数字化技术在提高颅颌面畸形整复手术精度中的效果评价

目的 ：探讨数字化外科辅助颅颌面畸形手术相对于传统手术的优势并评价其远期效果。方法 ：本研究是一项前瞻性队列研究,纳入因肿瘤、感染、先天发育等原因需要进行颅颌面畸形整复的患者,进行数字化辅助手术或传统经验性手术。纳入研究后按计划随访,收集基线期、治疗期及术后随访期的手术相关资料、CT数据,使用Mimics软件色谱误差分析分别计算2组患者术后实际下颌骨与理想下颌骨之间的差异。采用SPSS 21.0软件包对数据进行统计学分析。结果：建立了72例颅颌面畸形队列,数字化外科组和对照组各36例。色谱误差分析显示,数字化组手术前、后偏差为（1.06±0.06）mm,对照组为（1.23±0.06）mm;多因素线性回归分析显示,数字化外科与较好的下颌骨修复精度显著相关（P<0.05）,2组并发症发生率相同,无严重不良事件发生。结论：数字化外科技术辅助颅颌面畸形整复手术较传统经验性手术精度显著提高,未增加手术并发症,安全、可靠,远期效果稳定。     

3dMD摄影测量系统辅助颅颌面软组织畸形整复的初步报道

目的:初步建立3dMD摄影测量系统在颅颌面软组织畸形整复中的技术方法,并探讨其在术前规划、术中指导、术后评价中的应用价值。方法:选取典型颅颌面先天性及获得性软组织缺损畸形病例各1例,术前应用3dMD系统设计手术范围,定性定量计算出患者软组织畸形的主要部位与程度,按照术前规划施行畸形整复手术,并评价其术后效果。结果:2例患者术后均达到较满意的面形,3dMD术前模拟手术计算所得软组织畸形量与术中实际需要量基本相符。结论:经初步临床实践,建立了3dMD摄影测量系统辅助颅颌面软组织畸形整复的技术方法,该系统可为颅颌面软组织畸形整复手术提供较准确的定性定量分析,具有一定的应用价值。     

正颌外科三维立体可视化模拟手术研究

目的：建立基于CT图像数据的计算机辅助三维立体手术模拟系统，为了术前进行精确设计手术方案及达到术后良好效果提供真实可靠依据。方法：应用医学可视化技术和Visual C^**编程语言开发出立体结构三维重建和手术模拟软件，建立以CT数据为信息源的计算机正颌外科立体可视化手术仿真模拟系统，可模拟各种正颌外科手术移动骨质过程，并且以动态动画形式演示，可从任意角度进行观察。结果：该系统建立了颅颌面畸形立体结构模型，以动态形式成功演示了正颌外科截骨移动手术仿真模拟，手术过程真实逼真，立体可视化效果好，应用普通播放软件即可在计算机屏幕上播放模拟正颌外科手术过程，并可预测手术后上下颌咬合状态及手术效果。结论：正颌外科三维立体可视化模拟手术系统的建立，为正颌外科截骨矫治牙颌面畸形术前手术方案制定提供实用有效的技术手段和全心的科学方法，改变仅凭主观经验诊断畸形和设计手术方案的传统模式，可在计算机屏幕前制定手术方案进行医患交流，共同协商，提高了正颌外科手术安全性、精确性和矫治效果。     

光学导航定位多自由度机械臂辅助颅颌面骨畸形整复技术方法的建立及初步应用

目的:基于现有的光学定位正颌外科导航手术的技术路线,建立并验证光学导航定位下机械臂辅助颅颌面骨畸形整复手术的技术路线.方法:(1)应用工业机械臂Motoman作为执行机构,并与现有导航系统实现整合;(2)按照术前规划,在导航下对颅骨模型进行截骨操作;(3)记录实验相关数据并进行误差分析.结果:自主算法实现了机械臂与导航...     

