Cai Elijah Zhengyang, Koh Yun Pei, Hing Eileen Chor Hoong, Low Jin Rong, Shen Jia Yi, Wong Hung Chew, Sundar Gangadhara, Lim Thiam Chye
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Craniofac Surg. 2012 Sep;23(5):1567-73. doi: 10.1097/SCS.0b013e318260ef33.
Orbital reconstruction is a difficult procedure, success of which is dependent on the surgeon's experience. The lack of objective methods requires a fair amount of estimation is its execution. This study evaluates the efficacy of Kolibri (BrainLab, Munich, Germany), an intraoperative navigation device, in improving outcomes. From 2004 to 2009, 58 patients with orbital trauma who underwent surgery at the National University Hospital, Singapore, were included in this prospective matched control trial. Twenty-nine consecutive patients underwent surgery with Kolibri. The control group underwent surgery without the device. Both groups were matched for age, sex, orbital wall fracture, preoperative ophthalmologic features, etiology and severity of trauma, surgical approach, and types of implant used. The postoperative follow-up was at 1, 3, 6, and 12 months. For subjective assessment, the postoperative ophthalmologic features, including diplopia, infraorbital hypoesthesia, ophthalmoplegia, and enophthalmos, were compared. At 1, 3, 6, and 12 months, respectively, there were fewer patients with postoperative ophthalmologic complications in the study group (italicized; n = 29) compared with the control group (n = 29; P < 0.05): 12/29 (41%) versus 21/29 (72%), 8/29 (28%) versus 19/29 (66%), 5/29 (17%) versus 15/29 (52%), and 2/29 (7%) versus 12/29 (41%). For objective assessment, using the Kolibri workstation, operative plans were created and fused with postoperative computed tomographic scans. Vertical distances between the actual reconstructed and planned orbital floors were measured. On average, the vertical distance measured from the boundaries of floor defects for patients in the study group was 3.24 mm (95% confidence interval, 1.56-4.91) lower than the control group (P = 0.001). In conclusion, navigation minimizes postoperative complications, reduces the need for repeat procedures, and helps surgeons with planning, execution, and postoperative assessment.
眼眶重建是一项难度较大的手术，其成功与否取决于外科医生的经验。由于缺乏客观方法，在手术实施过程中需要进行大量的估计。本研究评估了术中导航设备Kolibri（德国慕尼黑BrainLab公司）在改善手术效果方面的有效性。2004年至2009年，新加坡国立大学医院58例眼眶外伤患者纳入本前瞻性配对对照试验。连续29例患者使用Kolibri进行手术。对照组手术未使用该设备。两组在年龄、性别、眶壁骨折、术前眼科特征、创伤病因及严重程度、手术入路和所用植入物类型方面进行匹配。术后随访时间为1、3、6和12个月。主观评估方面，比较了术后眼科特征，包括复视、眶下感觉减退、眼球运动障碍和眼球内陷。在1、3、6和12个月时，研究组（斜体；n = 29）术后眼科并发症患者数分别少于对照组（n = 29；P < 0.05）：12/29（41%）对21/2（72%），8/29（28%）对19/29（66%），5/29（17%）对15/29（52%），2/29（7%）对12/29（41%）。客观评估方面，使用Kolibri工作站制定手术计划并与术后计算机断层扫描融合。测量实际重建的眶底与计划眶底之间垂直距离。研究组患者从眶底缺损边界测量的平均垂直距离比对照组低3.24 mm（95%置信区间，1.56 - 4.91）（P = 0.001）。总之，导航可将术后并发症降至最低，减少重复手术的需求，并有助于外科医生进行手术规划、实施和术后评估。
