CN109119140A - It is a kind of for accurately treating the computer assisted navigation method of Old zygomatic fractures - Google Patents
It is a kind of for accurately treating the computer assisted navigation method of Old zygomatic fractures Download PDFInfo
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- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
Abstract
The invention belongs to Computer-aided Design Technology fields, it discloses a kind of for accurately treating the computer assisted navigation method of Old zygomatic fractures, it include: picture construction and segmentation based on 3D, preoperative CT data are input to Computer Aided Surgery design software, three-dimensional reconstruction is carried out to Maxillary region region, segmentation separates major fracture bone section and individually names；Surface marker method is created on each bone section surface and is positioned, at least 1 mark point in each bone section, at least four label is used for entire fracture of zygomatic bone, each bone section is merged with its cylindrical body index point, it imports data in surgical navigation design software, and is fused to 1 file to become surface markers point location air navigation plan；Then by strong side data according to face middle line mirror image, gradually control, which resets, forms navigation reset plan；Finally perform the operation according to navigation marker point fixed point plan and navigation reset plan.
Description
Technical field
The invention belongs to Computer-aided Design Technology fields, more particularly to one kind is for accurately treating oldness cheekbone bone
The computer assisted navigation method of folding.
Background technique
Currently, the prior art commonly used in the trade is such thatMake it in the facial prominent position of Middle face, zygomatic complex
It is often injured.The fracture of zygomatic complex can lead to the displacement of cheekbone and zygomatic arch, so as to cause such as limitation of mouth opening and face not
Symmetrical etc function and aesthetic problem.Fresh fracture can correct most of these problems by operative reduction and fixation.But
It is that, if treatment delay or reset are insufficient, may cause secondary deformity.Slight aesthetic problem can use foreign body implant
Graft is treated, such as polyethylene.However, for severe deformities, it may be necessary to fracture line be truncated and relocate.
The missing of Old zygomatic fractures, the normal anatomy mark as caused by fracture line dislocation and bone remodeling is made
It is obtained to be difficult to determine the correct position of cheekbone.In such a case it is difficult to obtain satisfactory Middle face symmetry ideal knot
Fruit.The development of computer technology is so that a large amount of computer assisted surgery technologies can be used for treating Oral Maxillofacial Trauma.Operation rule
Drawing the 3D printing model that software and computer generate has helped the accurate preoperative simulation of surgeon's progress ideal to obtain
Three-dimensional (3D) surgical simulation plan；Individually designed beauty implantation material also can be used the prior art manufacture successful result of and take
Certainly in the ability being transferred to pre-operative surgical plan in actual mechanical process.And using before navigating in art, it is difficult to be had
The result of benefit.The application of navigation system provides effective solution scheme for this problem in art.However, what this method faced
Challenge first is that cheekbone surface imperfection, lacks the positioning that apparent anatomic landmark carrys out fractured bones in guided operation navigation procedure,
Especially in the case where postponing fracture.Several air navigation aids have had been reported for treatment fracture of zygomatic bone.Some surgeons exist
Reusability navigation probe is good for the surface of side cheekbone during operation, until they can match with preoperative plan.This side
Method is although easy to operate, but also some are unreliable in terms of realizing ideal position.It has been reported that for the fast of STL model surgery
Fast forming technique and have been used to operation guiding system.In later approach, using operation software simulation operation and it is right
After surgical procedure is modeled, by surgical navigational, the position of cheekbone is positioned using prefabricated titanium plate.This method was than former
Technology it is more acurrate, but Preoperative Method work it is both complex and time-consuming.
In conclusion problem of the existing technology is:
(1) existing treatment Old zygomatic fractures, for severe deformities, it may be necessary to it cuts off fracture line and relocates,
For Old zygomatic fractures, the missing of the normal anatomy mark as caused by fracture line dislocation and bone remodeling is so that it is difficult
Determine the correct position of cheekbone.
(2) Old zygomatic fractures are referred to due to a lack of operative reduction, and accurate treatment is more difficult.
Solve the difficulty and meaning of above-mentioned technical problem:
The treatment of the secondary facial deformity of oldness fracture of zygoma and zygomatic arch is always the problem of Oral and Maxillofacial Surgery doctor.It is controlled
It treats difficult point and is the following aspects:
1, cheekbone itself form and irregular, surface is without obvious anatomical landmarks, and also there is no can obviously position
Hole spline structure；
2, delay treatment leads to fracture line malunion, cannot rely on fracture line match-place and reaches anatomical reduction.Anatomical landmarks
Shortage directly result in operative reduction and there is no clear reference, traditional treatment is ineffective.
The new operation piloting method of one kind provided by the invention, that is, cheekbone body surface marking object auxiliary operation piloting method by with
In assisting in the treatment of unilateral Old zygomatic fractures, this method makes Design more easy, avoids prefabricated surgical guide
Brought complicated process is navigated in art more simple and easy.Postoperative evaluation shows that this method can be accurately by Design method
It is transferred in actual operation, therapeutic effect is satisfied.
