计算机导航技术在眶颧部骨纤维异常增生症治疗中的应用

Application of computer navigation system in orbit-zygomatic fibrous dysplasia

目的探讨计算机导航技术在眶颧部骨纤维异常增生症手术中的应用价值及疗效分析。方法以2016年3月至2018年12月上海交通大学医学院附属第九人民医院整复外科收治的眶颧部骨纤维异常增生症患者为研究对象,均行术前三维CT扫描及计算机辅助设计,应用镜像设计原理将健侧与患侧进行配对比较,确定术中异常骨质切除范围并标明术中危险区域。术中将导航支架置于患者前额,配对完成后,于计算机导航辅助下经下睑缘-口内切口入路根据术前方案行异常骨纤维切除。于术前、术后6个月头颅CT三维重建模型上标记颧颌点、眶下点、颧突点及颧颌缝眶下缘点,分别测量其到正中矢状面的距离,采用配对t检验分别对患者术前和术后健、患双侧对称性进行分析。术后对眶颧部形态进行对比,并统计并发症发生情况。结果共纳入16例眶颧部骨纤维异常增生患者,其中男性12例,女性4例,年龄18~35岁。术前健、患双侧颧颌点、眶下点、颧突点到正中矢状面距离比较,差异均有统计学意义(P<0.01);颧颌缝眶下缘点双侧比较,差异无统计学意义(P>0.05)。术后健、患双侧4个标志点到正中矢状面的距离比较,差异均无统计学意义(P>0.05),健、患侧颧颌点到正中矢状面距离的差值由(10.1±6.2) mm减少至(2.7±6.4) mm,眶下点由(7.7±4.6) mm减少至(1.9±3.9) mm,颧突点由(8.5±7.5) mm减少至(0.7±1.5) mm,颧颌缝眶下缘点由(1.9±3.5) mm减少至(0.6±2.1) mm。所有患者术后疗效显著,患侧与健侧形态对称,轮廓自然,无并发症发生,满意度较高。结论应用计算机导航技术治疗眶颧部骨纤维异常增生症可有效解决经下睑缘-口内入路视野暴露困难的问题,显著提升手术的精确性、对称性及安全性。

Objective To evaluate the clinical value and effect of the application of computer navigation system in orbital-zygomatic fibrous dysplasia.Methods From March 2016 to December 2018,16 patients with orbital-zygomatic fibrous dysplasia admitted to Shanghai 9th People’s Hospital,Shanghai Jiao Tong University School of Medicine were included in this study.CT scans and computer aided designs were finished preoperatively.By mirrored and compared with the healthy side,preoperative-designed lesion removal area was determined and surgical regions were highlighted.Digital reference frame was fixed rigidly to patient’s forehead.After accurate registration,lesion area was removed with the aid of surgical navigation system according to preoperative-designed plan restrictively through lower eyelid-intraoral approach.The symmetric morphology of orbital-zygomatic region was analyzed postoperatively.Zygomaxillare,oribitale,zygomaticand lower orbital point of zygomatic maxillary were marked both in preoperative and postoperative three-dimensional reconstructions,and the distance between them and mid-sagittal plane was measured.Paired-t tests were applied in this study for symmetric analysis.Results In this study,16 patients with orbital zygomatic bone fiber dysplasia assisted by computer navigation were included,consisted of 12 males and 4 females,ranging from 18 years old to 35 years old.The differences of preoperative symmetric analysis in zygomaxillare,oribitale,zygomatic had statistical significance(P<0.01).The difference of preoperative symmetric analysis in lower orbital point of zygomatic maxillary had no statistical significance(P>0.05).The differences of postoperative symmetric analysis in zygomaxillare,oribitale,zygomatic and lower orbital point of zygomatic maxillary had no statistical significance(P>0.05).The difference in zygomaxillare decreased from(10.1±6.2)mm to(2.7±6.4)mm.The difference in oribitale(ORI)decreased from(7.7±4.6)mm to(1.9±3.9)mm.The difference in zygomatic decreased from(8.5±7.5)mm to(0.7±1.5)mm.The difference in lower orbital point of zygomatic maxillary decreased from(1.9±3.5)mm to(0.6±2.1)mm.The morphology of the affected side and the healthy side was symmetrical.The contour was natural and no postoperative complications occurred.The postoperative satisfaction rate was high.Conclusions Computer navigation system can solve the problem of limited exposure of lower eyelid-intraoral approach in orbital-zygomatic fibrous dysplasia and significantly improve the accuracy,effectiveness and safety during surgery.