手術導航技術在顴骨顴弓骨折治療應用中的精確度評價

虎小毅　李立峰　史婧怡　屠軍波　侯成群

[摘要]目的：通過評估手術導航技術輔助治療顴骨顴弓骨折的精確度，探討其在頜面部手術治療中的應用價值。方法：選擇2015年1月-2018年11月在西安交通大學口腔醫院就診的單側顴骨顴弓骨折患者19例。術前行薄層CT掃描，并將CT數據導入手術導航術前規劃軟件。在手術規劃系統中選擇健側顴骨顴弓結構并鏡像至患側，鏡像的范圍大于患側骨折所累及范圍，一般情況下鏡像體范圍至少上至眶上緣，下達顴牙槽嵴，后至顴弓根部。通過進一步微調鏡像體設計出骨折“復位”的理想位置，再將設計好的模型導入手術導航儀并在術中輔助引導骨折復位固定。術后均行CT復查，通過兩種方式評估手術導航的精確性。方式一：將術后CT數據導入術前設計軟件，經過圖像融合后測量術后患側顴骨顴弓的位置與術前設計的差異;方式二：通過在術后CT上測量并對比雙側顴骨的位置評估雙側顴骨的對稱性。結果：術后關鍵標志點間距同術前設計差異不超過2mm，術前術后差異不具有統計學意義，手術效果滿意。結論：手術導航技術輔助單側顴骨顴弓骨折復位固定具有良好的精確度。

[關鍵詞]手術導航;顴骨顴弓骨折;手術治療;堅固內固定;精確度

[中圖分類號]R782.4? ? [文獻標志碼]A? ? [文章編號]1008-6455（2019）10-0082-04

Abstract： Objective? To evaluate the accuracy and benefits of surgical navigation technology in the treatment of zygomatic arch fracture. Methods? From January 2015 to November 2018， nineteen patients diagnosed with unilateral zygomatic fracture were selected in the Stomatological Hospital of Xi'an Jiaotong University. Thin slice CT scans were performed before operation， and CT data were imported into the preoperative planning software of surgical navigation. In the surgical planning system， the zygomatic arch structure of the healthy side is selected and mirrored to the affected side. The scope of the mirror images was larger than that of the affected side. Generally， the scope of the mirror part should include at least the upper orbital margin， the zygomatic alveolar ridge and the root of zygoma. The ideal positions of fracture reduction were designed by further fine-tuning of the mirror body， and then the designed models were introduced into the surgical navigator and used in guiding fracture reduction and fixation during the operation. Postoperative CT examination was performed to evaluate the accuracy of surgical navigation in two ways. Method 1： The post-operative CT data were introduced into the preoperative design software， and the difference between preoperative design and postoperative zygomatic arch position were measured after image fusion. Method 2： The symmetry of bilateral zygomatic bones was evaluated by measuring and comparing the position of bilateral zygomatic bones on post-operative CT. Results? The distances of the key markers between the preoperative design and postoperative zygoma were less than 2 mm. No significant difference was observed between the preoperative and the postoperative zygomatic position. Conclusion? Surgical navigation is accurate and reliable for assisted reduction and fixation of unilateral zygomatic arch fracture.

Key words： surgical navigation; zygomatic fracture; surgical treatment; rigid internal fixation; accuracy

顴骨顴弓位于面部突出部位，是頜面部骨折好發部位之一。由于顴骨的位置對于面中部外形的支撐至關重要，因而欠理想的顴骨顴弓骨折復位往往遺留面部不對稱畸形，影響美觀。……