Three-dimensional printing models improve understanding of spinal fracture--A randomized controlled study in China

Zhenzhu Li, Zefu Li, Ruiyu Xu, Meng Li, Jianmin Li, Yongliang Liu, Dehua Sui, Wensheng Zhang, Zheng Chen, Zhenzhu Li, Zefu Li, Ruiyu Xu, Meng Li, Jianmin Li, Yongliang Liu, Dehua Sui, Wensheng Zhang, Zheng Chen

Abstract

Three-dimensional printing (3 Dp) is being increasingly used in medical education. Although the use of such lifelike models is beneficial, well-powered, randomized studies supporting this statement are scarce. Two spinal fracture simulation models were generated by 3 Dp. Altogether, 120 medical students (54.2% females) were randomized into three teaching module groups [two-dimensional computed tomography images (CT), 3D, or 3 Dp] and asked to answer 10 key anatomical and 4 evaluative questions. Students in the 3 Dp or 3D group performed significantly better than those in the CT group, although males in the 3D group scored higher than females. Students in the 3 Dp group were the first to answer all questions, and there were no sex-related differences. Pleasure, assistance, effect, and confidence were more predominant in students in the 3 Dp group than in those in the 3D and CT groups. This randomized study revealed that the 3 Dp model markedly improved the identification of complex spinal fracture anatomy by medical students and was equally appreciated and comprehended by both sexes. Therefore, the lifelike fracture model made by 3 Dp technology should be used as a means of premedical education.

Figures

Figure 1. Flow chart of the study…
Figure 1. Flow chart of the study design.
Figure 2. Screenshot of the teaching module…
Figure 2. Screenshot of the teaching module for two-dimensional computed tomography images.
The ninth thoracic vertebra (T9):a, b, and c (axial, sagittal, coronal views, respectively); the second cervical vertebra (C2): d, e, and f (axial, sagittal, coronal views, respectively).
Figure 3. Screenshot of the teaching module…
Figure 3. Screenshot of the teaching module for three-dimensional images.
The ninth thoracic vertebra (T9): a, b, c, and d (dorsal, right, ventral, and left views, respectively); the second cervical vertebra C2: e, f, g, and h (dorsal, right, ventral, and left views, respectively).
Figure 4. Photos of the teaching module…
Figure 4. Photos of the teaching module for three-dimensional printing models.
Two lifelike fracture models were reconstructed by a three-dimensional (3D) printer. The ninth thoracic vertebra (T9): a, b, c, and d (dorsal, right, ventral, and left views, respectively); the second cervical vertebra (C2): e, f, g, and h (dorsal, right, ventral, and left views, respectively)
Figure 5. Sum score of correct answers.
Figure 5. Sum score of correct answers.
Students in the three-dimensional printing (3Dp) or 3D groups performed significantly better than those in the computed tomography (CT) group; males in the 3D group scored higher than females, in contrast to those in the 3Dp (post hoc by Sidak’s test) groups. FTM: F value of the three teaching modules; Fsex: F value of sex; **p < 0.01.
Figure 6. Overall time (s) required for…
Figure 6. Overall time (s) required for answering the 10 questions.
Students in the three-dimensional printing (3Dp) group were the first to answer all the questions (Tukey’s test), and there were no sex-related differences. However, more time was spent by females in the CT group. *p 

