Objective To investigate the cl inical results of the flap pedicled with collateral branch of descendingrarus of lateral circumflex femoral artery with digital three-dimensional reconstruction technique for lower l imb soft tissue defects. Methods Between March 2009 and January 2010, 7 patients with lower l imb soft tissue defects were treated with free flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery. There were 6 males and 1 female with an age range from 6 to 51 years. They were injured by traffic accident (4 cases), or by object hit from height (3 cases). The locations were foot in 2 cases, ankle in 2 cases, and anterior tibia in 3 cases. The disease duration was 8 hours to 40 days (mean, 20 days). All the cases compl icated by exposure of tendons or bones. The areas of soft tissue defect ranged from 12 cm × 7 cm to 20 cm × 14 cm. Free flaps were transplanted at 4 to 16 days after symptomatic treatment. Before operation, all the flaps were designed with digital three-dimensional reconstruction technique. The size of flaps ranged from 15 cm × 9 cm to 22 cm × 16 cm The donor sites were closed directly in all cases. Results All the flaps survived. The wounds and incisions at donor sites healed by first intention. All the patients were followed up 6 to 12 months. The texture, appearance, and function of the flaps were satisfactory, and no compl ication occurred. All the flaps had protective sensation, which could meet the requirement of the daily l ife. The function of ankle was satisfactory with normal walk; the extension was 19-22° and the flexion was 30-36°. No obvious scar formed at donor sites. Conclusion The flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery has rel iable blood supply, easy operation, l ittle influence on the donor site, and high success rate with digital three-dimensional reconstruction technique. It is an excellent option for repairing lower l imb soft tissue defects.
ObjectiveTo explore potential value of three-dimensional reconstruction technique for preoperative evaluation of hepatic alveolar echinococcosis. MethodsTwenty-one cases of hepatic alveolar echinococcosis proved by postoperative pathological examination in Affiliated Hospital of Qinghai University from October 2013 to March 2014 were analyzed retrospectively. The three periods of patients’ liver dynamic thin layerCTscan images were collected and imported in three-dimensional reconstruction software by DICOM format. The volume of the virtual resected liver tissue was calculated by software, and then was compared with the actual resected liver tissue volume. ResultsThe resected liver volume was (761.94±505.77) mL and (756.19±501.78) mL in the virtual surgery and in the veritable surgery, respectively. The proportion of resected liver in the total liver was (39.27±18.75)% and (38.95±16.99)% in the virtual surgery and in the veritable surgery, respectively. The resected liver volume had no significant difference between the virtual surgery and veritable surgery (P>0.05), which a positive relation (r=0.989, P<0.001). ConclusionThe limited preliminary data in this study show that three-dimensional reconstruction technique and virtual planning system for surgery could accurately guide resection of lesion and provide preoperative guidance of accurate liver resection for hepatic alveolar echinococcosis.
Objective To quantitatively evaluate the effect of 2 types of pressures induced injury by using threedimensional (3D) reconstruction of rats loaded tibial is anterior muscle from two-dimensional (2D) image of serial histological sections. Methods Twenty female or male Sprague Dawley rats, aged 10-12 weeks and weighing 280-300 g, were randomlydivided into experimental group (n=10) and control group (n=10). The random side of tibial is anterior muscle was givenintermittent gradient (8.0-21.3 kPa) and sustained (13.3 kPa) pressure in 0.12 cm2 area in experimental group and controlgroup, respectively; the experiment was terminated and the general condition of rats was observed after 3 cycles, and a single cycle included 2 hours of compression and 30 minutes of release. The general observations of pressed skin and tibial is anterior muscle were done after 24 hours of pressure rel ief, and the tibial is anterior muscle was harvested integrally from the loaded side, then made into interval 4 μm serial sections. After HE staining, 2D images were obtained. Necrosis and injury areas were distinguished by Image Pro Plus (IPP) 6.0 software and image registration was conducted by Photoshop 8.0.1 after 2D panorama images acquired by digital microscope (× 40) and IPP mosaic software. 3D reconstruction was establ ished via data processing using Mimics 10.1 software so as to get the volume, the surface area, and 3D images of the whole piece of tibial is anterior muscle and injury areas respectively. Results All rats of 2 groups survived till experiment terminated and no skin ulcers occurred after 24 hours. Edema and indentation were observed on press side skin and tibial is anterior muscles of 2 groups, fadeless maroon area was observed in control group. A total of 994 sl ices were obtained from 20 samples of tibial is anterior muscles. 3D images suggested that injury of control group was severe, which penetrated the whole piece of tibial is anterior muscle and expandedalong the tibia bony prominence. By contrast, injury of experimental group was less, but had similar width to the contact surface of indentor. There was no significant difference in the volume and the surface area of tibial is anterior muscle between 2 groups (P gt; 0.05), while the injury volume and the injury surface area were significantly smaller in experimental group than in control group (P lt; 0.05). Conclusion 3D reconstruction is an effective method to quantitatively evaluate pathological changes inside the integrity tissue and can provide the visual basis for the mechanical property distributed in the loaded muscle. Intermittent gradient pressure can reduce deep tissue injury.
