CANS系统在上颌骨颧骨复合体骨折中的应用

Application of CANS in Maxillary Zygomatic Complex Fracture

目的探讨计算机辅助导航系统(computer-aided navigation system,CANS)在上颌骨颧骨复合体骨折中的应用,并评价其应用效果。方法选择2018年3月—2018年5月中国医科大学附属第一医院整形外科8例单侧上颌骨颧骨复合体骨折患者,术前拍摄3D-CT并将数据导入Accu Navi软件,镜像原理规划设计骨折复位,应用CANS术中实时导航对术中骨折端进行精确指导复位。术后3天复查3D-CT,对比进行手术准确度及导航误差评价。结果通过CANS所有患者成功完成复位内固定。术中明确手术器械与解剖结构的位置关系,精确度高,系统误差小于1 mm。术前CT数据显示:颧突的前后径患侧与健侧差值平均(2.659±1.418)mm;颧骨下缘的前后径患侧与健侧差值平均(3.411±1.637)mm。术后CT数据显示颧突的前后径患侧与健侧差值平均(0.432±0.563)mm;颧骨下缘的前后径患侧与健侧差值平均平均(0.534±0.725)mm。术后较术前差值明显减小(P<0.001),术后3D-CT检查示骨折复位与术前设计基本一致,患者术后愈合良好,面部不对称畸形面形显著改善。结论CANS可以实现上颌骨颧骨复合体骨折术前设计、手术模拟及术后评估,在三维方向上实现上颌骨颧骨复合体的精准复位,获得满意的手术效果。

Objective To explore the application of CANS in the maxillary zygomatic complex fracture and evaluate its effect.Methods A total of 8 patients with unilateral zygomatic maxillary complex fracture in plastic surgery department of the First Affiliated Hospital of China Medical University from March 2018 to May 2018 were selected.3 D-CT were taken before the operation and data were imported into Accu Navi software.preoperative planning of fracture reduction based on the mirror principle and real-time navigation technique were used to accurately guide the reduction of the fractures at the end of the operation.3 D-CT was reexamined three days after surgery to evaluate the accuracy of operation and navigation errors.Results The open reduction and internal fixation of fracture reduction of all the patients were successfully performed by CANS technology.The positional relationship between surgical instruments and anatomical structures was defined during operation with high accuracy and systematic error less than 1 mm.Preoperative CT data showed that the average difference of the anterior and posterior zygomatic process diameter between the affected side and the healthy side was(2.659±1.418)mm,and the average difference of the anterior and posterior zygomatic process diameter between the affected side and the healthy side was(3.411±1.637)mm.Postoperative CT data showed that the average difference of anterior and posterior zygomatic process diameter between the affected side and the healthy side was(0.432±0.563)mm,and the average difference of anterior and posterior zygomatic process diameter between the affected side and the healthy side was(0.534±0.725)mm.The difference was significantly decreased after operation(P<0.001).3 D-CT of Postoperative examination showed that fracture reduction was the same as preoperative design basically.The fracture healed well after operation,and the asymmetric facial deformity was improved significantly.Conclusions CANS can realize the preoperative design,surgical simulation and post-operative evaluation of maxillary zygomatic complex fracture.Accurate reduction of maxillary and zygomatic can be achieved in three-dimensional direction,and satisfactory surgical results can be obtained.