上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (1): 112-.

• 技术与方法 • 上一篇    下一篇

手术模拟及实时导航技术在颌面部陈旧性骨折修复中的应用

林艳萍1, 陈晓军1, 张诗雷2, 沈国芳2, 王成焘1   

  1. 上海交通大学 1. 机械与动力工程学院, 上海 200240；2. 医学院第九人民医院口腔颌面外科, 上海 200011
  • 出版日期:2010-01-26 发布日期:2010-01-26
  • 通讯作者: 张诗雷, 电子信箱: leinny@online.sh.cn。
  • 作者简介:林艳萍（1978—）, 女, 讲师, 博士；电子信箱: yanping_lin@sjtu.edu.cn。
  • 基金资助:

    国家自然科学基金(30872906, 30801302)

Computer-aided surgical simulation and navigation in reconstruction of old maxillofacial fractures

LIN Yan-ping1, CHEN Xiao-jun1, ZHANG Shi-lei2, SHEN Guo-fang2, WANG Cheng-tao1   

  1. 1. School of Mechanical Engineering, Shanghai Jiaotong University, Shanghai 200240, China；2. Department of Oral and Maxillofacial Surgery, The Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
  • Online:2010-01-26 Published:2010-01-26
  • Supported by:

    National Natural Science Foundation of China, 30872906, 30801302

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摘要：

目的 将三维手术模拟及术中实时导航技术应用于陈旧性颌面部骨折修复，提高手术的精度。方法 收集颌面部陈旧性骨折患者6例，经临床及影像学检查确认为单侧颌面部陈旧性骨折，术前将患者的CT图像重建为三维立体模型，通过旋转和平移断骨，将其重新定位在合适的位置上完成骨折模拟修复。同时，通过镜像健侧模型对比患侧复位后断骨位置是否合理。术中，完成空间配准后，通过实时跟踪手术器械和患者的空间位置，将手术器械与患者的关系实时反映在屏幕上，引导医师完成断骨的复位，实现实时手术导航。结果 术前实现颌面部骨折修复的三维模拟，术中实现患者和手术器械的实时跟踪，配准误差<1 mm。6位患者的术后CT检查显示，骨折复位与术前设计误差均<1.5 mm，手术创伤小，无并发症。结论 计算机辅助手术模拟和手术导航技术可有效地提高颌面部陈旧性骨折修复的手术精度。

关键词: 手术模拟, 实时导航, 颌面部陈旧性骨折修复

Abstract:

Objective To apply the three-dimensional pre-operative simulation and intra-operative real-time navigation in the reconstruction of old maxillofacial fractures so as to increase the surgical precision. Methods Six patients with old maxillofacial fractures were enrolled, and the diagnosis of unilateral old maxillofacial fractures was confirmed by clinical and imaging examinations. Virtual three-dimensional skull models were reconstructed from pre-operative CT images. The fractured bone was moved or rotated, and was reposed in a desired site according to the mirrored part from the healthy side. After patient-to-image registration, the surgical instruments and patients were tracked in real-time by optical tracking system during operation, and in this way the maxillofacial fractures were reposed satisfactorily guided by the virtual image. Results Three-dimensional simulation before operation and real-time navigation of patients and instruments during operation were realized. The error of registration was less than 1 mm. The post-operative CT examinations of these six patients revealed that the fracture reposition was same to the pre-operative planning, and the difference between them was less than 1.5 mm. The operations were minimally-invasive, with no complications. Conclusion Computer-aided surgical simulation and navigation system can effectively increase the surgical precision of reconstruction of old maxillofacial fractures.

Key words: surgical simulation, real-time navigation, reconstruction of old maxillofacial fractures