计算机辅助技术在口腔颌面外科的应用和展望

计算机辅助技术在口腔颌面外科领域已经部分被用于常规的临床诊治。本文就诊断性成像，手术设计和模拟及术中仪器导航等技术在口腔颌面外科的应用作了回顾，并对进一步的计算机辅助手术和机器人技术的发展作了展望。     

导航手术在颅颌面外科的应用及误差控制

导航手术越来越多地应用于颅颌面种植修复、损伤、面部整复、正颌外科、放疗及射频热凝治疗。精确性是导航手术的关键,误差的控制贯穿于影像获取、配准、实时跟踪及导航手术操作的各个步骤中。本文就颅颌面外科的导航手术应用及误差控制作一综述。     

计算机辅助导航系统在颌面部陈旧性骨折治疗中的应用

目的：研究计算机辅助导航系统（computer assisted navigation system,CANS）在颌面部陈旧性骨折治疗中的应用及其效果评价。方法：5例单侧面中部陈旧性骨折患者,定位钉植入后行面部CT扫描。在CANS上行术前设计及三维手术模拟骨折复位,计算机辅助导航下行颌面部陈旧性骨折的切开复位内固定术。术后CT复查,并与术前设计比较,检验骨折复位情况。结果：患者解剖结构与面部三维重建模型完全吻合,术中实现实时导航。手术器械实现空间定位,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检查示骨折复位与术前设计基本一致,复位最大偏差小于2mm。复视、眼球下陷、运动受限症状消失,畸形明显改善,面部对称。结论：计算机辅助导航外科有助于提高颅颌面陈旧性骨折的复位精度,是一种较为理想有效的治疗颌面部复杂骨折的辅助方法。     

计算机辅助导航技术在口腔颌面外科的应用—104例病例分析

目的:探讨计算机辅助导航技术在口腔颌面外科的应用,并评价其效果。方法:选择104例需进行口腔颌面手术的患者,包括陈旧性颧-上颌-眶周骨折34例,颞下颌关节骨性强直27例,骨纤维异常增殖症29例,下颌角肥大畸形9例,颌面部软骨、骨肿瘤3例,面部异物2例。定位钉植入后,拍摄颌面部CT,进行术前设计及模拟,利用镜像技术确定患侧截骨部位、截骨量、骨折复位位置及重建外形。导航辅助下进行手术操作。术后复查CT,与术前设计图像融合,进行手术准确度及导航误差评价。结果:经过点配准和(或)面配准后,所有患者顺利完成导航手术。手术器械实现空间定位,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1 mm。术后CT检查示截骨部位、截骨量、骨折复位与术前设计基本一致,平均误差(1.46±0.24)mm。104例患者术后愈合良好,无严重并发症,面部不对称畸形患者术后面形显著改善。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,有助于提高颌面部手术的精确性,减少创伤,恢复面部对称性,是一种较为理想的颌面部手术辅助方法。     

卢利教授课题组荣获辽宁省科学技术进步奖一等奖

以中国医科大学附属口腔医院卢利教授为第一完成人的课题项目"数字化技术和微创外科技术在颌面外科中的应用"荣获2014年辽宁省科学技术进步奖一等奖。卢利教授带领的课题组团队包括杨鸣良、白晓峰、颜光启、王绪凯和孙长伏等。课题组开展该项目的临床研究历时十年,将数字外科、手术导航和微创外科技术应用于颌面外科。通过整合三维精确测量、手术模拟、预测和配准等技术手段,在围术期完成颅颌面畸形和缺损的数字化手术模拟和个性化修复体的制     

先天性颅、颌面畸形整复手术的麻醉处理

目的:探讨先天性颅颌面畸形整复手术的麻醉处理。方法:回顾性分析1990～2006年823例先天性颅颌面畸形整复手术患者临床资料,着重对其麻醉处理及术中监测进行总结。结果:823例先天性颅颌面畸形整复术全身麻醉无死亡和严重并发症。结论:先天性颅颌面畸形患者全麻要注意气道困难的处理,手术中不做蛛网膜下腔穿刺监测颅内压也是安全可行的。     

