Rabie Amr, Ibrahim Ahmed M S, Lee Bernard T, Lin Samuel J
Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
J Craniofac Surg. 2011 Jul;22(4):1466-7. doi: 10.1097/SCS.0b013e31821d1982.
Using conventional complex facial fracture management principles, confirmation of adequate facial fracture reduction can be achieved only by obtaining a postoperative computed tomography (CT) scan. If the CT scan revealed any discrepancy in fracture alignment, additional procedures for correction may be required. The concept of intraoperative CT scanning provides immediate postreduction or intraoperative information that orients the surgeon to the potential need for additional maneuvers for improved fracture reduction and osseous fixation. We assessed the early technical feasibility of real-time intraoperative CT scanning using the xCAT ENT (Xoran Technologies, Inc, Ann Arbor, MI), for monitoring of fracture reduction with the possibility of immediate intraoperative revision if needed, potentially obviating the need for revision procedures.
Three adult patients were studied who were admitted from the emergency department. During their respective reconstructive procedures, the xCAT ENT was used to provide images: Axial, coronal, sagittal, and three-dimensional reformatted images with segmentation of the CT data set and mirroring of the reconstructed side to the unaffected side were used for precise measurement and comparison of the reconstruction. The scans were examined by the operating surgeon and an intraoperative decision was made as to whether immediate revision was required.
Facial fracture management with intraoperative CT monitoring was changed in 2 of the 3 cases. One patient who underwent immediate revision had an open reduction-internal fixation after cranialization. The second patient who had a revision had a persistent subcondylar fracture that was found not amenable to closed reduction.
The intraoperative CT scan may positively change the outcome of facial fracture reduction especially when dealing with complex fractures. Additional studies are needed for studying its potential impact in monitoring reduction of facial fractures.
运用传统的复杂面部骨折处理原则，只有通过术后计算机断层扫描（CT）才能确认面部骨折复位是否充分。如果CT扫描显示骨折对线存在任何差异，可能需要额外的矫正手术。术中CT扫描的概念可提供复位后即时或术中信息，使外科医生了解是否可能需要额外操作以改善骨折复位和骨固定。我们评估了使用xCAT ENT（Xoran Technologies公司，密歇根州安阿伯）进行实时术中CT扫描的早期技术可行性，以监测骨折复位情况，并在需要时即时进行术中修正，从而可能避免修正手术。
研究了三名从急诊科收治的成年患者。在各自的重建手术过程中，使用xCAT ENT提供图像：轴向、冠状、矢状和三维重建图像，对CT数据集进行分割并将重建侧镜像至未受影响侧，用于精确测量和比较重建情况。扫描结果由主刀医生检查，并就是否需要即时修正做出术中决定。
3例患者中有2例的面部骨折处理因术中CT监测而改变。1例立即接受修正的患者在颅骨化后进行了切开复位内固定。另1例接受修正的患者存在髁突下持续性骨折，发现无法进行闭合复位。
术中CT扫描可能会积极改变面部骨折复位的结果，尤其是在处理复杂骨折时。需要进一步研究其在监测面部骨折复位方面的潜在影响。
