计算机方向kade期刊,计算机辅助导航技术在上颌骨肿瘤切除及缺损重建中的应用...

摘要

目的：探讨计算机辅助导航技术在上颌骨肿瘤切除及同期重建中的应用。方法：选择进行上颌骨肿瘤切除及同期重建的患者5例．其中骨肉瘤1例．骨化纤维瘤4例。定位钉植入后拍摄颌面部CT，进行术前设计及模拟，确定肿瘤切除范围、截骨部位及重建外形。导航辅助下进行肿瘤切除及同期重建。术后随访，CT复查，与术前设计图像融合，进行手术精确度及导航误差评价。结果：经术前设计及术中导航定位，所有患者顺利完成肿瘤切除及同期重建术。4例患者进行了假体植入．1例患者进行血管化腓骨移植上颌骨重建术．术中实现了手术器械的实时定位．术者能够明确其与解剖结构的位置关系，精确度高．系统误差小于1mm。术后CT检查示截骨部位、切除范同、重建外形与术前设计基本一致。5例患者术后愈合良好，无严重并发症，面部对称。随访1-3a，肿瘤无复发。结论：计算机辅助导航外科可以实现术前设计、手术模拟及术后预测，有助于上颌骨肿瘤切除范围的确定、缺损重建，面部对称性的恢复．是一种有效的颌面部手术辅助方法．

PURPOSE： The aim of this study was to evaluate the validity of navigation-guided en bloc tumor resection and defect reconstruction in the treatment of maxillary bony tumors. METHODS： One patient with maxillary osteosarcoma and four patients with ossifying fibroma were enrolled in this study. After preoperative planning and 3-dimensional simulation, the osteotomy lines for resection were delineated and the normal anatomic structures for defect reconstruction were ascertained. With the guidance of TBNavis navigation system, an en bloc tumor resection and simultaneous defect rehabilitation were performed. RESULTS： Under the guidance of navigation, tumor resection and primary reconstruction were performed successfully. Maxillary defect was reconstructed by custom hydroxyapatite (HA) prosthesis in 4 patients and vascularized fibular musculocutaneous flap in one case. The system provided continuously updated information on the position and movement of surgical instruments in the operating field in relation to the preoperative imaging data set. The accuracy of the system measured by the computer did not exceed lmm. The osteotomy lines and reconstruction contour were checked by postoperative CT, and good matching with the preoperative planning was achieved. Patients showed no signs of tumor recurrence and prosthesis infection during the 12 to 35 months of follow-up. CONCLUSIONS： Image- guided navigation makes radical maxillary bone tumor resection more reliable by implementing preoperative planning, showing the determined safety margins, preserving vital structures, and guiding reconstruction. It is regarded as a valuable technique in this potentially complicated procedure. Supported by National Natural Science Foundation of China (81101131), Shanghai Shenkang Foundation (SHDC 12010205) and Shanghai Foundation for Outstanding Young Teachers in University.