Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.
Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.
Sci Rep. 2022 May 12;12(1):7893. doi: 10.1038/s41598-022-11659-x.
This study analyzed the outcomes of zygomatico-orbital fracture reconstruction using the real-time navigation system with intraoperative three-dimensional (3D) C-arm computed tomography (CT). Fifteen patients with zygomatico-orbital or isolated orbital/zygoma fractures were enrolled in this prospective cohort. For zygoma reduction, the displacement at five key sutures and the differences between preoperative and intraoperative CT images were compared. For orbital reconstruction, the bilateral orbital volume differences in the anterior, middle, and posterior angles over the medial transitional buttress were measured. Two patients required implant adjustment once after the intraoperative 3D C-arm assessment. On comparing the preoperative and postoperative findings for the zygoma, the average sum of displacement was 19.48 (range, 5.1-34.65) vs. 1.96 (0-3.95) mm (P < 0.001) and the deviation index was 13.56 (10-24.35) vs. 2.44 (0.6-4.85) (P < 0.001). For the orbit, the mean preoperative to postoperative bilateral orbital volume difference was 3.93 (0.35-10.95) vs. 1.05 (0.12-3.61) mm (P < 0.001). The mean difference in the bilateral angles at the transition buttress was significantly decreased postoperatively at the middle and posterior one-third. There was no significant difference in orbital volume, angle of the transition zone, and the sum of five zygoma distances between post operative results and preoperative virtual planning. The surgical navigation system with the intraoperative 3D C-arm can effectively improve the accuracy of zygomatico-orbital fracture reconstruction and decrease implant adjustment times.
本研究分析了使用术中三维（3D）C 臂计算机断层扫描（CT）实时导航系统进行颧骨-眶骨骨折重建的结果。本前瞻性队列纳入了 15 例颧骨-眶骨或孤立性眶/颧骨骨折患者。对于颧骨复位，比较了五个关键缝线的移位和术前与术中 CT 图像的差异。对于眶骨重建，测量了内侧过渡支撑处前、中、后角双侧眶容积差异。两名患者在术中 3D C 臂评估后需要调整一次植入物。比较颧骨术前和术后结果，平均总移位量为 19.48（5.1-34.65）mm 比 1.96（0-3.95）mm（P<0.001），偏差指数为 13.56（10-24.35）比 2.44（0.6-4.85）（P<0.001）。对于眶骨，术前到术后双侧眶容积差异的平均值为 3.93（0.35-10.95）mm 比 1.05（0.12-3.61）mm（P<0.001）。术后中、后三分之一过渡支撑处双侧角度的平均差异明显减小。术后结果与术前虚拟规划的眶容积、过渡区角度和五个颧骨距离总和无显著差异。术中 3D C 臂手术导航系统可有效提高颧骨-眶骨骨折重建的准确性，减少植入物调整次数。
