改良配准数字导航在下颌骨三维可视化精准手术中的临床应用  

CLINICAL APPLICATION OF MODIFIED REGISTRATION-BASED DIGITAL NAVIGATION IN 3D VISUALIZED PRECISION SURGERY FOR THE MANDIBLE

作　　者：王奇民[1] 薛娇 童磊[1] 周建华[1] 董刚[1] 郑建金[1] 陈正岗[1] 贾暮云[2] 邱建忠[1] 袁荣涛[1] WANG Qimin;XUE Jiao;TONG Lei;ZHOU Jianhua;DONG Gang;ZHENG Jianjin;CHEN Zhenggang;JIA Muyun;QIU Jianzhong;YUAN Rongtao(Department of Oral and Maxillafacial Surgery, Qingdao Municipal Hospital, Affiliated to Qingdao University, Qingdao 266071, China)

机构地区：[1]青岛大学附属青岛市市立医院口腔颌面外科,山东青岛266071 [2]青岛大学附属医院口腔颌面外科

出　　处：《精准医学杂志》2020年第5期405-409,414,共6页Journal of Precision Medicine

基　　金：山东省自然科学基金资助项目(ZR2016HM34);青岛市科技局科研基金项目(14-6-1-6-zdzx)。

摘　　要：目的探讨改良配准数字导航系统在下颌骨三维可视化精准手术中的临床应用价值。方法选取于青岛大学附属青岛市市立医院行下颌骨手术的患者36例,其中口腔恶性肿瘤8例,良性病变18例,双侧下颌升支矢状劈开截骨术(BSSRO)患者10例。所有患者术前均行颅面骨三维数字模型重建,分析设计下颌骨截骨范围及腓骨截骨塑形范围,设计下颌骨截骨、腓骨塑形及移植骨复位导板,3D打印下颌骨术前模型、重建模型及各导板。应用数字导航系统,重建下颌骨及病灶,规划手术设计。手术患者分为2组,A组为经典配准下颌骨手术组,配准装置安放于颏部或者下颌骨下缘;B组为改良配准下颌骨手术组,配准装置安放于颅骨。术中分别采用经典配准或改良配准方式,选取测量位点进行吻合度测量,比较术中导航下移植腓骨位置与术前规划的差异,比较正颌术中骨移动后位置与术前规划的差异。术后CT扫描,三维数字重建,再次验证手术效果。应用调查问卷对患者及家属进行满意度调查。术后6~9个月,应用3D打印种植导板,在移植骨上行种植牙修复。结果A组与B组患者及其家属术前与术后满意度均高,两组满意度比较差异无显著性(P>0.1)。A组、B组两种导航配准方式术中导航实施良好,两组术中导航下移植腓骨位置与术前规划及正颌术中骨移动后位置与术前规划的差异比较差异无显著性(P>0.1),两组面型恢复良好。但B组导航配准中去除了参考架对下颌术区的遮挡,术野清晰,手术操作方便;在双颌手术中,无须进行下颌骨参考架的固定与配准,减少了手术步骤及对患者的创伤。两组患者双层移植腓骨精准复位,移植骨牙种植均获成功,良好恢复颜面外观及咀嚼功能。正颌BSSRO手术时,两组患者下颌骨均移位于理想位置。结论改良配准数字导航解决了参考架对手术实施的干扰,简化了手术操作,具�Objective To investigate the clinical value of modified registration-based digital navigation in 3D visualized precision surgery for the mandible.Methods A total of 36 patients who underwent mandible surgery in Qingdao Municipal Hospital,Affiliated to Qingdao University were enrolled,among whom 8 had oral malignant tumor,18 had benign lesion,and 10 underwent bilateral sagittal split ramus osteotomy(BSSRO)for the mandible.The 3D digital model of craniofacial bone was established before surgery,the extent of mandible osteotomy and the extent of fibula osteotomy and molding were analyzed and designed,guide plates were designed for mandible osteotomy,fibula molding,and bone graft reduction,and 3D printing technique was used to make the preoperative model,reconstruction model,and each guide plate for mandible surgery.The digital navigation system was used to reconstruct the mandible and lesions and develop surgical planning.The patients were divided into group A(treated with classic mandible navigation surgery,in which the registration device was placed on the chin or the lower margin of the mandible)and group B(treated with modified mandible registration surgery,in which the registration device was placed on the skull).Classic or modified registration was used during surgery,and the measurement points were selected to measure the degree of anastomosis.The difference between intraoperative navigation-guided fibula graft position and preoperative planning was compared,as well as the difference between intraoperative position after bone movement and preoperative planning.The surgical effect was verified by postoperative CT scan and 3D digital reconstruction,and a questionnaire was used to investigate the degree of satisfaction among patients and their families.At 6-9 months after surgery,3D-printed implant guide plate was used for dental implant restoration on the bone graft.Results The patients in both groups and their families had a high degree of satisfaction before and after surgery,and there was no significant diff

关 键 词：下颌骨重建术 外科手术 计算机辅助 配准 打印 三维 最小侵入性外科手术 精准医学 

分 类 号：R782.2[医药卫生—口腔医学] R319.1[医药卫生—临床医学]