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目的应用手术导航系统辅助下颌骨缺损修复重建,与单纯使用CAD/CAM导板技术对比,评价导航技术疗效。方法选择已行下颌骨肿瘤切除同期修复重建的患者22例,术中采用实时导航系统Brain Lab+CAD/CAM导板辅助自体移植骨关键部位定位的病例10例(A组);术中单独采用CAD/CAM导板辅助关键部位定位的病例12例(B组),2组均术前行计算机辅助设计、术中行模型外科技术处理。术后均予颌面部三维CT复查,与术前设计三维CT比对,选择下颌角点(A)和髁状突外极点(C)作为下颌骨重建外形的关键标志点,利用Geomagic studio 12.0软件测量两标志点在术前设计与术后完成的三维位置的直线距离(AL、CL),并进行统计学分析;术后6个月复查随访,对颜面部对称性进行手术效果比较。结果 2组均顺利完成手术,两个标志点的距离偏差为:A组AL为(1.86±0.20)mm,CL为(1.63±0.24)mm;B组AL为(3.75±1.14)mm,CL为(2.96±0.85)mm。2组AL、CL测量值分别进行独立样本t检验比较,差异具有统计学意义(P<0.05);关键标志点就位A组较B组精确,A组术后面型对称性较B组好。结论术中采用手术导航系统比单纯使用CAD/CAM导板更能提高下颌骨修复重建的手术精确度和疗效,恢复面部对称性。
Objective To evaluate the effect of navigation technique by using surgical navigation system to assist the reconstruction and reconstruction of mandibular defects, compared with the simple use of CAD / CAM guide technique. Methods Twenty-two patients underwent resection and reconstruction of mandibular tumors during the same period. Ten patients (A group) were treated with the real-time navigation system Brain Lab + CAD / CAM guide plate to assist the localization of the autograft bone. Intraoperative CAD / CAM guide plate assisted positioning of key cases in 12 cases (B group), two groups were preoperative computer-aided design, intraoperative line model surgical techniques. Three-dimensional computed tomography (CT) examination of maxillofacial region was performed after operation, compared with the preoperative design of three-dimensional CT. Mandibular angle (A) and condylar pole (C) were selected as the key markers of mandible reconstruction. Geomagic studio 12.0 The software measured the linear distance (AL, CL) of the two markers between the preoperative design and the three-dimensional position after the surgery and performed statistical analysis. The follow-up was performed 6 months after the surgery to compare the facial symmetry. Results Both groups had successful operation. The distance between the two markers was (1.86 ± 0.20) mm in CL and (1.63 ± 0.24) mm in CL, and (3.75 ± 1.14) mm in CL and B (2.96 ± 0.85) mm. The two groups of AL and CL measurements were compared with independent samples t-test, the difference was statistically significant (P <0.05); key markers in place A group than the B group accurate, A group postoperative facial symmetry than B group . Conclusion Surgical navigation system can improve the accuracy and curative effect of mandibular reconstruction more than the simple use of CAD / CAM guide plate and restore facial symmetry.