ObjectiveTo evaluate the application value of three-dimensional (3D) reconstruction in preoperative surgical diagnosis of new classification criteria for lung adenocarcinoma, which is helpful to develop a deep learning model of artificial intelligence in the auxiliary diagnosis and treatment of lung cancer.MethodsThe clinical data of 173 patients with ground-glass lung nodules with a diameter of ≤2 cm, who were admitted from October 2018 to June 2020 in our hospital were retrospectively analyzed. Among them, 55 were males and 118 were females with a median age of 61 (28-82) years. Pulmonary nodules in different parts of the same patient were treated as independent events, and a total of 181 subjects were included. According to the new classification criteria of pathological types, they were divided into pre-invasive lesions (atypical adenomatous hyperplasia and and adenocarcinoma in situ), minimally invasive adenocarcinoma and invasive adenocarcinoma. The relationship between 3D reconstruction parameters and different pathological subtypes of lung adenocarcinoma, and their diagnostic values were analyzed by multiplanar reconstruction and volume reconstruction techniques.ResultsIn different pathological types of lung adenocarcinoma, the diameter of lung nodules (P<0.001), average CT value (P<0.001), consolidation/tumor ratio (CTR, P<0.001), type of nodules (P<0.001), nodular morphology (P<0.001), pleural indenlation sign (P<0.001), air bronchogram sign (P=0.010), vascular access inside the nodule (P=0.005), TNM staging (P<0.001) were significantly different, while nodule growth sites were not (P=0.054). At the same time, it was also found that with the increased invasiveness of different pathological subtypes of lung adenocarcinoma, the proportion of dominant signs of each group gradually increased. Meanwhile, nodule diameter and the average CT value or CTR were independent risk factors for malignant degree of lung adenocarcinoma.ConclusionImaging signs of lung adenocarcinoma in 3D reconstruction, including nodule diameter, the average CT value, CTR, shape, type, vascular access conditions, air bronchogram sign, pleural indenlation sign, play an important role in the diagnosis of lung adenocarcinoma subtype and can provide guidance for personalized therapy to patients in clinics.
Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites (gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.
ObjectiveTo analyze intrahepatic vascular structures, divide liver segment automatically, and carry out virtual anatomic hepatectomy for virtual liver surgery planning based on liver threedimensional images. MethodsThe branches of portal vein were labeled in the level of segment based on spiral CT scanning images by using the liver surgery planning system software Liv 1.0. Thus, the simulation of an anatomical resection could be carried out. ResultsAccording to the portal segment branches, each individual liver segment could be divided automatically. The three-dimensional liver model was reconstructed based on liver segments, and the margin of liver segments was displayed clearly. On that basis, the simulation of anatomical resection and the volumetric estimation could be performed. ConclusionsThe three-dimensional liver model with intrahepatic vessel is reconstructed clearly, automatic segmentation of liver segment, the simulation of anatomical resection, and volumetric estimation can be applied in succession. The planning can be accomplished with Liv 1.0 on personal computer by the user, which provides a software platform for clinical application of virtual liver techniques.
