计算机辅助导航下颧上颌骨骨折复位固定的初步临床研究  

Preliminary clinical study of reduction and fixation of zygomatic maxillary fracture with computer-aided navigation

作　　者：赵守卫 钱浩亮 江宏兵[1] 程杰[1] 杜一飞[1] 郭松松[1] 叶金海[1] 袁华[1] Zhao Shouwei;Qian Haoliang;Jiang Hongbing;Chen Jie;Du Yifei;Guo Songsong;Ye Jinhai;Yuan Hua(Jiangsu Key Laboratory of Oral Disease, Department of Oral and Maxillofacial, Affiliated Stomatological Hospital of NM U , Nanjing 210029, China)

机构地区：[1]南京医科大学口腔疾病研究江苏省重点实验室南京医科大学附属口腔医院口腔颌面外科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2018年第5期658-663,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏高校优势学科建设工程资助(2014-37)

摘　　要：目的:介绍计算机辅助导航技术下的颧上颌骨骨折复位内固定技术,并评价其治疗效果。方法:选取10例单侧颧上颌骨骨折的患者,术前拍摄锥形束CT(CBCT)并将数据导入Accu Navi软件,采用镜像原理规划骨折复位,实时导航技术对术中骨折端复位进行精确指导。术后1个月拍摄CBCT,在横断面、矢状面以及冠状面3个维度上,测量患侧和健侧参考点间的差值,评价治疗效果。结果:通过计算机辅助导航技术成功完成所有患者的复位固定;术前CT数据分析显示患侧与健侧差值范围0.037~9.257 mm,术后数据分析显示患侧与健侧差值范围0.000~3.490 mm,术后较术前差值明显减小(P<0.001),提示术后复位良好;术前各维度健患侧差值2~4 mm比例为33.9%(61/180),4~6 mm比例为7.8%(14/180),>6 mm比例为6.1%(11/180);术后各维度上健患侧差值均<4 mm,其中2~4 mm比例为3.3%(6/180)。结论:计算机辅助导航技术可用于指导颧上颌骨骨折的精准复位,在三维方向上获得满意的面部对称性。Objective：To introduce the technique of reduction and internal fixation of zygomatic maxillary fracture with three-dimensional navigation technique and evaluate its therapeutic effect. Methods：A total of 10 patients with zygomatic maxillary fracture of the upper jaw were selected. Cone-beam CT（CBCT）were taken before the operation and data were imported into Accu Navi software.The mirror reduction principle,preoperative planning of fracture reduction and real-time navigation technique were used to accurately guide the reduction of the fractures at the end of the operation. CBCT was taken one month after surgery and the difference between the reference points and the sagittal and coronal planes was evaluated before and after surgery. Results：The open reduction and internal fixation of fracture reduction of all the patients were successfully performed by the three-dimensional reconstruction of surgical navigation technology. Preoperative CT data analysis showed that the D-value range between the affected side and uninjured side of0.037-9.257 mm,and the postoperative CT data analysis showed that the D-value range of 0.000-3.490 mm. The postoperative difference was significantly lower（P〈0.001）,suggesting good postoperative reduction. The dimensions of preoperative health ipsilateral 2-4 mm value ratio of 33.9%（61/180）,4-6 mm ratio was 7.8%（14/180）,〉6 mm ratio was 6.1%（11/180）;after the dimensions of health ipsilateral difference was 4 mm,and the ratio of 2-4 mm was 3.3%（6/180）. Conclusion：Three-dimensional image processing combined with computer aided navigation can be used to guide the accurate reduction of zygomatic fracture and evaluate the postoperative aesthetic effect.

关 键 词：三维导航 颧上颌骨 骨折 复位 坚固内固定 

分 类 号：R782.4[医药卫生—口腔医学]