Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
J Craniofac Surg. 2021;32(2):552-558. doi: 10.1097/SCS.0000000000006941.
Fractures of the zygomaticomaxillary complex (ZMC) represent an extremely heterogeneous group of injuries to the midfacial skeleton. Traditionally, the diagnosis of such fractures was based on 2-dimensional radiograms and, more recently, on volumetric computed tomography (CT) scans, while the treatment was exclusively based on the surgeon's experience. Many classification attempts have been made in the past, but no paper has taken into account the importance of virtual surgical planning (VSP) in proving a modernized classification. The authors propose a classification based on the use of VSP which can guide the surgeon to identify the optimal reduction method and reproduce it in the operating room through the use of navigation.
Patients with ZMC fractures were collected to create a study model. The VSP was used to generate 3-dimensional models of fractures. Fractured segments were duplicated and digitally put in the optimal reduction position. Repositioned fragments were overlapped to their original preoperative counterparts and exported to the surgical navigator to be navigated. Planned virtual reduction was overlaid to postoperative CT scan to assess the accuracy of reduction, explored using color maps and the calculation of root mean square error.
For all patients, the application of VSP was successfully accomplished. High accuracy was confirmed between the planned virtual reduction and the postoperative CT scan. A 5-item classification based on VSP is proposed. All patients were included in the presented subclasses.
The adoption of virtual planning in ZMC fractures allows for an improved study of the displacement of the fracture and might indicate to the surgeons the required maneuvers to achieve optimal reduction. The presented proposal of classification might be an aid to simplify the choice of the most appropriate reduction method and might provide a deeper insight into the morphologic characteristics of fractures.
颧骨复合体（ZMC）骨折是面中部骨骼的一组极具异质性的损伤。传统上，此类骨折的诊断基于二维射线照相，最近则基于容积计算机断层扫描（CT）扫描，而治疗则完全基于外科医生的经验。过去曾进行过多次分类尝试，但没有一篇论文考虑到虚拟手术规划（VSP）在证明现代化分类方面的重要性。作者提出了一种基于 VSP 使用的分类方法，该方法可以指导外科医生确定最佳的复位方法，并通过导航在手术室中复制它。
收集 ZMC 骨折患者以创建研究模型。使用 VSP 生成骨折的三维模型。复制骨折段并以数字方式放置在最佳复位位置。将重新定位的片段与原始术前片段重叠，并将其导出到手术导航仪中进行导航。将计划的虚拟复位叠加到术后 CT 扫描上，以评估复位的准确性，使用颜色图和均方根误差计算来探索。
对于所有患者，VSP 的应用均成功完成。计划的虚拟复位与术后 CT 扫描之间的准确性很高。提出了一种基于 VSP 的 5 项分类。所有患者均包括在所呈现的亚类中。
在 ZMC 骨折中采用虚拟规划可以更深入地研究骨折的移位，并可能向外科医生指示实现最佳复位所需的操作。所提出的分类建议可能有助于简化选择最合适的复位方法，并提供对骨折形态特征的更深入了解。
