Weijs Willem L J, Coppen Casper, Schreurs Ruud, Vreeken Rinaldo D, Verhulst Arico C, Merkx Matthias A W, Bergé Stefaan J, Maal Thomas J J
Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands.
Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam, University of Amsterdam (AMC), Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
J Craniomaxillofac Surg. 2016 Nov;44(11):1828-1832. doi: 10.1016/j.jcms.2016.08.024. Epub 2016 Sep 9.
Since reconstruction of composite defects in the head and neck region is a challenging and demanding problem for head and neck surgeons, surgical aids have been sought for decades. The purpose of this study was to evaluate the accuracy of prefabricated surgical resection templates used in mandibular segmental resections in comparison to the virtual surgical plan.
A prospective study was performed in 11 consecutive patients, with a primary T4 oral squamous cell carcinoma or osteoradionecrosis of the mandible. Preoperatively, a CBCT scan was acquired to delineate the size and extension of tumor invasion; a virtual patient-specific resection template was designed based on this information. Intraoperatively, the resection template was positioned on the mandible and secured using four fixation screws. Postoperatively, a CBCT scan was acquired. This scan was superimposed on the preoperative scan. Positioning of the resection template and inclination of the resection planes were evaluated on the virtual head model. In order to test the interobserver reliability of these new measurement methods, two different observers executed all measurements.
The mean shift of the proximal resection templates was 3.76 mm (standard deviation [SD] 3.10 mm). For the distal resection templates, the mean shift was 3.06 mm (SD 1.57 mm) with no significant interobserver difference (ICC = 0.99). An absolute mean deviation of 8.5° (SD 5.3°) was found for the proximal resection angle and 10.4° (SD 5.0°) for the distal resection angle. Again, no significant interobserver differences were found (ICC = 0.98).
The resection templates used in this study proved reasonably accurate. Although the concept of virtual surgical planning aids significantly in mandibular reconstruction with microvascular free flaps, further improvement of resection accuracy is necessary for further improvement of reconstruction accuracy.
由于头颈部复合缺损的重建对于头颈外科医生而言是一个具有挑战性且要求颇高的问题，数十年来一直在寻求手术辅助工具。本研究的目的是评估与虚拟手术计划相比，预制手术切除模板在下颌骨节段性切除中的准确性。
对连续11例原发性T4期口腔鳞状细胞癌或下颌骨放射性骨坏死患者进行了一项前瞻性研究。术前，获取CBCT扫描以描绘肿瘤侵犯的大小和范围；基于此信息设计了虚拟的个性化切除模板。术中，将切除模板放置在下颌骨上，并用四颗固定螺钉固定。术后，获取CBCT扫描。将该扫描与术前扫描进行叠加。在虚拟头部模型上评估切除模板的位置和切除平面的倾斜度。为了测试这些新测量方法的观察者间可靠性，由两名不同的观察者进行所有测量。
近端切除模板的平均移位为3.76毫米（标准差[SD]3.10毫米）。对于远端切除模板，平均移位为3.06毫米（SD 1.57毫米），观察者间差异无统计学意义（组内相关系数[ICC]=0.99）。近端切除角度的绝对平均偏差为8.5°（SD 5.3°），远端切除角度为10.4°（SD 5.0°）。同样，观察者间差异无统计学意义（ICC=0.98）。
本研究中使用的切除模板证明具有合理的准确性。尽管虚拟手术计划的概念在下颌骨微血管游离皮瓣重建中显著提供了帮助，但为了进一步提高重建准确性，仍需要进一步提高切除准确性。
