【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,具有极大的临床应用价值,引领颅颌面外科真正进入数字精准时代。更多还原

【Abstract】 Objective To investigate the clinical value of modified registration-based digital navigation in 3 D 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 3 D 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 3 D 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 3 D digital reconstruction, and a questionnaire was used to investigate the degree of satisfaction among patients and their families. At 6-9 months after surgery, 3 D-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 difference in degree of satisfaction between the two groups(P>0.1). Both groups achieved good implementation of intraoperative navigation based on these two registration methods, with similar differences between intraoperative navigation-guided fibula graft position and preoperative planning and between intraoperative position after bone movement and preo-perative planning(P>0.1), and both groups achieved good restoration of facial shape. In group B, the surgical field in the mandible was not blocked by the reference frame, with clear surgical field and convenient operation; in the bimaxillary surgery, there was no need for the fixation and registration of the mandible reference frame, which reduced surgical steps and trauma. Both groups achieved successful precision reduction of the double fibula grafts, successful dental implantation on the bone graft, and good reco-very of facial appearance and masticatory function. During BSSRO surgery, the mandible was moved to the ideal position in both groups. Conclusion Modified registration-based digital navigation effectively solves the interference of reference frame in surgery, simplifies surgical procedures, and thus has a great clinical application value, leading craniomaxillofacial surgery into the era of digital precision.更多还原