 张元智,顾立强,原林,等.腰骶丛神经的断层解剖学及可视化初步研究.中华创伤骨科杂志,2004,6(12):1362-1364
2 张元智,顾立强,原林,等.虚拟中国人女1号臂丛神经可视化初步研究.中华手外科杂志,2005,21(5):277-279
3 张元智,李严兵,唐茂林,等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志,2006,8(6):501-504
4 李鉴轶,张美超,赵卫东,等.激光三维扫描重建骨形态在解剖学教学中的应用.四川解剖学杂志,2005,13(3):30-31.
5 刘怡,张洪定,崔欣,等.虚拟现实VRML程序设计.天津:南开大学出版社,2007:1-3.
6 Thomas GF,Schaller S,Stierstorfer K,et al.Multi-detector CT systems and image-reconstruction techniques[J].Radiology,2005,235(3):756-773.
7 M Cimerman,A Kristan.Preoperative planning in pelvic and acetabular surgery:The value of advanced computerised planning modules.Pelvic and Acetabular Surgery,2007,38(4):442-449.
8 钟世镇.数字化虚拟人体的科学意义及应用前景.第一军医大学学报,2003,23(3):193-195.
9 单锦露,张绍祥,谭立文.虚拟现实技术在人体解剖学教学中的应用.局解手术学杂志,2008,17(1):45.
10 王平安.虚拟人在医学上的应用.首届国际医学影像学暨介入医学学术会 议论文汇编.北京:中国医学影像技术编辑部,2005.
11 谢叻,张绍祥,王友,等.数字化制造技术在外科中的应用.中华创伤骨科杂志,2008,10(2):109-110.
12唐雷,原林,黄文华,等.“虚拟中国人”(VCH)数据采集技术研究.中国临床解剖学杂志,2002,20(5):324-326.
13 钟世镇.“虚拟中国人”(vCH)切片建模研究进展.中国临床解剖学杂志,2002,20(5):323.
14原林,戴景兴,唐雷,等.数字化人体标本的遴选.中国临床解剖学杂志,2002,20(5):334-335.
15李安安,刘谦,龚辉,等.“虚拟中国人男性一号”高精度骨骼系统的三维建模.中国临床解剖学杂志,2006,24(3):292-295.
16崔高宇,张绍祥,刘正津,等.基于CVH的基底神经核区三维重建和虚拟现实研究.立体定向和功能性神经外科杂志,2005,18(2):65-68.
17周泽民,方驰华,黄立伟,等.基于数字化虚拟中国人女性一号胰腺图像的三维重建及可视化研究.中华外科杂志,2005,43(21):1401-1404.
18邰伟鹏,栾干,岳建华.基于数字虚拟人体血管的三维重建.延边大学医学学报,2004,27(4):245-247.
19胡荣慧,巫北海,张绍祥,等.髋关节CT三维重建与可视化研究.第三军医大学学报,2007,29(14):1371-1373.
20邱明国,张绍祥,刘正津,男性盆底可视化研究.第三军医大学学报,2004,26(4):328-331.
21 邱明国,张绍祥,刘正津,等.女性盆底可视化研究.解剖学杂志,2004,27(6):581-585.
22王洛夫,张绍祥,江军,等.肾脏及其周围结构的三维可视化研究.第三军医大学学报,2004,26(6):537-539.
23 庞学利,黄学全,肖红,等.首例中国可视化人体头颈部CT影像三维重建的初步研究.第三军医大学学报,2003,25(7):599-561.
24郭燕丽,张绍祥,刘正津,等.首例中国可视化人体心脏三维重建及临床意义.第三军医大学学报,2003,25(7):569-571.
25 王文嘉,刘谦,龚辉,等.数字虚拟中国人男性一号循环系统的三维建模.医用生物力学,2006,21(3):198-202.
26陆声,徐永清,张元智,等.腰丛神经的数字化解剖及其临床意义.解剖与临床,2007,12(4):233-235.
27 李幼琼,田勇,陈禹,等.中国人颅脑数字化研究.吉林大学学报(医学版),2003,29(4):408-411.
28 左一智,张绍祥,李林,等.中国数字化可视人肺动脉系统的断面显示和三维重建.南京医科大学学报(自然科学版),2007,27(6):562-566.
29 李万冬,徐惠绵,凌光烈,等.中国数字化可视人体腹腔内脏器官三维重建.中国医科大学学报,2006,35(5):484-487.
30 Ackerman MJ.The Visible Human Project:a resource for education.Acad Med,1999,74(6):667-670.
31 钟世镇.数字人-微创外科可能结合的新技术.广东医学,2005,26(1):1-2.
32 毕思文.数字人体-人体系统数字学总论.中国医学影像技术.2003,19(2):1-8.
33 毕思文,王秀利.数字人体研究的方法论.中国医学影像技术,2003(3):269-272.
34郭森慧,王枞,刘建毅.数字人体与人工智能-生命科学与信息科学的融合.中国医学影像技术,2003,19(1):22-24.
35 Heegaard JH,Leyvraz PF,Hovey CB.A computer model to simulate patellar biomechanics following total knee replacement:the effects of femoral component alignment.Clin Biomech(Bristol,Avon),2001,16(5):415-423.
36 Fink C,Rosenberger RE,Bale RJ,et al.Computer2assisted retrograde drilling of osteochondral lesions of the talus.Orthopade,2001,30(1 ):59-65.
37 Sati M,De Guise JA,Drounin G.Computer assisted knee surgery:diagnostics and planning of knee surgery.Comput Aided Surg,1997,2(2):108-123.
38 张峻,王友,等.三维CT重建在胫骨平台骨折中的应用.中华骨科杂志,1998, 18(7):387-390.
