基于快速原型技术的导航辅助下颌骨内置式牵张成骨术的实验研究  

Experimental study on navigation-guided internal mandibular distraction osteogenesis on rapid prototyping model

作　　者：蔡鸣[1] 沈国芳[1] 林艳萍[2] 王旭东[1] 张诗雷[1] 袁建兵[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》2010年第5期427-435,共9页China Journal of Oral and Maxillofacial Surgery

基　　金：国家高科技研究发展计划(SQ2009AA04ZX1485930);国家自然科学基金(30872906)~~

摘　　要：目的:应用自主研发的导航手术系统,在快速原型技术制作的三维头颅模型上进行内置式下颌骨牵张成骨术的实验研究,通过三维定点测量,分析该导航手术的精度。方法:对1例单侧下颌骨发育不足的患者行螺旋CT扫描后,采用快速原型技术制作5个相同的头模,按导航配准原则植入定位钉后再行CT扫描。应用AccuNavi 1.0软件对三维图像进行测量,并与游标卡尺实体测量的相应指标进行头模制作精度检测。然后进行下颌骨三维测量分析与虚拟单侧内置式下颌支牵张成骨术,将制定的手术规划通过实时TBNavis-CMFS导航系统在三维头模上实施,牵引到位后,行CT扫描图像重建,应用AccuNavi1.0软件与Surgicase5.0软件进行三维测量与牵引长轴间成角测量,采用SPSS13.0软件包对结果进行配对t检验。结果:快速原型制作的三维头模与AccuNavi1.0软件重建的三维图像间各测量指标无统计学差异(P>0.05)。模型手术平均牵引长度12.40mm(11.79～12.68mm),模拟手术与导航模型术后牵引长轴间成角均值为4.67°(2.01°～6.49°)。导航术后各项指标中,除CoL-CoR(P=0.037)、CoL-GoL(P=0.017)与模拟手术值间有显著性差异外,其余指标间均无显著性差异(P>0.05)。结论:应用快速原型技术制作的三维头颅模型与AccuNavi1.0软件的三维重建图像精度相仿。通过TBNavis-CMFS导航系统平台,建立了导航辅助下颌骨牵引成骨术的实验方法,准确地将手术规划转移到模型手术中。PURPOSE： To investigate the accuracy of navigation-guided unilateral mandibular distraction osteogenesis （DO） on rapid prototyping （RP） model by using TBNavis-CMFS navigation system. METHODS： 5 rapid prototyping skull models were manufactured based on the computerized tomographic （CT） acquisition of a hemimandibular hypoplasia patient and spiral CT scan was performed for each RP model after setting registration screws. Presurgical three dimensional （3-D） measurement of the 3-D reconstruction imagine was carried out in AccuNavi 1.0 software. Reproducibility of the 3-D measurement method and RP model were evaluated and simulation operation was planned to determine the mandibular distraction vector. Navigation-guided internal mandibular ramus DO was performed on RP model and post-surgical 3-D data was measured by AccuNavi 1.0 and Surgicase 5.0 software. Pared t-test was used for statistical analysis using SPSS 13.0 software package. RESULTS： 3-D measurement for mandibular DO planningby AccuNavi 1.0 repeated precisely.The mean distraction length was 12.40 mm, distractor axel angel of virtual and navigated operation was 4.67°. The differences of CoL-CoR（ P=0.037） and CoL-GoL（P=0.017） was significant which might be caused by landmark positioning error of right condyle point on RP model after distraction. There was no significant difference of remaining data which showed high accuracy for navigation-guided model surgery. CONCLUSION： Navigation-guided mandibular DO would be able to transfer the pre-surgical planning to real-time surgery precisely. TBNavis-CMFS system provided a platform for pre-surgical planning and virtual operation of mandibular DO and the accuracy of navigation-guided surgery was acceptable.

关 键 词：牵张成骨 导航外科 牙颌面畸形 快速原型 模型外科 

分 类 号：R782.2[医药卫生—口腔医学]