计算机辅助导航外科在颞下颌关节成形术中的应用  

Application of computer assisted navigation in the treatment of temporomandibular joint ankylosis

作　　者：于洪波[1] 沈国芳[1] 张诗雷[1] 王旭东[1] 王成焘[2] 林艳萍[2] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面外科,上海市口腔医学研究所·上海市口腔医学重点实验室,上海200011 [2]上海交通大学机械与动力工程学院,上海200030

出　　处：《上海口腔医学》2008年第5期452-456,共5页Shanghai Journal of Stomatology

基　　金：国家自然科学基金(30471897);上海交通大学医工(理)交叉研究基金(YG2007ZD09);上海市重点(优势)学科建设项目(Y0203)~~

摘　　要：目的:评价计算机辅助导航(CANS)技术在颞下颌关节成形术中的应用价值。方法:4例单侧颞下颌关节骨性强直患者,定位钉植入后行面部CT扫描。在CANS上行术前设计及三维手术模拟,确定骨切除位置及范围,计算机辅助导航下行颞下颌关节成形术。术后CT复查,并与术前设计比较。结果:患者解剖结构与面部三维重建模型完全吻合,术中实现实时导航。手术器械实现空间定位,术者能够明确其与解剖结构的位置关系,精确度高,系统误差小于1mm。术后CT检查示切除范围与术前设计完全一致,手术创伤小,无并发症。结论:计算机辅助导航颞下颌关节成形术是一种较为安全、有效的治疗颞下颌关节强直的方法。PURPOSE： The aim of this study is to evaluate the effect of image-guided navigation on gap arthroplasty in the treatment of temporomandibular joint （TMJ） ankylosis. METHODS： Four patients with unilateral TMJ ankylosis underwent gap arthroplasty with the guide of computer-assisted navigation. With preoperative planning and 3-dimensional simulation, normal anatomical structures of the TMJ were created by superimposing and comparing the unaffected and the affected side. The amount and range of ankylotic bone was determined and displayed. All patients were treated by TMJ gap arthroplasty under the guide of navigation system. RESULTS： Through registration, an accurate match between the intraoperative anatomy and the CT images had been achieved. With the guide of the navigation, anatomy structures and the position of surgical instruments were shown real-time on the screen. No complications occurred in all patients and the systematic error was within 1 ram. The use of image-guided navigation resulted in the promotion of safe surgical excision of the ankylosed skull base tissue. CONCLUSIONS： Navigation-guided resection of the ankylotic bone in the TMJ gap arthroplasty is a valuable and safe technique in this potentially complicated procedure. Supported by National Natural Science Foundation of China （Grant No.30471897）, Research Fund of Medicine and Engineering of Shanghai Jiao Tong University（Grant No.YG2007ZD09） and Shanghai Leading Academic Discipline Project（Grant No.Y0203）.

关 键 词：计算机辅助导航 手术模拟 关节成形术 颞下颌关节强直 

分 类 号：R782.6[医药卫生—口腔医学]