计算机辅助导航技术在口腔颌面外科的应用-104例病例分析  

Application of computer-assisted navigation in oral and maxillofacial surgery:retrospective analysis of 104 consecutive cases

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

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：《上海口腔医学》2012年第4期416-421,共6页Shanghai Journal of Stomatology

基　　金：国家自然科学基金(81101131,30471897);上海市科学技术委员会重点项目(11441902200);上海交通大学医工理交叉研究基金(YG2011MS06)~~

摘　　要：目的:探讨计算机辅助导航技术在口腔颌面外科的应用,并评价其效果。方法:选择104例需进行口腔颌面手术的患者,包括陈旧性颧-上颌-眶周骨折34例,颞下颌关节骨性强直27例,骨纤维异常增殖症29例,下颌角肥大畸形9例,颌面部软骨、骨肿瘤3例,面部异物2例。定位钉植入后,拍摄颌面部CT,进行术前设计及模拟,利用镜像技术确定患侧截骨部位、截骨量、骨折复位位置及重建外形。导航辅助下进行手术操作。术后复查CT,与术前设计图像融合,进行手术准确度及导航误差评价。结果:经过点配准和(或)面配准后,所有患者顺利完成导航手术。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1 mm。术后CT检查示截骨部位、截骨量、骨折复位与术前设计基本一致,平均误差(1.46±0.24)mm。104例患者术后愈合良好,无严重并发症,面部不对称畸形患者术后面形显著改善。结论:计算机辅助导航外科可以实现术前设计、手术模拟及术后预测,有助于提高颌面部手术的精确性,减少创伤,恢复面部对称性,是一种较为理想的颌面部手术辅助方法。PURPOSE： To evaluate the application of computer-assisted navigation system（CANS） in Oral and Maxillofacial Surgery.METHODS： One hundred and four patients were included in this study,including 34 with zygomatic-orbital-maxillary fracture,27 with unilateral TMJ ankylosis,29 with fibrous dysplasia,9 with mandibular angle hypertropia,3 with cartilage and bone tumors and 2 with facial foreign bodies.CT scan was performed and the data was saved as Dicom（digital imaging and communications in medicine） format.With preoperative planning and 3-dimensional simulation,normal anatomic structures of the affected side were created by superimposing and mirroring the unaffected side.The osteotomy lines,amount and range of resection,the reduction position of bony segments and the reconstruction morphology was determined and displayed.All surgeries were performed under the guidance of navigation system.The accuracy of navigation was evaluated by comparing the postoperative CT three-dimensional model with preoperative surgical planning.RESULTS： Through registration,an accurate match between the intra-operative anatomy and the CT images was achieved.With the guidance of navigation,anatomic 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 mm.Good coincidence with preoperative planning was achieved for osteotomy lines,the amount of resection and reduction of fractures.The mean error between virtual and real results was（1.46±0.24） mm.All patients healed uneventfully and facial symmetry was improved.CONCLUSIONS： With the ability of preoperative planning,surgical simulation and postoperative prediction,CANS shows its great value in improving the accuracy of oral and maxillofacial surgery,reducing trauma and restoring facial symmetry.It is regarded as a valuable and safe technique in this potentially complicated procedure.

关 键 词：计算机辅助导航 口腔颌面外科 手术设计 配准 精确性 

分 类 号：TP391.7[自动化与计算机技术—计算机应用技术] R782.2[自动化与计算机技术—计算机科学与技术]