计算机辅助导航系统在下颌骨缺损修复重建中的初步应用

发布时间：2018-01-21 13:19

本文关键词： 计算机辅助导航系统下颌骨缺损修复重建　出处：《中国修复重建外科杂志》2015年06期 　论文类型：期刊论文

【摘要】：目的探讨计算机辅助导航系统(computer assisted navigation system,CANS)在下颌骨缺损修复重建中的效果。方法 2012年4月-2014年9月,收治8例下颌骨良性病变切除后一期行修复重建的患者。男5例,女3例;年龄22~50岁,平均34.5岁。造釉细胞瘤4例,牙源性角化囊肿3例,髁状突骨瘤1例。病变切除后缺损部位参照CRABS方法分类:右侧CRAB型、左侧RABS型、左侧CR型、右侧RAB型、左侧C型、右侧RABS+左侧S型各1例,右侧AB型2例。术前戴预制的咬合板行颌面部CT及常规供骨区CT检查,应用Brain Lab Iplan软件及Surgicase CMF 5.0软件对颌面部等CT数据分割、三维重建、术前设计及虚拟手术,术中利用模型外科技术切除下颌骨肿瘤,采用Brain Lab导航系统实时验证下颌角和髁状突等部位的定位。术后利用Geomagic studio12.0软件通过二维测量和三维色谱偏差分析进行手术精确度评价;随访观察颜面部对称性、并发症和复发情况。结果 8例患者均顺利完成术前设计、模拟手术和实时导航手术。术后CT复查和三维色谱偏差分析示截骨部位、切除范围、重建外形与术前设计基本一致,下颌角点和髁状突外极点在术前设计复位点与术后CT模型上就位点距离分别相差(1.83±0.19)mm和(1.61±0.24)mm。术后患者均获随访,随访时间2~6个月,平均3.5个月。除肋骨移植患者张口度轻度受限外,余未见明显并发症。患者面部对称性良好,随访期间未见肿瘤复发。结论 CANS可显著提高下颌骨缺损修复重建术的精确性,有效减少并发症,恢复面部对称性,可有效辅助下颌骨缺损修复重建手术。
[Abstract]:Objective to explore computer assisted navigation system. Methods from April 2012 to September 2014, 8 patients (5 males) with benign mandibular lesions were treated. Female 3 cases; The age was 22 ~ 50 years (mean 34.5 years), ameloblastoma 4 cases, odontogenic keratocyst 3 cases. One case of condylar osteoma. According to CRABS method, the defects were classified as right CRAB type, left RABS type, left CR type, right RAB type and left C type. There were 1 case of S type on the left side of RABS and 2 cases of AB type on the right side. The maxillofacial CT and the routine donor area CT were performed with prefabricated occlusal plate before operation. Brain Lab Iplan software and Surgicase CMF 5.0 software were used to segment CT data of maxillofacial region, 3D reconstruction, preoperative design and virtual surgery. Model surgery was used to remove mandibular tumors. The localization of mandibular angle and condyle was verified by Brain Lab navigation system in real time. Geomagic was used after operation. Studio12.0 software was used to evaluate the accuracy of the operation by two dimensional measurement and three dimensional chromatographic deviation analysis. Results the preoperative design, simulated operation and real-time navigation operation were successfully completed in 8 patients. Ct reexamination and 3D chromatographic deviation analysis showed the osteotomy site. The range of resection and the reconstruction appearance were basically consistent with the preoperative design. The distance between the mandibular corner and the external pole of the condyle was 1.83 卤0.19 mm and 1.61 卤0.24, respectively, on the pre-operative reduction point and the post-operative CT model, which were 1.83 卤0.19 mm and 1.61 卤0.24, respectively. All patients were followed up after operation. The follow-up time ranged from 2 to 6 months (mean 3.5 months). There were no obvious complications except the slight limitation of the opening degree of rib transplantation patients. The facial symmetry of the patients was good. Conclusion CANS can significantly improve the accuracy of mandibular reconstruction, reduce complications and restore facial symmetry. It can effectively assist the reconstruction of mandibular defect.
【作者单位】：浙江大学医学院附属第一医院口腔颌面外科;衢州市人民医院口腔科;浙江工业大学机械工程学院;
【分类号】：R782.2
【正文快照】： 1 Department of Oral and Maxillofacial Surgery,the First Ai liated Hospital,College of Medicine,Zhejiang University,Hangzhou Zhejiang,310003,P.R.China;2 Department of Stomatology,the People’s Hospital of Quzhou;3 College of Mechanical Engineering,Zhejia

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