Aukema L M N, de Geer A F, van Alphen M J A, Schreuder W H, van Veen R L P, Ruers T J M, Siepel F J, Karakullukcu M B
Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Robotics and Mechatronics, University of Twente, Enschede, The Netherlands.
Int J Comput Assist Radiol Surg. 2025 Feb;20(2):369-377. doi: 10.1007/s11548-024-03282-0. Epub 2024 Nov 25.
In mandibular reconstructive surgery with free fibula flap, 3D-printed patient-specific cutting guides are the current state of the art. Although these guides enable accurate transfer of the virtual surgical plan to the operating room, disadvantages include long waiting times until surgery and the inability to change the virtual plan intraoperatively in case of tumor growth. Alternatively, (electromagnetic) surgical navigation combined with a non-patient-specific cutting guide could be used, requiring accurate image-to-patient registration. In this phantom study, we evaluated the accuracy of a hybrid registration method for the fibula and the additional error that is caused by navigating with a prototype of a novel non-patient-specific cutting guide to virtually planned osteotomy planes.
The accuracy of hybrid registration and navigation was assessed in terms of target registration error (TRE), angular difference, and length difference of the intended fibula segments using three 3D-printed fibular phantoms with assessment points on osteotomy planes. Using electromagnetic tracking, hybrid registration was performed with point registration followed by surface registration on the lateral fibular surface. The fibula was fixated in the non-patient-specific cutting guide to navigate to planned osteotomy planes after which the accuracy was assessed.
Registration was achieved with a mean TRE, angular difference, and segment length difference of 2.3 ± 0.9 mm, 2.1 ± 1.4°, and 0.3 ± 0.3 mm respectively after hybrid registration. Navigation with the novel cutting guide increased the length difference (0.7 ± 0.6 mm), but decreased the angular difference (1.8 ± 1.3°).
Hybrid registration showed to be a feasible and noninvasive method to register the fibula in phantom setup and could be used for electromagnetically navigated osteotomies with a novel non-patient-specific cutting guide. Future studies should focus on testing this registration method in clinical setting.
在游离腓骨瓣下颌骨重建手术中，3D打印的患者特异性切割导板是当前的先进技术。尽管这些导板能够将虚拟手术计划准确地转移到手术室，但缺点包括手术前等待时间长，以及在肿瘤生长的情况下无法在术中更改虚拟计划。或者，可以使用（电磁）手术导航结合非患者特异性切割导板，这需要精确的图像到患者配准。在这项模型研究中，我们评估了一种用于腓骨的混合配准方法的准确性，以及使用新型非患者特异性切割导板的原型导航到虚拟计划截骨平面所引起的额外误差。
使用三个在截骨平面上有评估点的3D打印腓骨模型，通过目标配准误差（TRE）、角度差和预期腓骨段的长度差来评估混合配准和导航的准确性。使用电磁跟踪，先进行点配准，然后在腓骨外侧表面进行表面配准，完成混合配准。将腓骨固定在非患者特异性切割导板中，导航到计划的截骨平面，然后评估准确性。
混合配准后，平均TRE、角度差和段长度差分别为2.3±0.9毫米、2.1±1.4°和0.3±0.3毫米，实现了配准。使用新型切割导板进行导航增加了长度差（0.7±0.6毫米），但减小了角度差（1.8±1.3°）。
混合配准是在模型设置中对腓骨进行配准的一种可行且无创的方法，可用于使用新型非患者特异性切割导板的电磁导航截骨术。未来的研究应侧重于在临床环境中测试这种配准方法。