颅面外科三维诊断分析和手术设计系统的建立

目的　探讨正常颅面结构内在美学规律、研究复杂颅面畸形的解剖结构特征及其整复手术设计方法。方法　建立了颅颌面外科三维诊断分析和手术设计计算机系统 (3DCMFCADS) ,并将系统应用于正常颅面分析和颅面畸形整复手术设计。结果　所建系统整机运行稳定 ,测量分析误差微小 ,精密度最大变异系数仅 1.92 % ,手术模拟设计和构建的移植体或植入体三维模型形态逼真、参数准确。所建系统和方法的优特点表现在 :1可同时显示硬、软组织结构并对其进行三维测量分析和手术模拟设计。 2可显示颅面立体结构 ;可定性和定量地诊断分析颅面畸形 ;可进行手术模拟并设计移植或植入修复体三维模型。 3可利用国内较普及的 CT扫描机和微型计算机设备开展工作 ,系统操作方法易于为外科医生掌握使用 ,具有临床实用性。 4定量诊断和手术设计的准确性、精密度高 ,且具有客观性。结论　 3DCMFCAD系统和方法的建立为颅面畸形形成机制研究、诊断分析、手术设计和疗效评价提供了新的科学方法和理论依据。     

数字化技术用于25例患者正颌手术效果评价

目的:应用数字化技术辅助正颌外科三维重建测量、术前诊断、手术设计与模拟、导板制作、导航验证和效果评估,探索制订更加科学、合理的数字化诊治方法和流程.方法:选取25例先天性牙颌面畸形患者,术前行颅颌面CT扫描,将CT数据导入Mimics 20.0软件,建立数字化原始模型.确定三维重建测量硬组织标志点并进行测量、分析、诊断...     

Computer-aided 3-D simulation and prediction of craniofacial surgery: a new approach

Background: In plastic and reconstructive craniofacial surgery, careful preoperative planning is essential. In complex cases of craniofacial synostosis, rapid prototyping models are used to simulate the surgery and reduce operating time. Recently, 3-D CT model surgery has been introduced for presurgical planning and prediction of the postoperative result. Objective: For simulation of craniofacial surgery a computer-based system was developed that allows visualization and manipulation of CT-data using computer graphics techniques. Surgical procedures in all areas of the bony skull can be performed interactively. Results: The case of a child with scaphocephalus is presented. Surgery is planned using the craniofacial surgery simulator described above. Conclusion: The computer-based interactive surgery simulation systems presented here allow precise visualization of craniofacial surgery. The accurate computer-aided 3-D simulation of bone displacements is also the prerequisite for transfer of the simulated surgery using a navigation system for surgery. Thus the preoperatively planned procedure could be transferred directly to the operating table. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.     

Computer-aided 3-D simulation and prediction of craniofacial surgery: a new approach.

BACKGROUND: In plastic and reconstructive craniofacial surgery, careful preoperative planning is essential. In complex cases of craniofacial synostosis, rapid prototyping models are used to simulate the surgery and reduce operating time. Recently, 3-D CT model surgery has been introduced for presurgical planning and prediction of the postoperative result. OBJECTIVE: For simulation of craniofacial surgery a computer-based system was developed that allows visualization and manipulation of CT-data using computer graphics techniques. Surgical procedures in all areas of the bony skull can be performed interactively. RESULTS: The case of a child with scaphocephalus is presented. Surgery is planned using the craniofacial surgery simulator described above. CONCLUSION: The computer-based interactive surgery simulation systems presented here allow precise visualization of craniofacial surgery. The accurate computer-aided 3-D simulation of bone displacements is also the prerequisite for transfer of the simulated surgery using a navigation system for surgery. Thus the preoperatively planned procedure could be transferred directly to the operating table.     