Summary of the invention
In view of the problems of the existing technology, the present invention provides a kind of by accurately treating based on Old zygomatic fractures
Calculation machine auxiliary navigation method.
The invention is realized in this way a kind of for accurately treating the computer assisted navigation side of Old zygomatic fractures
Method, it is described for accurately treat Old zygomatic fractures computer assisted navigation method the following steps are included:
Preoperative CT data are input to Computer Aided Surgery design software, to jaw by step 1,3D rendering building and segmentation
Facial area carries out three-dimensional reconstruction, and segmentation separates major fracture bone section and individually names；
Step 2 creates surface marker method on each bone section surface and positions, and the quantity of mark point is determined to be in each
At least 1 label in bone section, at least four label are used for entire fracture of zygomatic bone, and each bone section is melted with its cylindrical body index point
It closes, imports data in surgical navigation design software, and merge into 1 file to become surface markers point location air navigation plan；
Step 3, then by strong side data according to face middle line mirror image, gradually control, which resets, forms navigation reset plan；Finally
It performs the operation according to navigation marker point fixed point plan and navigation reset plan.
Then, the preoperative CT data of patient and pre-operative surgical planning file are input in navigation system, for navigating in art.
Operation assists menisectomy in surgical navigation system, and installation has the frame of reference of 3 light reflection spheres at patient's skull,
Registration is completed by passive optical scanning or other modes, and completes to perform the operation.In conclusion advantages of the present invention and good effect Are as follows:
The new operation piloting method of one kind provided by the invention, that is, cheekbone body surface marking object auxiliary operation
Air navigation aid, comprising:
(1) by four or more reset reference point location cheekbone bone blocks in the position of three-dimensional space, surgical navigational is more simple
Just；
(2) method by increaseing accordingly marker can solve the reset of complicated several sections of fracture；
(3) method for being not required to preoperative prefabricated surgical guide, the more easy effect of Preoperative Method.
The present invention is as an aid in the unilateral Old zygomatic fractures for the treatment of and avoids pre- so that Design is more easy
Complicated process brought by surgical guide processed is navigated in art more simple and easy；Postoperative evaluation shows that this method can be accurately by art
Preceding design method is transferred in actual operation, and therapeutic effect is satisfied；The application of surgical navigation systems provided by the invention is aobvious
It writes and improves the treatment precision and therapeutic effect of Old zygomatic fractures, it can be on the basis of guaranteeing safety, under navigation guide
Larger range of reconstruction eye socket, more accurate recovery Orbital shape, preferably corrects endophthalmos.
Detailed description of the invention
Fig. 1 is provided in an embodiment of the present invention for accurately treating the computer assisted navigation method of Old zygomatic fractures
Flow chart.
Fig. 2 is provided in an embodiment of the present invention by post-surgery skull data and preoperative planning data progress 3D comparison schematic diagram.
Specific embodiment
In order to make the objectives, technical solutions, and advantages of the present invention clearer, with reference to embodiments, to the present invention
It is further elaborated.It should be appreciated that the specific embodiments described herein are merely illustrative of the present invention, it is not used to
Limit the present invention.
Application principle of the invention is explained in detail with reference to the accompanying drawing.
As shown in Figure 1, provided in an embodiment of the present invention for accurately treating the computer aided manufacturing assistant director of a film or play of Old zygomatic fractures
Boat method the following steps are included:
Preoperative CT data are transferred to Computer Aided Surgery design software by S101, picture construction and segmentation based on 3D,
To Maxillary region region, three-dimensional reconstruction is carried out, segmentation separates major fracture bone section and individually names；
S102 creates surface marker method on each bone section surface and positions, and the quantity of mark point is determined to be in each section
At least 1 label in section, at least four label are used for entire fracture of zygomatic bone, and each segment is merged with its cylindrical body index point,
It imports data in surgical navigation design software, and merges into 1 object to become surface markers point location air navigation plan；
S103, then by strong side data according to face middle line mirror image, gradually control, which resets, forms navigation reset plan.Finally press
It performs the operation according to navigation marker point fixed point plan and navigation reset plan.
In step S101, patient provided by the invention receives preoperative spiral CT；Using on CD-ROM digital imagery and
Communication document is by CT data processing and is transferred to 5.0 editions softwares of Surgicase CMF and iPlan CMF software pre-operative surgical meter
Draw and postoperative evaluation；VectorVision navigation system is used for surgical navigational.
In step S102, VectorVision navigation system provided by the invention is navigated for operating room；It is anti-with 3 light
The reference frame for penetrating ball is fixed firmly to the skull of patient to identify the position of patient；By using Z-touch wireless laser
Registration is completed in the facial surface scanning of indicator.
The present invention will be further described below with reference to examples.
Embodiment 1
In the present invention, it is treated using a kind of new navigation repositioning method, that is, cheekbone body surface marking object auxiliary navigation method
6 unilateral oldness fracture of zygoma and zygomatic arch patients, and using two kinds of computer measurement methods and evaluate its therapeutic effect and navigation
Accuracy.
