数字化技术在下颌骨囊性肿物开窗减压术治疗中的应用研究

Application of computer-aided surgery techniques in fenestration and decompression of mandibular cystic tumor

目的研究数字化技术在下颌骨囊性肿物开窗减压术治疗中的应用及其效果评价。方法选取2012年1月至2014年12月在赤峰学院附属医院口腔医学中心就诊的下颌骨囊性肿物患者40例,随机分成试验组和对照组,各20例。试验组术前行头部64排螺旋CT三维重建,将所获得DICOM图像数据利用数字化软件mimics 17.0制作三维实体模型,模拟手术确定开窗位置和下牙槽神经定位,制作囊肿塞,术中依照模拟所得数据进行开窗减压术。对照组常规术前检查后行囊肿开窗减压术。术后定期复查,保留影像学数据,将数据进行统计学分析。结果试验组的手术时间[(31.89±0.58)min]明显短于对照组的手术时间[(61.79±1.34)min],组间差异有统计学意义(t=20.525,P <0.05)。试验组患者均无下牙槽神经损伤症状,而对照组有7例(占35%)出现不同程度的神经损伤症状,组间差异有统计学意义(χ~2=6.234,P <0.05)。试验组患者在术后仅有2例(占10%)患牙科焦虑症,而对照组有10例(占50%)患牙科焦虑症,组间差异有统计学意义(χ~2=7.619,P <0.05)。试验组术后6个月和12个月的骨再生状况均优于对照组,差异有统计学意义(均P <0.05)。结论数字化外科技术使下颌骨囊性肿物开窗减压术治疗做到术前准确设计、术中参照定位,可简化手术步骤、提高手术安全性,尤其可保护下牙槽神经。数字化外科技术有助于提高手术精度,是一种有效的下颌骨囊性肿物开窗减压术治疗的辅助手段。

Objective To evaluate the application and effect of computer-aided surgery(CAS)in fenestration and decompression of mandibular cystic tumor.Methods Totally 40 patients with mandibular cystic tumors were randomly divided into experimental group and control group,each with 20 cases.The patients in experimental group received the preoperative examination by CT reconstruction and then patients′DICOM data were used to make three dimensional entity models by mimics 17.0.The location of fenestration and decompression and inferior alveolar nerve(IAN)were determined on the models.The cyst plug was made and fenestration and decompression was performed according to the data obtained.The control group was treated with conventional operation.Postoperative periodic review was made.Keep the imaging data and analyze the data statistically.Results The operation time[(31.89±0.58)min]in the experimental group was significantly less than that in the control group[(61.79±1.34)min](t=20.525,P<0.05).No patient had symptoms of IAN injury in the experimental group while 7 patients had different degrees of nerve injury symptoms in the control group(χ2=6.234,P<0.05).The incidence of dental anxiety in the experimental group(2 cases,10%)was significantly lower than that in the control group(10 cases,50%)(χ2=7.619,P<0.05).The regeneration of bone at 6 and 12 months after surgery in the experimental group was significantly better than that in the control group(P<0.05).Conclusion CAS helps to accomplish fenestration and decompression for mandibular cystic tumor,providing accurate preoperative design and intraoperative positioning reference,which simplifies the surgical procedure,improves the surgical results and protects the inferior alveolar nerve.CAS technique in fenestration and decompression in the treatment of mandibular cystic tumor is helpful to improve the accuracy of surgery,which is regarded as an effective auxillary method in this procedure.