Xia James J, Shevchenko Liza, Gateno Jaime, Teichgraeber John F, Taylor Terry D, Lasky Robert E, English Jeryl D, Kau Chung H, McGrory Kathleen R
Department of Oral and Maxillofacial Surgery, Methodist Hospital Research Institute, Houston, TX 77030, USA.
J Oral Maxillofac Surg. 2011 Jul;69(7):2014-24. doi: 10.1016/j.joms.2011.02.018.
The purpose of this study was to determine whether the surgical outcomes achieved with computer-aided surgical simulation (CASS) are better than those achieved with traditional methods.
Twelve consecutive patients with craniomaxillofacial (CMF) deformities were enrolled. According to the CASS clinical protocol, a 3-dimensional computer composite skull model for each patient was generated and reoriented to the neutral head posture. These models underwent 2 virtual surgeries: 1 was based on CASS (experimental group) and the other was based on traditional methods 1 year later (control group). Once the 2 virtual surgeries were completed, 2 experienced oral and maxillofacial surgeons at 2 different settings evaluated the 2 surgical outcomes. They were blinded to the planning method used on the virtual models and each other's evaluation results. The primary outcome was overall CMF skeletal harmony. The secondary outcomes were individual maxillary, mandibular, and chin harmonies. Statistical analyses were performed.
Overall CMF skeletal harmony achieved with CASS was statistically significantly better than that achieved with traditional methods. In addition, the maxillary and mandibular surgical outcomes achieved with CASS were significantly better. Furthermore, although not included in the statistical model, the chin symmetry achieved by CASS tended to be better. A regression model was established between mandibular symmetry and overall CMF skeletal harmony.
The surgical outcomes achieved with CASS are significantly better than those achieved with traditional planning methods. In addition, CASS enables the surgeon to better correct maxillary yaw deformity, better place proximal/distal segments, and better restore mandibular symmetry. The critical step in achieving better overall CMF skeletal harmony is to restore mandibular symmetry.
本研究旨在确定计算机辅助手术模拟（CASS）所取得的手术效果是否优于传统方法所取得的效果。
连续纳入12例颅颌面（CMF）畸形患者。根据CASS临床方案，为每位患者生成一个三维计算机合成颅骨模型，并将其重新定向至中立头位姿势。这些模型进行了2次虚拟手术：1次基于CASS（实验组），另1次在1年后基于传统方法（对照组）。2次虚拟手术完成后，2名经验丰富的口腔颌面外科医生在2个不同地点评估这2种手术效果。他们对虚拟模型上使用的规划方法以及彼此的评估结果不知情。主要结局是整体颅颌面骨骼协调性。次要结局是上颌、下颌和颏部的个体协调性。进行了统计分析。
CASS所实现的整体颅颌面骨骼协调性在统计学上显著优于传统方法所实现的协调性。此外，CASS所取得的上颌和下颌手术效果显著更好。而且，尽管未纳入统计模型，但CASS所实现的颏部对称性往往更好。建立了下颌对称性与整体颅颌面骨骼协调性之间的回归模型。
CASS所取得的手术效果显著优于传统规划方法。此外，CASS使外科医生能够更好地矫正上颌偏斜畸形、更好地放置近段/远段，以及更好地恢复下颌对称性。实现更好的整体颅颌面骨骼协调性的关键步骤是恢复下颌对称性。