1. patient and method
1.1 patient
In May, 2011~2011 year August is old in the unilateral zygoma that Peking University School of Stomatology trauma center is gone to a doctor
Old property fracture patient 6, male 5, women 1,33~60 years old age (42.8 years old average).The injured time is between operating time
Every 31~246 days (74.5 days average).For 5 patients because motor vehicle accident is caused injury, 1 is caused injury (table 1) because of assaults.
Table 1: patient's basic condition
1.2 method
All patients are preoperative to acquire helical CT data (BrightSpeed, GE company, the U.S.), thickness 1.25mm, with light
Disk-form exports DICOM format file.In this research, SurgicaseCMF 5.0software (Materialise is used
Inc, Leuven, Belgium) and iPlan CMF software (BrainLAB, Feldkirchen, Germany) carry out it is preoperative
Virtual operation design assists carrying out hand using VectorVision navigation system (BrainLAB, Feldkirchen, Germany)
Art navigation.
The treatment process of one Old zygomatic fractures patient will be specifically described to illustrate particular technique process.Suffer from
Person, male, 41 years old, main cause traffic accident injury caused left side cheekbone zygomatic arch multiple fracture, went to a doctor in our hospital within 36th after wound.Complete craniofacial region
After CT scan, CT data are imported into Design software in dicom format, completes Design by step, then count navigation
It draws and imports navigation system, surgical navigation assists lower osteotomy, reset and fixation, and postoperative evaluation cheekbone reset effect is specific to flow
Journey is as follows:
1.2.1 preoperative digital surgery design
Preoperative number surgery design is broadly divided into three steps: the first step, craniofacial region bone three-dimensional reconstruction and segmentation；Second
Step is implanted into cheekbone body surface marking object, forms marker positioning plan (Plan 1)；Third step resets bone section and forms marker
It resets air navigation plan (Plan2).
Step 1: pre-operative data rebuilds segmentation
Patient's DICOM series data is imported into SurgicaseCMF5.0 software, completes Maxillary region three-dimensional reconstruction, and doubling
The zygoma bone block of offset position is sequentially completed segmentation.
Step 2: cheekbone body surface marking object positions
The cylindrical marker STL surface data (basal diameter 2mm, height 3mm) for having designed completion is imported into patient
Pre-operative data.In the preoperative in design software, perpendicular to the zygoma bone section surface implantable marker object of fracture.Entire zygoma
At least it is implanted into 4 pieces of markers, first three piece of marker location should be located at that cheekbone volume is prominent, socket of the eye lower edge, zygomatic arch, and the 4th piece of marker is answered
Outside the plane that first three piece of marker is formed, cheekbone alveolar ridge is generally selected.Multiple fracture such as occurs, it should be in biggish bone block
Place more than two markers.Then these markers are merged with patient's three-dimensional data, and is led with STL surface data format
Out.
The preoperative CT of patient (DICOM format) and the preoperative three-dimensional data (STL format) with reset flag object are successively led
Enter the preoperative planning software of iPlan CMF, and the two is merged, forms marker positioning plan (Plan 1, Figure 3A).
Step 3: computer simulation resets
In the preoperative planning software of iPlan CMF, patient's head position is adjusted, nasion, sella turcica central point and bilateral ear point are selected
The plane that line midpoint is formed is median sagittal plane.Using the image feature in software, patient is good for side three-dimensional data mirror image extremely
Strong side, the slight mirror image data that adjusts are matched with the non-displacement fracture bone section of Ipsilateral.
Then referring to mirror image data, the fracture of zygoma and zygomatic arch bone block and its phase for having divided and having merged marker are adjusted separately
Match, simulate operative reduction position, forms marker and reset air navigation plan (Plan2).It will include patient base's data, marker
Positioning plan (Plan 1) and marker reset air navigation plan (Plan2) export, use to navigating surgery.
1.2.2 navigation assists lower surgical operation
Face contour regional registration
Air navigation plan is imported into navigation work station VectorVision software, after the completion of general anesthesia, row about 1cm in portion's is small overhead
Notch installs frame of reference at parietal bone position, and fixed position should avoid natural sutura, use the opposite laser stylus (Z-touch)
Contouring is registered, and selects the skins such as forehead, geisoma, bridge of the nose weakness close to craniofacial skeleton surface anatomy as far as possible in registration process
Clearly position multiple spot carries out label, reduces three dimensional space coordinate of the error head in art of registration close to bone surface as far as possible
System and the three-dimensional coordinate system of CT image match, this study group patient registration's error is respectively less than 1.5mm.
Surgical exposure and position reset marker
The zygoma of vestibular ditch combined approach exposure fracture in coronary valve, socket of the eye lower edge and mouth.Before osteotomy, reference marker
Each bone section marker location, electric drill punching label position reset label are found in object positioning plan (Plan 1) art under navigation guide
Object location.
