增强现实虚实融合技术辅助在乙状窦后入路开颅手术中的应用效果  

Application effect of assisted augmented reality-based Online-Merge-Offline technology in retrosigmoid craniotomy

作　　者：曾祥博 叶远良 李连[1] 朱达[1] 李傲 龙浪 ZENG Xiang-bo;YE Yuan-liang;LI Lian;ZHU Da;LI Ao;LONG Lang(Department of Neurosurgery,Liuzhou People′s Hospital,Liuzhou 545006,China)

机构地区：[1]广西柳州市人民医院神经外科,柳州市545006

出　　处：《广西医学》2021年第8期931-934,947,共5页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z20200127)。

摘　　要：目的探讨增强现实虚实融合技术辅助在乙状窦后入路开颅手术中的应用效果。方法回顾性分析40例行增强现实虚实融合技术辅助下经枕下乙状窦后入路手术治疗的患者的临床资料。将术前CT或者CT血管造影检查的图像进行后颅窝三维重建,使用CT自带裁剪功能剪除横窦-乙状窦颅骨压迹,制作引导术中路径的虚拟图片,然后以颅骨的二腹肌沟、骨缝、星点等解剖学标志为匹配标记,使用手机增强现实虚实融合技术将制作好的虚拟图片与术中颅骨的解剖学标记完全重叠,再根据重合图片确定横窦-乙状窦的颅骨表面投影,设计出关键孔及骨窗位置,然后进行手术操作。记录患者头皮切口长度、关键孔与横窦乙状窦位置关系、骨窗与静脉窦位置关系、骨窗大小、完成骨窗开颅时间、开颅出血量。结果40例患者均顺利完成手术。关键孔与静脉窦位置关系:完全暴露拐角35例(87.5%),单纯暴露横窦3例(7.5%),单纯暴露乙状窦2例(5.0%),无暴露静脉窦0例。骨窗与静脉窦位置关系:一次性铣除骨瓣不需要再咬除骨质(完全暴露到横窦及乙状窦边缘)30例(75.0%),单纯暴露横窦边缘6例(15.0%),单纯暴露乙状窦边缘4例(10.0%),无暴露静脉窦0例。关键孔距离横窦最短距离(0.5±0.3)cm,关键孔距离乙状窦最短距离(0.6±0.3)cm;头皮直线切口长(6.0±0.5)cm,骨窗大小(2.5±0.5)cm^(2),从切皮到骨窗完成时间(15.0±0.5)min;完成骨窗开颅出血(25.0±5.0)mL,无一例发生静脉窦破裂出血。结论采用增强现实虚实融合技术辅助乙状窦后入路开颅手术,可以实现个体化、精确化定位关键孔与横窦乙状窦位置,设计更适宜的骨窗及游离骨瓣,避免不必要的暴露与损伤。Objective To explore the application effect of assisted augmented reality-based Online-Merge-Offline technology in retrosigmoid craniotomy.Methods The clinical data of 40 patients,who underwent surgical treatment via suboccipital retrosigmoid approach by assisted augmented reality-based Online-Merge-Offline technology,were retrospectively analyzed.A three-dimensional reconstruction of the posterior cranial fossa was conducted on the images of preoperative CT or CT angiography examination,the transverse-sigmoid sinus impression of the cranium was eliminated using the clipping function of CT,the visualization of directing intraoperative approaches was performed,then the cranium was marked with a number of anatomic landmarks,i.e.digastric fossa,bone suture,and asterion,the established virtual images overlapped intraoperative anatomic landmarks on the cranium perfectly using augmented reality-based Online-Merge-Offline technology on mobile phone,the transverse-sigmoid sinus projection on the surface of the cranium based on the overlapped images was identified to determine the locations of key hole and bone window,and then the surgical procedure was performed.The scalp incision length,spatial relationship between key hole and the transverse-sigmoid sinus,spatial relationship between bone window and the venous sinus,bone window size,duration for completing bone window craniotomy,and blood loss in craniotomy of the patients were recorded.Results All 40 patients completed the operation successfully.The spatial relationship between key hole and the venous sinus was as follows:completely exposed corner occurred in 35(87.5%)cases,simple exposure of the transverse sinus in 3(7.5%)cases,simple exposure of the sigmoid sinus in 2(5.0%)cases,and no cases had the venous sinus exposure.The spatial relationship between bone window and the venous sinus was as follows:30(75.0%)cases had one-off removal of bone flap with no need to remove osseous substance(completely exposed to the edge of the transverse and sigmoid sinus),6(15.0%)cas

关 键 词：增强现实 乙状窦后入路 关键孔 开颅手术 成像 三维 

分 类 号：R651.11[医药卫生—外科学]