Vollmer Andreas, Saravi Babak, Breitenbuecher Niko, Mueller-Richter Urs, Straub Anton, Šimić Luka, Kübler Alexander, Vollmer Michael, Gubik Sebastian, Volland Julian, Hartmann Stefan, Brands Roman C
Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany.
Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
Front Surg. 2023 Dec 15;10:1321217. doi: 10.3389/fsurg.2023.1321217. eCollection 2023.
This study aims to critically evaluate the effectiveness and accuracy of a time safing and cost-efficient open-source algorithm for in-house planning of mandibular reconstructions using the free osteocutaneous fibula graft. The evaluation focuses on quantifying anatomical accuracy and assessing the impact on ischemia time.
A pilot study was conducted, including patients who underwent in-house planned computer-aided design and manufacturing (CAD/CAM) of free fibula flaps between 2021 and 2023. Out of all patient cases, we included all with postoperative 3D imaging in the study. The study utilized open-source software tools for the planning step, and three-dimensional (3D) printing techniques. The Hausdorff distance and Dice coefficient metrics were used to evaluate the accuracy of the planning procedure.
The study assessed eight patients (five males and three females, mean age 61.75 ± 3.69 years) with different diagnoses such as osteoradionecrosis and oral squamous cell carcinoma. The average ischemia time was 68.38 ± 27.95 min. For the evaluation of preoperative planning vs. the postoperative outcome, the mean Hausdorff Distance was 1.22 ± 0.40. The Dice Coefficients yielded a mean of 0.77 ± 0.07, suggesting a satisfactory concordance between the planned and postoperative states. Dice Coefficient and Hausdorff Distance revealed significant correlations with ischemia time (Spearman's rho = -0.810, = 0.015 and Spearman's rho = 0.762, = 0.028, respectively). Linear regression models adjusting for disease type further substantiated these findings.
The in-house planning algorithm not only achieved high anatomical accuracy, as reflected by the Dice Coefficients and Hausdorff Distance metrics, but this accuracy also exhibited a significant correlation with reduced ischemia time. This underlines the critical role of meticulous planning in surgical outcomes. Additionally, the algorithm's open-source nature renders it cost-efficient, easy to learn, and broadly applicable, offering promising avenues for enhancing both healthcare affordability and accessibility.
本研究旨在严格评估一种用于下颌骨重建内部规划的开源算法的有效性和准确性，该算法采用游离腓骨骨皮瓣，具有节省时间和成本效益。评估重点在于量化解剖学准确性以及评估对缺血时间的影响。
进行了一项试点研究，纳入2021年至2023年间接受内部规划的游离腓骨瓣计算机辅助设计与制造（CAD/CAM）的患者。在所有患者病例中，我们纳入了所有术后有3D成像的患者进行研究。该研究在规划步骤中使用了开源软件工具和三维（3D）打印技术。使用豪斯多夫距离和骰子系数指标来评估规划程序的准确性。
该研究评估了8例患者（5例男性和3例女性，平均年龄61.75±3.69岁），诊断各异，如放射性骨坏死和口腔鳞状细胞癌。平均缺血时间为68.38±27.95分钟。对于术前规划与术后结果的评估，平均豪斯多夫距离为1.22±0.40。骰子系数的平均值为0.77±0.07，表明规划状态与术后状态之间具有令人满意的一致性。骰子系数和豪斯多夫距离与缺血时间均呈显著相关性（斯皮尔曼相关系数分别为-0.810，P = 0.015和斯皮尔曼相关系数为0.762，P = 0.028）。针对疾病类型进行调整的线性回归模型进一步证实了这些发现。
内部规划算法不仅通过骰子系数和豪斯多夫距离指标体现出较高的解剖学准确性，而且这种准确性还与缺血时间的缩短显著相关。这突出了精细规划在手术结果中的关键作用。此外，该算法的开源性质使其具有成本效益、易于学习且广泛适用，为提高医疗保健的可承受性和可及性提供了有前景的途径。