References

    1. Groth C., Kravitz N. D., Jones P. E., Graham J. W. & Redmond W. R. Three-dimensional printing technology. Journal of clinical orthodontics : JCO 48, 475–485 (2014).
    1. Rengier F. et al.. 3D printing based on imaging data: review of medical applications. International journal of computer assisted radiology and surgery 5, 335–341, 10.1007/s11548-010-0476-x (2010).
    1. Peltola S. M., Melchels F. P., Grijpma D. W. & Kellomaki M. A review of rapid prototyping techniques for tissue engineering purposes. Ann Med 40, 268–280, 10.1080/07853890701881788 (2008).
    1. Wang F., Ren X. & Yang L. Research progress of three-dimensional printing technique in joint surgery. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 28, 272–275 (2014).
    1. Luo Q., Lau T. W., Fang X. & Leung F. Application of three-dimensional printing technique in orthopaedics. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 28, 268–271 (2014).
    1. Gerstle T. L., Ibrahim A. M., Kim P. S., Lee B. T. & Lin S. J. A plastic surgery application in evolution: three-dimensional printing. Plastic and reconstructive surgery 133, 446–451, 10.1097/01.prs.0000436844.92623.d3 (2014).
    1. Schneider J. et al.. A novel 3D integrated platform for the high-resolution study of cell migration plasticity. Macromol Biosci 13, 973–983, 10.1002/mabi.201200416 (2013).
    1. Flugge T. V., Nelson K., Schmelzeisen R. & Metzger M. C. Three-dimensional plotting and printing of an implant drilling guide: simplifying guided implant surgery. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 71, 1340–1346, 10.1016/j.joms.2013.04.010 (2013).
    1. Chien K. B., Makridakis E. & Shah R. N. Three-dimensional printing of soy protein scaffolds for tissue regeneration. Tissue engineering. Part C, Methods 19, 417–426, 10.1089/ten.TEC.2012.0383 (2013).
    1. Akiba T., Inagaki T. & Nakada T. Three-Dimensional Printing Model of Anomalous Bronchi before Surgery. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 20 Suppl, 659–662, 10.5761/atcs.cr.13-00189 (2014).
    1. Li Q. Application of three-dimensional printing technique in plastic surgery. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 28, 266–267 (2014).
    1. Torres K., Staskiewicz G., Sniezynski M., Drop A. & Maciejewski R. Application of rapid prototyping techniques for modelling of anatomical structures in medical training and education. Folia Morphol (Warsz) 70, 1–4 (2011).
    1. Huang Z., Wang X. Z. & Hou Y. Z. Novel method of fabricating individual trays for maxillectomy patients by computer-aided design and rapid prototyping. Journal of prosthodontics : official journal of the American College of Prosthodontists 24, 115–120, 10.1111/jopr.12183 (2015).
    1. Muller-Stich B. P. et al.. Regular three-dimensional presentations improve in the identification of surgical liver anatomy - a randomized study. BMC medical education 13, 131, 10.1186/1472-6920-13-131 (2013).
    1. Beermann J. et al.. Three-dimensional visualisation improves understanding of surgical liver anatomy. Medical education 44, 936–940, 10.1111/j.1365-2923.2010.03742.x (2010).
    1. Rengier F. et al.. 3D printing based on imaging data: review of medical applications. International Journal of Computer Assisted Radiology and Surgery 5, 335–341, 10.1007/s11548-010-0476-x (2010).
    1. Fuller S. M., Butz D. R., Vevang C. B. & Makhlouf M. V. Application of 3-dimensional printing in hand surgery for production of a novel bone reduction clamp. The Journal of hand surgery 39, 1840–1845, 10.1016/j.jhsa.2014.06.009 (2014).
    1. Anderson P. J., Yong R., Surman T. L., Rajion Z. A. & Ranjitkar S. Application of three-dimensional computed tomography in craniofacial clinical practice and research. Aust Dent J 59 Suppl 1, 174–185, 10.1111/adj.12154 (2014).
    1. Preece D., Williams S. B., Lam R. & Weller R. “Let’s get physical”: advantages of a physical model over 3D computer models and textbooks in learning imaging anatomy. Anatomical sciences education 6, 216–224, 10.1002/ase.1345 (2013).
    1. Chueh J. Y., Wakhloo A. K. & Gounis M. J. Neurovascular modeling: small-batch manufacturing of silicone vascular replicas. AJNR. American journal of neuroradiology 30, 1159–1164, 10.3174/ajnr.A1543 (2009).
    1. Vranicar M., Gregory W., Douglas W. I., Di Sessa P. & Di Sessa T. G. The use of stereolithographic hand held models for evaluation of congenital anomalies of the great arteries. Studies in health technology and informatics 132, 538–543 (2008).

Source: PubMed

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