导航系统在鼻眶筛复合骨折术中的应用

Use of a surgical navigation system in naso-orbital-ethmoid fracture surgery

目的探讨导航系统在鼻眶筛复合骨折手术中的应用,寻求导航系统的介入对鼻眶筛复合骨折手术复位精准性的帮助及导航系统手术的优势。方法 62例鼻眶筛复合骨折的患者被纳入试验中。在采集并导入DICOM格式的CT影像学数据后,术前利用计算机辅助设计复合面部对称性的鼻眶筛复合骨折复位方案,术中在导航系统的指导下完成鼻眶筛复合骨折的复位手术,并实时验证复位后位置与术前设计方案的匹配程度。结果在导航系统通过注册后,术中的骨折及解剖位置与CT影像学数据精准吻合,计算机的系统误差控制在1 mm之内。所有的手术都在实时导航下顺利完成,术中根据术前的复位方案精准复位,利用导航系统判断复位后骨质与设计方案的匹配程度。患者术后面部外形改善明显,所有纳入的患者对手术复位结果满意。结论在计算机辅助下,通过术前测量、模拟、设计,导航技术有利于提高鼻眶筛复合骨折术中复位的精准性、减少手术风险、降低再次手术的发生率、恢复面部对称性。

Objective To explore the application of computer-assisted navigation in naso-orbital-ethmoid fracture surgery. Methods Sixty-two patients, comprising 21 patients with orbital margin fracture, 3 patients with frontal bone fracture, 15 patients with maxillary fracture, and 23 patients with compoud naso-orbital-ethmoid fracture, were enrolled in this study. Computed tomography （CT） scans were obtained and data were stored in the digital imaging and communications in medicine （DICOM） format. A mor- phological reconstruction was made and displayed using preoperative simulation with mirroring procedures. All operations were per- formed under the guidance of a navigation system. The accuracy of navigation was evaluated by comparing the postoperative CT three-dimensional model with the preoperative surgical planning. Results Through registration, an accurate match between the intr- aoperative anatomy and the CT images was achieved. The systematic error evaluated by a computer was within a 1 mm margin. All operations were performed successfully with the guidance of real-time navigation. All patients recovered uneventfully and profile was improved significantly. Conclusion With the opportunity to perform preoperative planning and surgical simulation, computer-as- sisted navigation shows great value in improving the accuracy of naso-orbital-ethmoid fracture surgery, reducing risk during opera- tion and the incidence of secondary surgery, and restoring facial symmetry.