Application of tooth supported guide plate combined with navigation technology in the treatment of mandibular fracture
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摘要:
目的 对比2种下颌骨骨折切开复位内固定的方法，探讨牙支持式导板联合导航技术的应用价值。 方法 选取2022年1—6月蚌埠医学院第一附属医院口腔科收治的下颌骨骨折患者60例，排除全身多发伤，按照随机数字表分为A、B 2组，各30例。手术前和手术后1周摄取颌面部三维CT和口腔全景片，所有手术均由1名主任医师主刀完成，数据分析及导航软件为AccuNavi-A 2.1。A组选择牙支持式导板联合导航引导下的切开复位内固定术，B组选择传统的切开复位内固定术。完成手术后将术后和术前模拟复位的颌面部三维CT图像拟合，测量2个图像骨段之间的最大和平均偏差距离，术后3个月复查，评价2种方法的治疗效果。 结果 2组手术顺利完成，术后伤口愈合良好，面部外形、咬合关系恢复正常，无并发症出现。术前模拟设计和术后骨段的重建图像拟合后，A组最大偏差距离为(1.47±0.18)mm，平均偏差距离为(1.09±0.12)mm。B组最大偏差距离为(3.05±0.40)mm，平均偏差距离为(2.57±0.28)mm。B组的最大偏差值和平均偏差值大于A组，差异有统计学意义(均P＜0.05)。术后3个月2组患者功能及外形评价优良。 结论 相较于传统切开复位内固定术，牙支持式导板联合导航技术引导下的下颌骨骨折切开复位内固定术可缩短手术时间，提高手术的精确性，临床治疗效果良好，有推广价值。 Abstract:Objective To compare two methods of open incision and internal fixation for mandibular fractures and to explore the application value of tooth-supported guidesin combination with navigation technology. Methods Sixty patients with mandibular fracture admitted to the Department of Stomatology, the First Affiliated Hospital of Bengbu Medical College from January to June 2022 were selected, excluding multiple injuries of the whole body. According to the random number table, they were divided into A group and B group, with 30 cases in each group. Three-dimensional maxillofacial CT and oral panoramic films were taken before and one week after surgery. The operation was performed by a chief surgeon, and the data analysis and navigation software was AccuNavi-A 2.1. The patients in group A were treated with open incision and internal fixation guided by tooth support template combined with navigation, and the patients in group B were treated with traditional open incision and internal fixation. The maximum and average deviation distance between the two images were measured by fitting the three-dimensional CT images of the maxillofacial region after surgery and the preoperative and postoperative simulated reduction. The patients were reviewed 3 months after surgery to evaluate the therapeutic effect of the two methods. Results The operation of the two groups was successfully completed, with good postoperative wound healing, normal facial shape and occlusal relationship, and no complications occurred. In group A, the maximum deviation was (1.47±0.18) mm and the average deviation was (1.09±0.12) mm after fitting the preoperative simulation design and postoperative reconstruction images. In group B, the maximum deviation distance was (3.05±0.40) mm, and the average deviation distance was (2.57±0.28) mm. The maximum deviation value and mean deviation value of group B were greater than those in group A, and the difference was statistically significant (all P < 0.05). At 3 months after operation, the function and physical evaluation of patients in both groups was excellent. Conclusion Compared with the traditional open incision and internal fixation, the open incision and internal fixation of mandibular fracture guided by tooth supported guide plate and navigation technology can shorten the operation time, improve the accuracy of the operation, with good clinical treatment effect, and has the value of promotion. -
Key words:
- Mandibular fracture /
- Tooth support guide plate /
- 3D printing /
- Computer navigation
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图 1 术前相关检查、导板打印及钛板弯制
Figure 1. Preoperative examination, guide plate printing and titanium plate bending
图 2 下颌骨复位导板安放、选取配准点、术中验证骨折复位
Figure 2. Placement of reduction guide plate, selection of registration points, intraoperative verification of fracture reduction
图 3 术后面部外形、咬合关系及影像学图像
Figure 3. Postoperative facial appearance, occlusal relationship and imaging images
图 4 复位后下颌骨和虚拟设计拟合度(mm)
Figure 4. Mandibular and virtual design fit after reduction (mm)
表 1 2组下颌骨骨折患者复位准确度比较(x ±s, mm)
Table 1. Comparison of reduction accuracy mandibular fracture patients between the two groups(x ±s, mm)
组别 例数 最大偏差值 平均偏差值 A组 30 1.47±0.18 1.09±0.12 B组 30 3.05±0.40 2.57±0.28 t值 19.756 26.498 P值 < 0.001 < 0.001 
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表 2 2组下颌骨骨折患者术后疗效比较[例(%)]
Table 2. Comparison of postoperative efficacy of mandibular fracture patients between the two groups[cases (%)]
组别 例数 优 良 中 差 A组 30 28(93.33) 2 (6.67) 0 0 B组 30 27(90.00) 1 (3.33) 2(6.67) 0 注：2组疗效比较，Z=0.524，P=0.600。
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