Bone block is resetted with reference to reset flag object
Osteotomy, displacement fracture bone section of loosening, reference marker reset air navigation plan (Plan2) from top to bottom, from front to back
Each bone section is successively resetted, is resetted first close to marker at sutura zygomaticofrontalis, is restored cheekbone height, use Synthes1.3mm titanium plate
Titanium nail system is fixed in completing；Then nearly socket of the eye lower edge fracture marker is resetted, cheekbone bulging and fixation are restored；Reset nearly zygomatic arch
Fracture marker restores cheekbone width and fixation；
Marker location at nearly cheekbone alveolar ridge is finally verified, cheekbone is avoided three-dimensional torsional occur.Wound is closed in layering suture,
Complete operation.
1.2.3 postoperative effect is evaluated
All patients carry out CT examination, and conventional follow-up three months or more again in postoperative two weeks.It is commented using two methods
Valence surgical effect, including navigation accuracy and Facial symmetry
1) compare postoperative patient 3D data using 3D rendering chromatography and marker resets air navigation plan (Plan2), meter
Calculate navigation accuracy.The postoperative craniofacial region three-dimensional reconstruction data of patient and marker are resetted into air navigation plan (Plan2) with STL format number
According to export.Then the two is inputted into 12.0 software of Geomagic Qualify after facial multiple spot is registrated and selects preoperative meter respectively
Drawing with fracture of zygoma and zygomatic arch region in post-procedure data is target area, and post-procedure data avoids titanium plate fixed area when selecting as far as possible.
Then 3D comparison is carried out, compares actual variance of the two on spatial position, show that 3D compares report, use difference
Color represents the difference of different range, completes chromatography, generates 3D and compares report.In report, numerical value difference positive value (+) is represented
In the outside of surgical planning target area, difference negative value (-) represents postoperative target area location point and is performing the operation postoperative target area location point
The inside in planned target area show that the two average value compares mean difference for evaluating navigation accuracy, the patient 3D after calculating
For 1.115/-1.194mm.
2) postoperative patient Facial symmetry is evaluated using axle position CT measurement cheekbone bulging and zygomatic arch width difference.By postoperative CT
Data import the preoperative planning software of iPlan CMF (BrainLAB, Feldkirchen, Germany), and orbitomeatal plane and just is arranged
Middle sagittal plane is reference planes, and using median sagittal line as Y-axis in zygomatic arch axle position, and basis cranii crosspoint is origin, establishes and sits
Mark system measures bilateral malar reduction most bump to initial point distance and bilateral zygomatic arch widest point to Y-axis vertical range respectively, it is poor to compare the two
Value, evaluates the symmetry of postoperative zygoma.
As shown in Fig. 2, the postoperative cheekbone bulging difference of patient is 1.2mm, zygomatic arch width differential is 1.7mm.
2. result
6 patients complete to treat according to procedure above, and follow-up 3 to 6 months.
Postoperative 3D compares, and chromatography shows that 6 patient's navigation areas are postoperative and surgery planning mean difference is 1.24/-
1.4mm.Navigation area precision controlling (table 2) within 1.5mm.
Postoperative CT symmetry measurement shows that 6 patient's bilateral malar reduction bulging mean differences are 1.22mm (0.2-1.9mm), cheekbone
Bending width mean difference is 1.28mm (0.2-1.9mm).Width and bulging difference within 2mm (table 2).
Table 2: postoperative CT measurement and chromatogram analysis data
6 patient's follow-up 3 months or more, do not occur obvious postoperative complication, facial appearance is symmetrical, is not required to further hand
Art treatment.
Embodiment 1,
Patient provided by the invention receives preoperative spiral CT and (checks within postoperative 2 weeks) (thickness degree 1.25mm；Britain, it is general,
Bright Speed 16).Preoperative CT is input to Surgicase CMF with digital imagery and communication (DICOM) document form
5.0 editions softwares (Materialise, Leuven, Belgium) and iPlan CMF software (BrainLAB, Feldkirchen,
Germany pre-operative surgical plan and postoperative evaluation) are used for.VectorVision navigation system (BrainLAB) is led for performing the operation
Boat.
VectorVision navigation system provided by the invention is navigated for operating room.After general anesthesia induction, will have
There is the reference frame of 3 light reflection spheres to be fixed firmly to the skull of patient to identify the position of patient.Then by using Z-
Registration is completed in the facial surface scanning of touch wireless laser indicator.The software can verify all 6 patients surgery areas automatically
The registration accuracy in domain, and the registration error of all cases is respectively less than 0.7mm.
Then it uses under margo palpebrae, the cheekbone and zygomatic arch of coronary valve and intra-oral approach method exposure fracture.Careful operation is to keep away
Exempt to fracture site excess pressure.After exposure fracture, the displacement of navigation probe test fracture, especially small bone are used
Section.
Before osteotomy, each bone section label level is found under navigation guide in reference marker positioning plan (Plan 1) art
It sets, electric drill punching label position reset marker location.
