手术导航系统在下颌骨修复重建术中的疗效研究

Clinical evaluation of surgical navigation system in the reconstruction of mandibular defects

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 compare the clinical effects of surgical navigation system and CAD/CAM surgical template in the reconstruction of mandibular defects. Methods Twenty-two patients with mandibular tumor resection and concurrent defect reconstruction were selected. Ten patients received real-time Brain LAB navigation system to position vital parts of the bone autograft after CAD/CAM surgical guide template technology（ group A） ;12 cases received CAD/CAM surgical guide template technology（ group B）. Preoperative computer aided design （CAD） and intraoperative model surgery treat- ment were carried in both groups. After the operations, postoperative 3 D CT was used to compare with preoperative design. Mandibular angle point（A） and condylar poles outside （C） was selected as key landmarks of mandibular. Geomagic studio 12.0 software was used to measure the straight-line distance of two landmarks in the preoperative design model and post- operative model（AL,CL） for performing statistical analysis. Patients were observed for facial symmetry at the time of 6 months after operation for surgical effect comparison. Results The surgery of both groups was successfully performed. The AL and CL value of A group was （ 1.86±0.20） mm and （2.96±0.85 ） mm, respectively. The matched results were an- alyzed with a comparative t-test, there was significant differences （ P 〈 0.05 ） ; Location of key landmarks in A group was more precise than group B, also the facial symmetry in group A was better than group B. Conclusion Compared with CAD/CAM surgical template, surgical navigation system can improve the accuracy and effects of mandibular defect recon- struction, and restore facial symmetry.