Committeri Umberto, Magliulo Roberta, Carraturo Emanuele, Arena Antonio, Abbate Vincenzo, Salzano Giovanni, Troise Stefania, Barone Simona, Germano Cristiana, Vaira Luigi Angelo, Giovacchini Francesco, Cataldo Rosanna, Grassia Maria Gabriella, Califano Luigi, Piombino Pasquale
Department of Maxillofacial Surgery, AOU 'Federico II', Naples, Italy.
Department of Maxillofacial Surgery, AOU 'Federico II', Naples, Italy.
J Craniomaxillofac Surg. 2024 Dec;52(12):1497-1504. doi: 10.1016/j.jcms.2024.08.020. Epub 2024 Sep 29.
Multifragmentary and displaced zygomaticomaxillary complex (ZMC) fractures are often a challenge for the maxillofacial surgeon. The aim of this study was to evaluate the improved performance in the management of patients with tripod fracture of the orbito-zygomaticomaxillary complex, using two different methods of virtual surgical planning - virtual reduction and mirroring - compared with traditional management. A cohort of 60 patients was selected and divided into three groups, each consisting of 20 individuals. Patients in the first group were managed using the virtual reduction method, those in the second group using the mirroring method, and those in the third group using a traditional surgical approach. Having achieved virtual fracture reduction, a stereolithographic model was printed, on which preplating of the plates was performed. The results showed that virtual reduction was the most accurate in absolute terms, with a mean discrepancy in juxtaposition of the preoperative and postoperative CT images of 0.175 mm (SD ± 0.147), compared with 0.403 (SD ± 0.166) for the mirror method (and traditional method (0.875, SD ± 0.112; p > 0.0001). The average surgical time for virtual reduction (89.5 min) was faster than for mirroring (94.25 min) and for the traditional approach (96.75 min). In conclusion, the use of virtual surgical planning allows greater intraoperative accuracy, reduced surgical time, and reduced postoperative complications compared with traditional surgery. Of the two methods, virtual reduction performed best for the outcomes decribed.
多片段移位性颧上颌复合体（ZMC）骨折对于颌面外科医生来说常常是一项挑战。本研究的目的是评估在处理眶颧上颌复合体三脚架骨折患者时，与传统治疗方法相比，使用两种不同的虚拟手术规划方法——虚拟复位和镜像法——的改进效果。选取了60例患者并分为三组，每组20人。第一组患者采用虚拟复位法治疗，第二组采用镜像法，第三组采用传统手术方法。在完成虚拟骨折复位后，打印出实体模型，并在其上进行钢板预塑形。结果表明，就绝对数值而言，虚拟复位最为精确，术前和术后CT图像并列的平均差异为0.175毫米（标准差±0.147），而镜像法为0.403（标准差±0.166），传统方法为0.875（标准差±0.112；p>0.0001）。虚拟复位的平均手术时间（89.5分钟）比镜像法（94.25分钟）和传统方法（96.75分钟）更快。总之，与传统手术相比，使用虚拟手术规划可提高术中准确性、缩短手术时间并减少术后并发症。在这两种方法中，虚拟复位在所述结果方面表现最佳。
