计算机导航技术辅助额眶部骨纤维异常增生症的手术治疗  

Computer assisted navigation in fronto-orbital fibrous dysplasia surgery

作　　者：吴颖之 潘思妲 郭范立 杨君毅 穆雄铮 Wu Yingzhi;Pan Sida;Guo Fanli;Yang Junyi;Mu Xiongzheng(Department of Plastic Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院整形外科,上海200040

出　　处：《中华整形外科杂志》2022年第8期899-904,共6页Chinese Journal of Plastic Surgery

基　　金：上海市卫健委科研基金青年项目(20174Y0088)。

摘　　要：目的探讨术前应用计算机三维模拟设计切除额眶部骨纤维异常增生症病灶范围、术中计算机导航技术辅助进行视神经管减压,以保护视神经的可行性和安全性。方法回顾性分析2016年1月至2020年6月复旦大学附属华山医院收治的额眶部稳定期骨纤维异常增生症患者的临床资料。术前应用计算机三维模拟技术设计切除病灶范围,术中计算机导航技术辅助对额眶部骨纤维组织进行保留外形的次全切除、按设计模型立体额眶部开窗,同时对视神经管内段和球内段进行术中减压,保留额眶带的外形重塑。术前、术后即刻、术后6个月测量突眼度、患侧额部前凸点左右差值、患侧额部外侧点左右差值、眶额点左右差值、患侧视力,检查眼底情况,并对术前与术后即刻、术前与术后6个月各左右差值使用配对t检验进行统计学分析,P<0.05为差异有统计学意义。结果共纳入7例患者,男性2例,女性5例,平均年龄22.5岁。7例患者均获6~39个月随访,平均11.4个月。术后6个月,两侧眼球突度的差异变化,由术前平均(6.7±1.6)mm,改善至(2.9±1.1)mm,手术前后比较差异有统计学意义(P<0.001);患侧额部前凸点左右差值从术前(18.1±3.4)mm,改善到术后即刻(3.1±3.5)mm(P=0.001)、术后6个月(4.0±3.6)mm(P=0.001);额部外侧点左右差值从术前(21.4±4.1)mm,改善到术后即刻(1.8±1.9)mm(P<0.001)、术后6个月(2.5±2.1)mm(P<0.001);眶额点左右差值从术前(12.2±2.5)mm,改善到术后即刻(2.3±3.0)mm(P=0.004)、术后6个月(2.7±2.9)mm(P=0.006)。患侧视力检查术前平均裸眼视力4.5,术后6个月4.6,手术前后比较差异无统计学意义(P>0.05)。结论使用计算机三维模拟设计切除病灶范围、术中导航技术辅助进行视神经管减压,可以安全、有效的保护视神经,精确改善稳定期额眶部骨纤维异常增生症患者额眶部外形。Objective To explore the feasibility and safety of the prophylactic optic canal decompression in frontol-orbital fibrous dysplasia surgery by three-dimensional simulation design and computer assisted navigation.Methods A retrospected study was conducted in Huashan Hospital affiliated to Fudan University.Patients with stable fronto-orbital fibrous dysplasia were recruited from January 2016 to June 2020.Preoperatively,three-dimensional simulation design was used to design the scope of resection.Then a subtotal resection of fibrous dysplasia lesion was performed by computer assisted navigation and reshaping of the orbit rim was achieved by preserving the fronto-orbital bandeau.Meanwhile,the intracanal and intraorbital parts of optic nerve canal decompression was performed.Follow-up of the pre-op and post-op difference of the frontal bulge point,the lateral forehead point and orbitofrontal point of the affected side,the degree of proptosis,visual acuity and fundus were analyzed by paired t test.Results A total of 7 patients were recruited,including 2 males and 5 females,with an average age of 22.5 years.The average follow-up time was 11.4 months,and the difference in exophthalmos between the two sides improved from an average of(6.7±1.6)mm before operation to an average of(2.9±1.1)mm at 6 months after operation,which was statistically significant(P<0.001).The difference between the pre-op and post-op of the frontal bulge point on the affected side also improved from(18.1±3.4)mm before surgery to(3.1±3.5)mm(P=0.001)immediately after surgery and(4.0±3.6)mm(P=0.001)at 6 months after surgery.The difference of lateral forehead point improved from(21.4±4.1)mm before surgery to(1.8±1.9)mm(P<0.001)immediately after surgery and(2.5±2.1)mm(P<0.001)at 6 months after surgery,and the difference of orbitofrontal point improved from(12.2±2.5)mm before surgery to(2.3±3.0)m(P=0.004)immediately after surgery and(2.7±2.9)mm(P=0.006)at 6 months after surgery.The average uncorrected visual acuity of the affected side before op

关 键 词：骨纤维异常增生症 三维计算机设计 术中导航 视神经减压 

分 类 号：R779.6[医药卫生—眼科]