Objective To study the clinical significance of multi-slice spiral CT in portal vein imaging. Methods One hundred and thirty seven cases underwent enhanced scan with GE Light SpeedQX/i4 CT scanner were collected, including 41 cases of liver cancer, 20 cases of hepatic cirrhosis, 21 cases of cavernous hemangioma of liver, 9 cases of hepatic abscess, 6 cases of carcinoma of gallbladder, 14 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 5 cases in normal. The results of portal vein images were reconstructed with three-dimensional software and analyzed. Results In 109 cases, portal vein, cranial mesenteric vein, and splenic vein were demonstrated successfully in the stage of portal vein: volume rendering images were clear in 84 cases, and maximum intensity projection images and multiplanar reconstruction images were clear in 109 cases. Forty-five cases of portal hypertension, 18 cases of opened collateral circulation, 15 cases of portal vein tumor thrombus, 1 case of splenic vein tumor thrombus, and 6 cases of large cavernous hemangioma were demonstrated successfully. Conclusion The portal vein imaging with multi-slice spiral CT can show the dissection and lesions of portal vein and its branches clearly, and can provide the clinical evidence for clinicians to formulate a treatment plan correctly.
Objective To introduce the recent advances of the application of computer technology in tissue engineering. Methods The recent original articlesrelated to computer technology, medical image technology, computer-aided design, the advanced manufacture technology were summarized and systematically analyzed.Results Computer-aided tissue engineering is a new fieldon tissue engineering. It is the future direction of tissue engineering study. This article reviews recent development of medical CT/MRI scanning, three-dimensional reconstruction, anatomical modeling, computeraided design, computer-aided manufacturing, rapid prototyping， RP manufacturing of tissue engineering scaffolds and computeraided implantation.Conclusion Computer-aided tissue engineering can be used in scaffolds design and fabrication, computer-aided artificial tissue implantation. It is a new field on tissue engineering.
Objective To review the research progress on the three-dimensional (3D) reconstruction and visual ization of peri pheral nerve. Methods Literature about the research on the 3D reconstruction and visual ization of peripheral nerve both at home and abroad were extensively reviewed and thoroughly analyzed. Results The appl ication of 3D reconstruction and visual ization technology was capable of not only reappearing the 3D outer contour and spatial adjacent relationship of peripheral nerve veritably but also displaying, rotating, zooming, dividing and real-time measuring their 3D internal structure and the del icate pathways in any direction either separately or totally. Prel iminary achievements were achievedin terms of brachial plexus, lumbosacral plexus, the functional cluster of nerve trunk, intramuscular nerve distribution pattern, peripheral nerve regeneration and the 3D reconstruction and visual ization research of complex tissue including peripheral nerve. However, the research on the visual ization of peripheral nerve was still in the initial stage since such problems as recognition, segmentation, registration and fusion of the peripheral nerve information were not resolved yet. Conclusion Researching 3D reconstruction and visual ization of the peripheral nerve is of great value for updating the diagnosis and treatment principle of peripheral nerve injury, improving its diagnosis and treatment method and launching a new way for the studying and teaching, which may be a new growing point for the peripheral nerve surgery.
Objective To employ spinal virtual surgery system (SVSS) for preoperative planning of thoracolumbar pedicle screw fixation, and to establ ish the measurement method for pedicle screw-related parameters. Methods Eight thoracicand lumbar spine specimens (T11-L3) were selected. First of all, SVSS was used for the preoperative planning of pedicle screw and the parameters of both sides of pedicle were measured in every vertebral segment, including angle of axial view (Aa), angle of sagittal view (As), x-direction entrance (XE), total pedicle length of axial view (TLa), total pedicle length of sagittal view (TLs), pedicle height (PH), pedicle width (PW), and pedicle spongy width (PSW). Then the corresponding parameters of the right and left pedicle screws of the specimens were measured actually. Finally, its accuracy was verified by comparing the data by virtual measurement and actual measurement. Results There was no significant difference in the parameters of virtual measurement (Aa, As, TLa, TLs, XE, PW, PSW, and PH) and actual measurement (Aa, As, TLa, XE, PW, PSW, and PH) between the right and left sides (P gt; 0.05). Except XE of the L3 vertebral segment and PSW of T11 and T12 vertebral segments (P lt; 0.05), the differences in other parameters of other segments were not significant (P gt; 0.05). Conclusion After statistical analysis and comparison, the feasibil ity of preoperative planning of thoracolumbar pedicle screw fixation and the accuracy of the measurement of the SVSS is verified.