Osteotomy, displacement fracture bone section of loosening, reference marker reset air navigation plan (Plan2) from top to bottom, from front to back
Each bone section is successively resetted, is resetted first close to marker at sutura zygomaticofrontalis, is restored cheekbone height, use Synthes1.3mm titanium plate
Titanium nail system is fixed in completing；Then nearly socket of the eye lower edge fracture marker is resetted, cheekbone bulging and fixation are restored；Reset nearly zygomatic arch
Fracture marker restores cheekbone width and fixation；Marker location at nearly cheekbone alveolar ridge is finally verified, cheekbone is avoided to occur three
Dimension torsion.Wound is closed in layering suture, completes operation.
Middle fracture of zygoma and zygomatic arch region is target area, and post-procedure data avoids titanium plate fixed area when selecting as far as possible.
1, patient
Stomatologic Hospital, Beijing Univ.'s Oral and Maxillofacial Surgery is led in May, 2011 in June, 2011 using cheekbone surface markers
Boat method treats 6 oldness unilateral side fracture of zygomatic bone patients.Institutional ethics committee of the invention ratifies the present invention
(number IRB00001052-11076), and all patients endorsed Written informed consent.5 people of male, women in patient
1 people, it is the age 33~60 years old, 42.8 years old average.These patients are since there are the delays of other position traumatism treatments.It is injured and operation
Between average delay time be 74.5 days (range 31 to 246).Motor vehicle accident (MVAs) is the main reason for group is injured (table
1)。
1 clinical data of table
Abbreviation:MVA, motor vehicle accident；Pt.No., patient number.
2, it assesses
All patients carry out CT examination, and conventional follow-up three months or more again in postoperative two weeks.It is commented using two methods
Valence surgical effect, including navigation accuracy and Facial symmetry
1) compare postoperative patient 3D data using 3D rendering chromatography and marker resets air navigation plan (Plan2), meter
Calculate navigation accuracy.The postoperative craniofacial region three-dimensional reconstruction data of patient and marker are resetted into air navigation plan (Plan2) with STL format number
According to export.Then the two is inputted into 12.0 software of Geomagic Qualify after facial multiple spot is registrated and selects preoperative meter respectively
Drawing with fracture of zygoma and zygomatic arch region in post-procedure data is target area, and post-procedure data avoids titanium plate fixed area when selecting as far as possible.
Then 3D comparison is carried out, compares actual variance of the two on spatial position, show that 3D compares report, use difference
Color represents the difference of different range, completes chromatography, generates 3D and compares report.In report, numerical value difference positive value (+) is represented
In the outside of surgical planning target area, difference negative value (-) represents postoperative target area location point and is performing the operation postoperative target area location point
The inside in planned target area show that the two average value compares mean difference for evaluating navigation accuracy, the patient 3D after calculating
For 1.115/-1.194mm.
2) postoperative patient Facial symmetry is evaluated using axle position CT measurement cheekbone bulging and zygomatic arch width difference.By postoperative CT
Data import the preoperative planning software of iPlan CMF (BrainLAB, Feldkirchen, Germany), and orbitomeatal plane and just is arranged
Middle sagittal plane is reference planes, and using median sagittal line as Y-axis in zygomatic arch axle position, and basis cranii crosspoint is origin, establishes and sits
Mark system measures bilateral malar reduction most bump to initial point distance and bilateral zygomatic arch widest point to Y-axis vertical range respectively, it is poor to compare the two
Value, evaluates the symmetry of postoperative zygoma.The postoperative cheekbone bulging difference of patient is 1.2mm, and zygomatic arch width differential is 1.7mm.
3, result
6 patients complete to treat according to procedure above, and follow-up 3 to 6 months.
Postoperative 3D compares, and chromatography shows that 6 patient's navigation areas are postoperative and surgery planning mean difference is 1.24/-
1.4mm.Navigation area precision controlling (table 2) within 1.5mm.
Postoperative CT symmetry measurement shows that 6 patient's bilateral malar reduction bulging mean differences are 1.22mm
(0.2-1.9mm), zygomatic arch width mean difference are 1.28mm (0.2-1.9mm).Width and bulging difference are
The 2 postoperative evaluation result of table within 2mm
Abbreviation:Pt.No., patient number.
4, Old zygomatic fractures and secondary sexual trauma rear face deformity, malunion and bone remodeling are caused
The normal anatomy mark missing segment that will make it difficult to fracture be repositioned onto its ideal position.Using surgical planning software and
The STL model that computer generates can help surgeon to realize accurate pre-operative surgical simulation.However, by pre-operative surgical plan
It is transferred to actual surgical procedures and still has problem.
Since mid-term the 1990s, surgical navigational has been increasingly used for treatment Craniofacial anomalies, and
It has become and solves the faced the challenge effective technology of this kind of damage.Various researchs report 3 kinds of main therapeutic schemes.Cheekbone table
Face checks, may is that most common method in navigating in art, carries out according to following regulation.It is preoperative in the works, will fracture segment weight
New definition is to ideal position, these positions are by the normal usually used one side of mirror image.In actual operation, by checking it repeatedly
It is simultaneously compared by surface with surgical planning, and the cheekbone of fracture is gradually repositioned planning location.In this approach,
Pre-operative surgical plan is easy to develop, but in the course of surgery, and surgeon must multiple checks position.However, cheekbone surface
And it is irregular, therefore searching predetermined position is particularly difficult, especially when bone has multiple fracture.
