计算机辅助导航系统在颌面部陈旧性骨折治疗中的应用  

Application of computer assisted navigation in the treatment of maxillofacial malunioned fractures

作　　者：沈国芳[1] 于洪波[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：《中国口腔颌面外科杂志》2009年第3期195-199,共5页China Journal of Oral and Maxillofacial Surgery

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);上海市科学技术委员会重点项目(074119511);上海市科学技术委员会资助项目(08DZ2271100)~~

摘　　要：目的:研究计算机辅助导航系统(computer assisted navigation system,CANS)在颌面部陈旧性骨折治疗中的应用及其效果评价。方法:5例单侧面中部陈旧性骨折患者,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骨折复位,计算机辅助导航下行颌面部陈旧性骨折的切开复位内固定术。术后CT复查,并与术前设计比较,检验骨折复位情况。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检查示骨折复位与术前设计基本一致,复位最大偏差小于2mm。复视、眼球下陷、运动受限症状消失,畸形明显改善,面部对称。结论:计算机辅助导航外科有助于提高颅颌面陈旧性骨折的复位精度,是一种较为理想有效的治疗颌面部复杂骨折的辅助方法。PURPOSE： To evaluate the effect of image-guided navigation on open reduction and rigid fixation in the treatment of maxillofacial malunioned fractures. METHODS： Five patients with maxillofaeial malunioned fractures were involved in this study. With preoperative planning and 3-dimensional simulation, normal anatomical structures of the deformed area were created by superimposing and comparing the unaffected with affected side. The position of dislocated bone for reduction was determined and displayed. All patients were treated by open reduction and rigid fixation under the guidance of navigation system. RESULTS： Through registration, an accurate match between the intraoperative anatomy and 3-dimensional reconstruction model was achieved and the systematic error was within 1 mm. With the guidance of navigation, anatomical structures and the position of surgical instruments were shown real-time on the screen. Fracture reduction was checked by postoperative CT scans and good coincidence with preoperative planning was found. The maximal deviation between reduction and preoperative planning was less than 2 mm. Sequela associated with orbital floor defects was eliminated and the postoperative facial appearance was improved remarkably. CONCLUSION： Navigationguided open reduction and rigid fixation in the treatment of maxillofacial old fractures is regarded as an ideal and valuable alternative in this potentially complicated procedure. Supported by National Natual Science Foundation of China

关 键 词：计算机辅助导航 颌骨骨折 继发畸形 手术模拟 复位 

分 类 号：R782.4[医药卫生—口腔医学]