Melroy Christopher T, Dubin Marc G, Hardy Stuart M, Senior Brent A
Department of Otolaryngology Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
Am J Rhinol. 2006 Jan-Feb;20(1):77-83.
The aim of this study was to compare three common methods (transillumination, plain radiographs, and computerized tomography [CT] image guidance) for estimating the position and extent of pneumatization of the frontal sinus in osteoplastic flap surgery.
Axial CT scans and 6-ft Caldwell radiographs were performed on 10 cadaver heads. For each head, soft tissue overlying the frontal bone was raised and the anticipated position and extent of the frontal sinus at four points was marked using three common methods. The silhouette of the frontal sinus from the Caldwell plain radiograph was excised and placed in position. Four points at the periphery also were made using information obtained from a passive optically guided image-guided surgery device, and transillumination via a frontal trephination also was used to estimate sinus extent. The true sinus size was measured at each point and compared with experimental values.
The use of CT image guidance generated the least difference between measured and actual values (mean = 1.91 mm; SEM = 0.29); this method was found statistically superior to Caldwell (p = 0.040) and transillumination (p = 0.007). Image guidance did not overestimate the size of the sinus (0/36) and was quicker than the Caldwell approach (8.5 versus 11.5 minutes). There was no learning curve appreciated with image guidance.
Accurate and precise estimation of the position and extent of the frontal sinus is crucial when performing osteoplastic flap surgery. Use of CT image guidance was statistically superior to Caldwell and transillumination methods and proved to be safe, reproducible, economic, and easy to learn.
本研究的目的是比较三种常用方法（透照法、普通X线片和计算机断层扫描[CT]图像引导）在骨成形瓣手术中评估额窦气化的位置和范围。
对10个尸头进行轴向CT扫描和6英尺考德威尔位X线片检查。对于每个头颅，掀起额骨上的软组织，使用三种常用方法标记额窦在四个点的预期位置和范围。从考德威尔位普通X线片上剪下额窦轮廓并放置到位。还利用被动光学引导图像引导手术设备获得的信息确定周边的四个点，并通过额部环钻透照法来估计窦的范围。在每个点测量真实的窦大小并与实验值进行比较。
使用CT图像引导时测量值与实际值之间的差异最小（平均值 = 1.91毫米；标准误 = 0.29）；该方法在统计学上优于考德威尔位X线片法（p = 0.040）和透照法（p = 0.007）。图像引导没有高估窦的大小（0/36），并且比考德威尔位X线片法更快（8.5分钟对11.5分钟）。图像引导不存在学习曲线。
在进行骨成形瓣手术时，准确精确地评估额窦的位置和范围至关重要。使用CT图像引导在统计学上优于考德威尔位X线片法和透照法，并且被证明是安全、可重复、经济且易于学习的。