Another method is to combine prosthetic surgery template .14 operation consent using navigation in art on STL model, according to CT number
According to production STL model.Then the osteotomy and reset of cheekbone are simulated on STL model, the template for guidance of performing the operation is (for example, synthetism
Plate) it can correct and adjust in advance.CT data from surgery models can obtain before surgery and for navigation template position.
In art to fracture cheekbone repositioning by navigation and in advance it is template guided.However, the templates such as titanium plate cannot manufacture, and no matter
How, they cannot be accurately bent to exactly match bone surface.Therefore, by template instruction position and surgical navigational it
Between mistake will be present.In addition, drawing template establishment is very time-consuming before the surgery.
Finally, most accurate method described so far may be that Baumann et al. 15Klug et al. 2 and Xia et al. 3 are reported
The method for being known as " reverse method " or " point-to-point scheme " in road.In this approach, operation is simulated or is used on STL model
Computer software visualization.After the cheekbone of displacement is split and is relocated, using computer software by fixed plate
It is bent and is screwed on 3D rendering.The cheekbone of diminution then returnes to its home position, and the position of screw hole is saved simultaneously
It is input to operation guiding system.In art, navigation system is used as the guidance in the auger shell hole before osteotomy.In osteotomy and again
Behind position, the bone of the fixed displacement of pre- slave board is used.This method has been proven that very high accuracy.Klug et al. measures model
The distance between patient's screw position finds that the average distance of 44 screws is 1.1 ± 0.3mm.But complicated operation meter
It draws and needs corresponding preoperative preparation time.
As previously mentioned, the use of the screw hole location of point-to-point navigation may be that treatment delay fracture of zygomatic bone is most effective and most quasi-
True method；But it is still extremely complex.However, the most important factor for influencing result is when reducing delay fracture of zygomatic bone, to lack
Weary anatomic landmark.Direct solution is that new mark is artificially created on cheekbone surface, this is described in the present invention one
Kind strategy.
When using solid, the position of 4 points can determine the position of object on 3D object.Zy-gomatic bone gives it
Protrusion, including protuberance, height and width, it is only necessary to find 4 points on cheekbone to determine its position.In this method
In, in preoperative 4 labels of at least production of 3D, entire fracture cheekbone is positioned with planning period in the preoperative；3 be vital.Face
Boundary mark note should be located to be split before cheekbone, and the position of socket of the eye lower edge and zygomatic arch respectively represents the height of middle line, protuberance and width.
Other labels are located at beside the plane formed by this 3 points, for checking accuracy.This method needs more than pervious method
Simple preoperative plan.In addition, this method had not both needed surgical template or had not needed STL model.
The deviation between Design and actual operation result was measured before.Yu et al. has found that maximum deviation is less than 2mm.
Klug et al. reports the average deviation of 1.1 ± 0.3mm.In the present invention, postoperative 3D object is shown compared with surgical planning,
All 6 patients obtain saturation degree accuracy, and average deviation is+1.24mm and 1.4mm.These tolerances and Yu etc. and
The result of the reports such as Klug is similar.In another study, Ogino etc. [12] is measured in 6 patients using postoperative CT scan
The middle line distance of point.Mean difference between left and right side is 1.6mm.In research of the invention, CT assesses reduction amplitude
Show that the Average Width Variation between impacted side and uninfluenced side is 1.28mm, average kurtosis deviation is 1.22 millimeters, table
Bright good symmetry.
In this group of patient of the invention, the 6th patient is 246 days in the injured delay time between operation, much
It is longer than other patients.Due to symphysis and remodeling, zygomatic arch and zygomatic arch have deformed and have stablized in the position of mistake.Therefore, hand
Art treatment seems that the case where not healing completely than bone is more difficult.Formal cheekbone osteotomy is carried out to correct craniofacial asymmetry,
And the air navigation aid has been demonstrated that operation accuracy can be effectively improved.However, the cheekbone deformity of these types can also pass through
Beauty implantation material is transplanted to treat, especially those use CAD and Computer-aided manufacturing before surgery
The implantation material of manufacture.
In the present invention, this method is only used for treatment Delayed onset unilateral side fracture of zygomatic bone, because the image of uninfluenced side can
To be mirrored to Ipsilateral, and the reference as reset, this be it is a kind of commonly using method.Due to the loss of reference data, delay
Bilateral malar reduction fracture be more difficult to treat.Lubbers etc. 16 is not it is even contemplated that " bilateral fault in face in outside " represents operation
Navigation, because reference side is lost.However, it is considered herein that fracture may need more using surgical navigational on the outside of bilateral, because
To be difficult to determine fracture only according to individual's judgement.Some methods allow the creation operation meter without reference to aspect
It draws.In the case where bilateral true, the one side for being easy to relocate can be reduced first.It then, can be subsequent using its mirror image
Another Ipsilateral for suffering from more complicated fracture is relocated, to reach facial symmetrical.When complicated bilateral fracture is lacked along with bone
It when damage, needs to treat, not only to reduce fracture, but also face in rebuilding, this is one very intractable for surgeon
Problem.In these cases, the soft tissue simulation of normal person 18-20 and three dimensional face database might have help.
