三维立体测量及计算机辅助导航技术在颧眶复合体骨折中的应用

Application of three-dimensional measurement and computer-aided navigation system in management of orbitozygomatic complex fracture

目的探讨三维立体测量及计算机辅助导航在颧眶复合体骨折治疗中的应用及效果评价。方法利用Mimics软件对15例颧眶复合体骨折患者颧骨位置测量健侧和术前、术后患侧：视神经孔中心点至颧颞缝点、颧额缝点、颧上颌缝点的距离On-Zm、On-Or、On-Tz，颧弓突点水平角、颧突点水平角、颧骨额突下角；并应用计算机辅助导航系统行术前设计及模拟、术中实时导航定位。结果健侧On-Tz、On-Or、On-Zm分别为（48.6±4.5）mm、（42.5±2.2）mm、（47.5±3.2）mm，术前患侧各线距分别为（50.4±2.2）mm、（37.2±1.0）mm、（53.4±3.6）mm，与健侧比较差异均有统计学意义（P〈0.05）；术后患侧各线距分别为（46.4±3.7）mm、（41.2±1.8）mm、（46.4±2.5）mm，与健侧比较差异均无统计学意义。健侧颧弓突点水平角、颧突点水平角、颧骨额突下角分别为（144.7±4.1）°、（132.5±2.3）°、（112.0±3.4）°，术前患侧各角度分别为（150.3±8.0）°、（141.1±4.2）°、（114.9±5.1）°，与健侧比较差异均有统计学意义（P〈0.05）；术后患侧各角度分别为（144.6±4.1）°、（132.8±2.0）°、（111.9±3.6）°，与健侧比较差异均无统计学意义。15例患者复位均达到三维对称，开口及咬合功能恢复好，手术效果满意。结论三维立体测量实现了颧眶复合体空间移位的定量测量，同时结合计算机辅助导航系统对颧眶复合体骨折做到了术前设计及模拟、术中实时导航定位及术后疗效评价的整体治疗。

Objective To evaluate the application of three-dimensional measurement and computeraided navigation system in treatment of orbitozygomatic complex fracture. Methods Pre-and post-operative three-dimensional measurements were taken by Mimics software to locate the zygomatic bones of 15 patients with orbitozygomatic complex fracture to determine distance of optical foramen to zygomaticotemporal suture （ On-Zm ） / zygomaticofrontal suture （On-Or）/zygomaticomaxillary suture （ On- Tz）, horizontal angle of zygomatic arch, horizontal angle of the zygomatic process, and inferior angel of the frontal process of zygomatie bone. Preoperative design and simulation, intraoperative real time navigation and postoperative evaluation were applied using computer assisted navigation system. Results On- Tz, On-Or, and On-Zm was （48.6±4.5 ） mm, （42.5±2.2 ） mm, and （47.5±3.2） mm in the unaf- fected side, but was （50.4±2.2 ） mm, （37.2±1.0） mm, and （53.4±3.6） mm in the affected side before operation （ P 〈 0.05 ）. Whereas On - Tz, On - Or, and On-Zm improved to （46.4±3.7 ） mm, （41.2±1.8）mm, and （46.4±2.5 ）mm in the affected side after operation, similar with the values in the unaffected side （ P 〈 0.05 ）. Horizontal angle of zygomatic arch, horizontal angle of the zygomatic process, and inferior angel of the frontal process of zygomatic bone was （ 144.7±4. 1 ）°, （ 132.5±2.3）°, and （112.0±3.4）° in the affected side, with significant differences from （150.3±8.0）°, （141.1±4.2）°, and （114.9±5. 1）° in the affected side before operation （P〈0.05）, but they were improved to almost the normal values （ 144.6±4.1 ）°, （ 132.8±2.0）°, and （ 111.9±3.6） °after operation. Satisfactory surgical outcomes, such as three dimensional symmetry and recovery of normal mouth-openingand occlusion, had been achieved. Conclusions Three-dimensional measurement is a quantitative study on the spatial displacement of orbitozygomatic complex. Combined with computer-assisted navigation system with preoperative design and simulation, intraoperative real time navigation and postoperative evaluation, three-dimensional measurement attains the overall management of orbitozygomatic complex fracture.