School of Technical Medicine, University of Twente, Enschede, The Netherlands.
Department of Head and Neck Surgery, Verwelius 3D Lab, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Int J Comput Assist Radiol Surg. 2020 Oct;15(10):1719-1725. doi: 10.1007/s11548-020-02234-8. Epub 2020 Jul 28.
3D-printed cutting guides are the current standard to translate the virtual surgery plan to the intraoperative setting. The production of these patient-specific cutting guides is time-consuming and costly, and therefore, alternative approaches are currently subject of research. The aim of this study was to assess the accuracy and reproducibility of using a novel electromagnetic (EM) navigated surgical cutting guide to perform virtually planned osteotomies in mandible models.
A novel 3D navigated cutting guide (dubbed Bladerunner) was designed and evaluated with a total of 20 osteotomies, performed on plaster mandibular models according to preoperative planning using EM navigation. The pre- and postoperative scans were registered, and the difference between the preoperatively planned osteotomy and the performed osteotomy was expressed as the distance between the planned and performed cutting planes, and the yaw and roll angles between the planes.
The mean difference in distance between the planned osteotomy and performed osteotomy was 1.1 mm (STD 0.6 mm), the mean yaw was 1.8° (STD 1.4°), and mean roll was 1.6° (STD 1.3°).
The proposed EM navigated cutting guide for mandibular osteotomies demonstrated accurate positioning of the cutting plane according to the preoperative virtual surgical plan with respect to distance, yaw and roll angles. This novel approach has the potential to make the use of 3D-printed cutting guides obsolete, thereby decreasing the interval between diagnosis and surgery, reduce cost and allow for adaptation of the virtual plan in case of rapid tumor proliferation or unanticipated in situ deviations from the preoperative CT/MR imaging.
3D 打印的截骨导板是目前将虚拟手术计划转化为术中环境的标准方法。这些个体化截骨导板的制作既耗时又昂贵，因此，目前正在研究替代方法。本研究的目的是评估使用新型电磁（EM）导航手术截骨导板在颌骨模型中进行虚拟规划截骨的准确性和可重复性。
设计了一种新型的 3D 导航截骨导板（称为 Bladerunner），并通过总共 20 例下颌骨模型的截骨术进行了评估，这些截骨术是根据术前 EM 导航规划进行的。对术前和术后的扫描进行配准，并将术前计划的截骨术与实际进行的截骨术之间的差异表示为计划截骨面与实际截骨面之间的距离以及两平面之间的偏航角和滚转角。
计划截骨术与实际截骨术之间的距离平均差异为 1.1mm（标准差 0.6mm），偏航角平均为 1.8°（标准差 1.4°），滚转角平均为 1.6°（标准差 1.3°）。
提出的用于下颌骨截骨的 EM 导航截骨导板在距离、偏航角和滚转角方面根据术前虚拟手术计划实现了截骨面的精确定位。这种新方法有可能使 3D 打印截骨导板过时，从而缩短诊断与手术之间的时间间隔，降低成本，并允许在肿瘤快速增殖或与术前 CT/MR 成像不符的原位偏差情况下适应虚拟计划。
