应用外科导航技术经皮微小切口拆除颧骨颧弓骨折术后内固定钛板

目的研究在外科导航技术的辅助下，采用经皮微小切口拆除颧骨颧弓骨折术后内固定装置的可行性与便利性，并评价手术效果。 方法选取8例颧骨颧弓骨折切开复位内固定术后需要拆除内固定装置的患者为实验组。术前将患者头颅的CT影像学DICOM数据输入导航系统工作站，进行钛板钛钉位置标记；术中在实时导航技术的辅助下，经内固定装置体表投影位置行微小皮肤切口入路，并结合口内前庭沟切口和内镜技术，按设计精确拆除内固定装置。术后对手术出血量，手术持续时间，住院时间等进行记录与测量，评估手术效果，并使用视觉模拟评分法（VAS）记录患者满意度。另选取采用冠状切口拆除颧骨颧弓骨折内固定装置的患者8例为对照组，记录相应指标做为对照，使用SPSS 19.0对数据进行处理分析，将两组均数、标准差进行独立样本t检验。 结果在外科导航技术辅助下，经皮行微小切口入路成功拆除了8位患者的钛板内固定装置，术后恢复良好，面部瘢痕轻微。平均手术中出血量实验组为（20.00 ± 3.77）mL，对照组为（87.50 ± 17.32）mL，差异有统计学意义（t=-10.769，P<0.001）；平均术后住院时间实验组为（1.62 ± 0.51）d，对照组为（3.25 ± 0.46）d，差异有统计学意义（t=-7.264，P<0.001）；平均VAS患者满意度评分实验组为2.75 ± 0.70，对照组为5.50 ± 0.92，差异有统计学意义（t=-6.677，P<0.001）。 结论应用外科导航技术联合经皮微小切口可以精确拆除颧骨颧弓骨折术后的内固定钛板与钛钉。此方法可以避免冠状切口造成的手术创伤和并发症，手术过程更加精准、创伤小、出血量少，患者满意度较高，是一种安全有效的治疗方法，但不适用于肥胖患者和使用长钛板固定的颧弓骨折。

Application of surgical navigation technique in removing internal fixation of titanium plates after the zygomatic fracture through mini skin incision

ObjectiveThe aim of this study was to evaluate the feasibility and convenience with the aid of surgical navigation technique in removing internal fixation of titanium plates after the zygomatic fracture by mini skin incision. MethodsEight patients who need to dismantle the titanium plate after open reduction and internal fixation for zygomatic fracture of zygomatic bone are selected as the experimental group. Preoperatively, all patients received three-dimensional computed tomography scan, and their skulls′ digital imaging data was input into the navigation system workstation to make a virtual surgical plan in advance. During surgery, with the help of real-time navigation technology, a mini skin incision approach was carried out through the skin projection position of the internal fixation device. And combined with intraoral vestibular groove incision and endoscopy technology, according to the design, the internal fixation device was accurately removed. Postoperatively, the amount of bleeding, duration of operation and hospitalization were measured and compared with those cases that had traditional coronal incision approach without the help of surgical navigation (SN) , and VAS questionnaire was also used to assess patients′ satisfaction and the surgery effect. Another eight patients who used the coronal incision to remove the internal fixations of zygomatic arch fracture were selected as the control group. The corresponding indicators were recorded in the control group. The data were processed and analyzed by SPSS 19.0, and the two groups of mean and standard deviation were analyzed by independent sample t test. ResultsWith the help of computer navigation technology, the titanium plate internal fixation device of 8 patients was successfully dismantled by percutaneous mini incision approach, with good postoperative recovery and slight facial scar. The average amount of bleeding of experimental group and control group were (20.00 ± 3.77) mL and (87.50 ± 17.32) mL (t=-10.769, P<0.001) . The duration of hospitalization of experimental group and control group were (1.62 ± 0.51) d and (3.25 ± 0.46) d (t=-7.264, P<0.001) . The VAS questionnaire of experimental group and control group were 2.75 ± 0.70 and 5.50 ± 0.92 (t=-6.677, P<0.001) . There were significant differences in Statistics. ConclusionsWith the help of surgical navigation technique, the mini skin incision can be used to remove the titanium plates and screws of zygomatic fracture accurately. This operation process is more accurate, less aggressive, and with higher patient satisfaction, which can be regarded as a safe and effective treatment method. But it is not suitable for obese patients and the zygomatic fracture which is fixed by long plates.