Advances and innovations in computer-assisted head and neck oncologic surgery

Over the past years, computer-assisted surgery has gained more importance in craniomaxillofacial surgery, especially in primary and secondary treatment of head and neck malignancies. The basis for oncologic treatment of the head and neck region requires detailed planning using computed tomography, cone-beam computed tomography, or magnetic resonance imaging in combination with computer-assisted, infrared-based navigation system. These techniques allow a preplanned image-guided path to the tumor region for taking biopsies, resection, or reconstruction. The aim of this work was to show the advances and technical benefits for tumor surgery in a daily clinical routine from the view of the craniomaxillofacial surgeon. The target of our working group was to develop and clinically evaluate a novel three-dimensional planning and navigation software solution for treatment of craniofacial tumors. This work was carried out on 5 categories for oncologic surgical procedures in which computer-assisted surgery was applied from 2005 to 2011: preplanned trajectorial-guided tumor biopsy, intraoperative image-controlled tumor resection, tumor mapping, reconstruction after tumor surgery (true to original), and oral rehabilitation (backward planning). Successful preoperative planning, import of image data suitable for navigation, and intraoperative precise infrared-based navigation were obtained for all 5 categories without any complications. Image-guided navigation technique for head and neck oncologic surgery provides a precise, safe surgical method with real-time excellent anatomic orientation. Regarding the advantages of computer-assisted surgery, this technique will play a major part in craniofacial reconstructive surgery and will address widespread general methodologic solutions that are of great interest in multidisciplinary oncologic treatment.     

Aesthetic results of fronto-orbital correction in trigonocephaly

The aesthetic results of craniofacial surgery for trigonocephaly were evaluated by a panel assessment using a scoring system based on deformities typical for this type of craniosynostosis. In this retrospective study pre-and postoperative photographs of 45 patients were scored for items typical for trigonocephaly: shape of the forehead, hypotelorism, and temporal depression. Each item was quantified as normal or absent (0 points), a mild deformity (1 point) or a severe deformity (2 points). Preoperatively, the most obvious deformity was temporal depression and this remained to be the most obvious deformity after surgery. There was a good overall correction of the presenting deformities with a decline in the mean score preoperatively from 4.49-1.13 postoperatively. There was a significant weak correlation between pre- and postoperative score only for hypotelorism. This indicates that the severity of the initial disease is not a major contributor to the final surgical result. Furthermore, surgical outcome seemed to be stable over time and was not influenced by the timing of surgery when surgery was scheduled between the ages of 6-15 months. Early craniofacial correction for trigonocephaly results in a stable, acceptable aesthetic result on which the initial deformity has little effect. The most common associated craniofacial characteristics are well- to very well-corrected when surgery is performed within the first 6-15 months. Main focus of deformity on short and long term remains the temporal depression, and thus requires extra attention during surgery.     

The role of less invasive surgery in the treatment of adolescent idiopathic scoliosis and adult spinal deformity

The overall impact of spinal deformity reconstructive surgery on short- and long-term quality of life and patients' perioperative experience has been widely studied in recent literature. With the advancement of modern less invasive (anterior/lateral/posterior percutaneous) spinal deformity techniques the ‘gold standard’ role of open traditional approaches has been questioned. Minimally invasive surgical (MIS) techniques are rapidly evolving and further research is required to determine whether a particular surgical treatment may be suitable for all patients or a patient-tailored individual treatment and surgical technique should be selected and could offer better results. Focus of the present article is to report the most recent research in ‘pure’ less invasive spinal deformity surgery (LIS) as applied both for adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD) and describe a single centre's experience on such ‘treatment philosophy’ as adopted in the last 7 years.     

Registration methods for surgical navigation of the mandible: a systematic review

Image-to-patient registration in navigated mandibular surgery is complex due to the mobile nature of the mandible compared with other craniofacial bones. As a result, surgical navigation is rarely employed in the mandibular region. This systematic review provides an overview of the different registration methods that are used for surgical navigation of the mandible. A systematic search was performed in the MEDLINE Ovid, Scopus, and Embase databases on March 25, 2021. Search terms included synonyms for mandibular surgery, surgical navigation, and registration methods. Articles about navigated mandibular surgery, where the registration method was explicitly mentioned, were included. The database search yielded a total of 2952 articles, from which 81 articles remained for analysis. Four main registration methods were identified: point registration, surface registration, hybrid registration, and computer vision-based registration. The mobility of the mandible is accounted for by either keeping the mandible in a fixed position during preoperative imaging and surgery, or by tracking the mandibular movements. Although different registration methods are available for navigated mandibular surgery, there is always a trade-off between accuracy, registration time, usability, and invasiveness. Future studies should focus on testing the different methods in larger patient studies and should report the registration accuracy.