In short, in the present invention, a kind of new surface markers air navigation aid be used to treat 6 Delayed onset unilateral side cheekbone bones
Folding.Complexity needed for cheekbone surface markers auxiliary surgical navigational can simplify the surgery planning of navigating surgery and avoid surgical template
Agreement.Navigation accuracy is also satisfactory, and obtains good Facial symmetry in all 6 patients.
Embodiment 2
24 unilateral Old zygomatic fractures patients for needing Surgical correction, the case-control matched using 1:1 are selected first
Patient is divided into study group's (navigating surgery group, 12) and control group (traditional operation group, 12) by retrospective study.Pass through art
CT measurement, the self-appraisal of patient's Postoperative Satisfaction and clinical examination afterwards, both evaluations therapeutic effect.The results show that surgical navigational group art
Bilateral malar reduction bulging and width difference (1.58mm, 1.47mm) are significantly less than traditional operation group (3.58mm, 3.63mm afterwards.Art
Subjective assessment equally shows that surgical navigational group therapeutic effect is substantially better than traditional operation group afterwards.Then we equally collect unilateral old
Old property fracture of zygomatic bone patient is divided into surgical guide group (three-dimensional head mould combination positioning guide plate technology) according to adjuvant treatment technology difference
With surgical navigational group (surgical navigation systems), pass through two groups of postoperative cheekbone bulgings of measurement, the evaluation treatment of zygomatic arch width difference
Effect.
As the result is shown not significant difference, but postoperative surgical navigation group cheekbone width is rescued in cheekbone bulging for two groups
Difference is substantially better than surgical guide group.
12 are completed the therapeutic effect that socket of the eye wall rebuilds case under navigation instruction, with endophthalmos degree, whole socket of the eye chamber volume
Difference, socket of the eye wall hernia go out each index such as tissue volume and are evaluated, and therapeutic effect is satisfied as the result is shown.In addition, by being set preoperative
It counts and is merged with postoperative CT, measurement has obtained the error of navigator fix, between 2~3mm, reaches international standards.
Embodiment 3
For the blind perspective randomized controlled clinical of single factor test list of unilateral cheekbone old fracture surgical navigation system auxiliary
Research, clinical effectiveness observer is set it is blind, surgical navigation systems application be single factors.
According to influences such as classification of fracture, gender, injured times, therefore 1:1 proportion, random controls are divided into two groups, one group of use
Conventional method or the treatment of other auxiliary treating methods, another group is assisted in the treatment of using surgical navigation systems.Time span is 3
Year, it shares 103 unilateral cheekbone old fracture patients and is included in, last 78 patients complete entire clinical research.Postoperative use
Subjective and objective two ways evaluates therapeutic effect.
The postoperative postoperative cheekbone symmetry evaluation of CT measurement display navigation group is substantially better than non-navigational group, and wherein navigation group is postoperative
CT and Design comparison display operation precision are in 1.3mm or so, postoperative patient and other clinic observation persons evaluation facial appearance
Symmetrical rate navigation group is apparently higher than non-navigational group.To prove that the application of surgical navigation systems significantly improves oldness cheekbone
The treatment precision and therapeutic effect of bone fracture.
Embodiment 4
On establishing the treatment process base that Computer navigation surgery auxiliary blow-out fracture socket of the eye wall is rebuild, pass through case-control
Further evaluation Computer navigation surgery rebuilds the clinical effectiveness that eye socket treats blow-out fracture for research.
It collects and fractures 49 in unilateral orbital, according to whether using Computer navigation surgery auxiliary operation to be divided into two groups, lead
Boat group 25 using Computer navigation surgeries assist in advance at titanium net rebuild eye socket, non-navigational group 24, using personalization in advance at titanium
Net rebuilds eye socket.It measures respectively and is perioperatively good for Ipsilateral eyeball protrusion, Orbital volume measurement and titanium net implantation depth, and be compared.
The results show that navigation group Ipsilateral endophthalmos degree of improvement (3.35 ± 1.46mm) is substantially better than non-navigational group (2.25
±1.14mm,P<0.05)；Navigation group Ipsilateral Orbital volume measurement amount of recovery (5.94 ± 2.20ml) is substantially better than non-navigational group group
(4.21±2.18ml,P<0.05)；Navigation group titanium net implantation depth (31.95 ± 2.97mm) is significantly greater than non-navigational group (29.27
± 2.72mm, P < 0.05), it is that apparent postoperative complication occurs that two groups are postoperative.By case-control study, lead as the result is shown
The lower application personalization of boat guidance rebuilds eye socket treatment blow-out fracture at titanium net in advance can be wider on the basis of guaranteeing safety
Reconstruction eye socket, more accurate recovery Orbital shape preferably corrects endophthalmos.It is required more in this operation of blow-out fracture
For in the operation of accurate high risk, Computer navigation surgery application effect is good, with the obvious advantage.
