计算机辅助设计与解剖定位在卵圆孔穿刺规划中的对比研究

目的研究利用计算机辅助设计技术(computer-assisted design, CAD)规划三叉神经毁损术卵圆孔穿刺路径与解剖定位法在穿刺参数方面的差异,提出解剖定位法的优化方案。方法选择2014年1月至2017年6月接受3D导航模板引导下半月神经节射频热凝术的原发性三叉神经痛患者57例,男22例,女35例。回顾分析每例患者的穿刺方案(CAD法),并与模拟的传统前入路定位方案(解剖定位法,取口角外2.5 cm作为进针点)进行对比分析,观察穿刺路径被遮挡情况。结果与传统解剖定位法比较,基于三维影像的CAD路径规划明显降低穿刺路径被遮挡率(P0.05),该方法在穿刺方向上的可获得卵圆孔面积及短径明显大于传统解剖定位法(P0.05)。91.2%患者通过CAD三维影像法规划的进针点分布在口角外2.5 cm进针点的内下方。结论将传统解剖定位法进针点向内下方调整,可以减少穿刺过程遮挡,获得一定的针道调整空间,有助于提高穿刺成功率。

Comparative study of computer assisted design technique and anatomical landmarks in foramen ovale puncture

Objective To compare the difference of puncturing parameters between computer-assisted design (CAD) technique and anatomical landmarks in foramen ovale puncture and to propose optimized procedure using anatomical landmarks.
Methods From January 2014 to June 2017, 57 patients 22 males and 35 females, were diagnosed with primary trigeminal neuralgia and treated with CAD template guided radiofrequency thermocoagulation therapy through foramen ovale (FO). We retrospectively analyzed the surgical plan with CAD method and simulated the traditional method of preoperative plan for each patient. The rate of the trajectory obstruction, available area and short diameter of FO in the direction of puncture were measured and compared between the two methods. Relative locations of percutaneous insertion points were measured.
Results Compared with the traditional method, CAD method significantly reduced the rate of trajectory obstruction (P < 0.05). Besides, available area and short diameter of FO in the direction of puncture were significantly greater in CAD method (P < 0.05). Compared with traditional method (2.5 cm lateral the oral angle), 91.2% of the insertion points in CAD method were distributed in the lower inner quadrant.
Conclusion Adjustment of the traditional insertion point to the lower inner part could reduce the occlusion of the cannulation, gain more space for puncture, hence it improvs the success rate of puncture.