39 兰海.计算机三维重建技术在骨科中的应用进展.四川医学,2003,24(7):757-758.
40 原林,黄文华,唐雷,等.数字化虚拟中国人女性一号数据图像处理.中国临床解剖学杂志,2003,21(3):193-195.
41 Dio A,Koide A.An Effecient Method of Triangulating Equi Valued Surfaces by Using Tetrahedral Cells.IE ICE Transactions,1991,74(1):214.
42 毛克亚,陈继营,毕文志,等.数字化人体骨骼重建和快速骨盆重建成型技术的实验研究.中国临床康复,2004,8(23):4728-4729.
43 Farag AA,Eid A.Video reconstructions in dentistry.Orthod Craniofac Res,2003,6Supp 11:108,discussion 179-182.
44 Mayman DJ,Rudan J,Yach J,et al.The Kingston periacetabular osteotomy utilizing computer enhancement:a new technique.Comput Aided Surg,2002,7(3):179-186.
45毛克亚,陈继营,郝立波等.数字化人体骨骼的初步临床应用.中国矫形外科杂志,2005,13(1):67-68.
46陈蓉,张伟国,张绍祥,等.可视化心脏在放射诊断学教学中的应用.西北医学教育,2007,15(5):951-953.
47吴毅,张绍祥,谭立文.男性泌尿生殖系统数字化模型在解剖教学中的应用.局解手术学杂志,2007,16(5):107.
48刘光久,张绍祥,谭立文.数字化人体解剖教学系统的构建.局解手术学杂志,2007,16(2):114.
49郭燕丽,张绍祥,刘正津,等.中国首套可视化人体在超声影像学教学中的应用.现代医药卫生,2004,20(8):702-703.
50张元智,李严兵,唐茂林,等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志,2006,8(6):501-504.
51徐凯,裴国献,张元智,等.基于个人计算机对足背供区移植皮瓣的三维可视化设计.中国组织工程研究与临床康复,2007,25:4879-4882.
52 裴国献,张元智.数字骨科学:一门骨科学新分支的萌生.2007,9(7):601-603.
53 张元智,李严兵,金丹,等.数字化三维重建技术在股前外侧皮瓣血供及其可视化中的应用.2007,9(7):650-653.
54 Smith DM,Aston SJ,Cutting CB,et al.Designing a virtual reality model for aesthetic surgery.Plast Reconstr Surg,2005,116(3):839-897.
55 Chou B,Handa Vl.Simulators and virtual reality in surgical education.Obstet Gynecol Clin North Am,2006,33(2):283-296.
56 Satava RM,Fried MP.A methodology for objective assessment of errors:an example using an endoscopic sinus surgery simulator.Otolary clin north am,2002,35(6):1289-1301.
57 Efimov IR.Virtual electrodes in virtual reality of defibrillation.J Cardiovasc Electrophysiol,2002,13(7):680-681.
58 Schiemann T.Freudenberg J,Pflesser B,et al.Exploring the visible human using the voxel-man framework.Comput Med Imaging Graph,2000,24(3):127-132.
59 韩继霞,毕思文.数字人体信息获取技术研究.世界科学技术-中医药现代化数字人体,2005,7(1):90-93.
60刘兵全,何继善,李振伟.医学图像后处理研究进展.国外医学生物医学工程分册,2004,27(4):248-252.
61 Marchetti C,Bianchi A,Bassi M,et al.Mathematical modeling and numerical simulation in maxillo-facial virtual surgery(VISU)[J].J Craniofac Surg,2006,17(4):661-667.
62 Gellrich NC,Schramm A,Hammer B,et al.Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity[J].Plast Reconstr Surg,2002,110(6):1417-1429.
63 Dammann F,Bode A,Schwaderer E,et al.Computer-aided surgical planning for implantation of hearing aids based on CT data in a VR environment[J].Radiographics,2001,21(1):183-191.
64 Seel MJ,Hafez MA,Eckman K,et al.Three-dimensional planning and virtual radiographs in revision total hip arthoplasty for instability[J].Clin Orthop Relat Res,2006,442:35-38.
65 Rommens PM,Hessmann MH.Acetabulum fractures[J].Unfallchirurg,1999,102(8):591-610.
66 Handels H,Ehrhardt J,Plotz W,et al.Three-dimensional planning and simulation of hip operations and computerassisted construction of endoprostheses in bone tumor surgery[J].Comput Aided Surg,2001,6(2):65-76.
67杜浩,张元智,王钢,等。三维重建与逆向工程技术设计半髋关节表面置换定位导航模板[J].中华创伤骨科杂志,2008,10(2):132-134.
68李严兵,李鉴轶,万伟,等。数字技术精确定位椎板进钉区与方向轴的方法[J].中华创伤骨科杂志,2008,10(2):124-127.
69师继红,陆声,张元智,等。数字化脊椎椎弓根导航模板在胸腰椎骨折中的应用[J].中华创伤骨科杂志,2008,10(2):138-141.
70陆声、徐永清、李严兵,等。脊柱椎弓根定位数字化导航模板的设计[J].中华创伤骨科杂志,2008,10(2):128-131.
71张权,周建伟,黄煌渊,等.计算机三维重建技术在指导髋臼恶性肿瘤切除与骨盆重建中的应用[J].中国矫形外科杂志,2005,13(7):518-520.
72 白桂有,杨博贵,张正治.数字化虚拟人体在医学上的应用进展.中国临床解剖学杂志,2006,24(6):705-706.
73 钟世镇.数字化虚拟人体的科学意义及应用前景.第一军医大学学报,2003,23(3):193-1951.
74钟世镇,黄文华,原林.数字化虚拟人体在医学应用上的前景.中华实用医学,2002,4(9):1-31.