Embodiment 5
Social benefit and economic benefit
This project initially sets up at home and proposes the basic fundamental process of the lower treatment oldness cheekbone Orbital fractures of navigation auxiliary.
Project Unit is completed navigation and assists lower Old zygomatic fractures treatment 131 times so far, blow-out fracture secondary deformities 81
Example time, case load occupy domestic the first, improve the therapeutic effect and treatment level of oldness cheekbone Orbital fractures, and at home repeatedly after
It is reported in continuous education and study class and scientific seminar, produces good social benefit.
The foregoing is merely illustrative of the preferred embodiments of the present invention, is not intended to limit the invention, all in essence of the invention
Made any modifications, equivalent replacements, and improvements etc., should all be included in the protection scope of the present invention within mind and principle.
Claims (3)
1. a kind of for accurately treating the computer assisted navigation method of Old zygomatic fractures, which is characterized in that described to be used for
The computer assisted navigation methods of accurate treatment Old zygomatic fractures the following steps are included:
Preoperative CT data are input to Computer Aided Surgery design software by step 1, picture construction and segmentation based on 3D, right
Maxillary region region carries out three-dimensional reconstruction, and segmentation separates major fracture bone section and individually names；
Step 2 creates surface marker method on each bone section surface and positions, and the quantity of mark point is determined to be in each bone section
On at least 1 label, at least four label is used for entire fracture of zygomatic bone, and each bone section merge with its cylindrical body index point, general
Data import in surgical navigation design software, are fused to 1 object to become surface markers point location air navigation plan；
Step 3, then by strong side data according to face middle line mirror image, gradually control, which resets, forms navigation reset plan；Finally according to
Navigation marker point fixed point plan and navigation reset plan are performed the operation.
2. as described in claim 1 for accurately treating the computer assisted navigation method of Old zygomatic fractures, feature
It is, the patient receives preoperative spiral CT；By CT data processing and number is transferred to using digital imagery and communication document
Surgery software carries out pre-operative surgical planning and postoperative evaluation；Navigation system is used for surgical navigational.
3. as described in claim 1 for accurately treating the computer assisted navigation method of Old zygomatic fractures, feature
It is, uses surgical navigational；Reference frame with 3 light reflection spheres is fixed firmly to the skull of patient to identify patient's
Position；Navigation registration is completed by passive optical scanning mode.
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| CN110063806A (en) * | 2019-04-30 | 2019-07-30 | 北京大学口腔医学院 | For improving the auxiliary device and application method of 3-D scanning precision in polydonita position mouthful |
| CN110464478A (en) * | 2019-08-01 | 2019-11-19 | 赵华国 | Percutaneous children's supracondylar fracture resets measuring device |
| CN110767021A (en) * | 2019-11-12 | 2020-02-07 | 杭州湖西云百生科技有限公司 | Robot joint replacement test system based on virtual reality technology |
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| CN110767021A (en) * | 2019-11-12 | 2020-02-07 | 杭州湖西云百生科技有限公司 | Robot joint replacement test system based on virtual reality technology |
| CN112017275A (en) * | 2020-08-26 | 2020-12-01 | 长春理工大学 | Auxiliary positioning method for face midsagittal reference plane |
| CN112164443B (en) * | 2020-09-27 | 2023-03-31 | 上海擎泰仿真科技有限公司 | Interactive simulation fracture reduction method |
| CN112164443A (en) * | 2020-09-27 | 2021-01-01 | 上海擎泰仿真科技有限公司 | Interactive simulation fracture reduction method |
| CN111967540B (en) * | 2020-09-29 | 2021-06-08 | 北京大学口腔医学院 | Maxillofacial fracture identification method and device based on CT database and terminal equipment |
| CN111967540A (en) * | 2020-09-29 | 2020-11-20 | 北京大学口腔医学院 | Maxillofacial fracture identification method and device based on CT database and terminal equipment |
| CN113180810A (en) * | 2021-04-06 | 2021-07-30 | 四川大学 | Bone fracture plate for zygomatic bone and zygomatic arch incision and internal pushing plastic surgery |
| CN113180810B (en) * | 2021-04-06 | 2023-04-07 | 四川大学 | Bone fracture plate for zygomatic bone and zygomatic arch incision and internal pushing plastic surgery |
| CN113180776A (en) * | 2021-04-21 | 2021-07-30 | 四川大学 | Bone cutting guide plate for zygomatic bone and zygomatic arch plastic surgery and internal pushing guide plate generation method |
| CN113180776B (en) * | 2021-04-21 | 2023-01-10 | 四川大学 | Bone cutting guide plate for zygomatic bone and zygomatic arch plastic surgery and internal pushing guide plate generation method |
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