计算机三维仿真设计技术在下颌骨复杂骨折治疗中的研究进展

doi:10.13591/j.cnki.kqyx.2023.04.018

摘要/Abstract

摘要：

下颌骨复杂骨折由于碎骨片数目多、断端移位明显,加之解剖结构的复杂,给切开复位内固定手术增加了大量难度。传统手术方式依赖术者个人经验且耗时费力。近年来,随着医学影像技术和计算机技术的发展,数字化外科技术逐渐应用于颌面外科各类手术中。国内外学者也尝试了将数字外科技术应用在各类型颌骨多发骨折的整复手术中。本文就计算机三维仿真技术在下颌骨复杂骨折中的临床应用及其与快速成型技术、手术导航技术、混合现实技术、人工智能的联合应用这五个方面作一综述和展望。

关键词: 下颌骨粉碎性骨折, 计算机三维仿真技术, 快速成型技术, 手术导航, 混合现实技术, 人工智能

Abstract:

Because of the large number of bone fragments, the obvious displacement of broken ends and the complex anatomical structure, open reduction and internal fixation of complex mandibular fractures are difficult. The traditional operation method relies heavily on operator's experience and is time-consuming and laborious. In recent years, with the development of medical imaging technology and computer technology, digital surgery technology has been gradually applied to all kinds of maxillofacial surgery. Domestic and foreign scholars have also tried to apply it to the restoration of various types of multiple jaw fractures. In this paper, clinical application of 3D simulation technology in the field of complex mandibular fracture, combined rapid prototyping technology, surgical navigation, mixed reality and artificial intelligence are reviewed, and its application is summarized and prospect is analyzed.

Key words: comminuted fractures of mandible, 3D simulation technology, rapid prototyping technology, surgical navigation, mixed reality, artificial intelligence

中图分类号:

R782.4

顾徐嘉,孟箭,李志萍. 计算机三维仿真设计技术在下颌骨复杂骨折治疗中的研究进展[J]. 口腔医学, 2023, 43(4): 380-384.

GU Xujia,MENG Jian,LI Zhiping. Research progress of 3D simulation technology in the treatment of complex mandibular fractures[J]. Stomatology, 2023, 43(4): 380-384.

参考文献 41

[1]	徐晓峰, 朱方兴, 廖倩, 等. 75例下颌骨粉碎性骨折的治疗效果评价[J]. 中国口腔颌面外科杂志, 2021, 19(5):456-459.
[2]	Pickrell BB, Serebrakian AT, Maricevich RS. Mandible fractures[J]. Semin Plast Surg, 2017, 31(2):100-107. doi: 10.1055/s-0037-1601374 pmid: 28496390
[3]	蔡志刚. 数字化外科技术在颅颌面修复重建中的应用及进展[J]. 中华整形外科杂志, 2022(1):1-8.
[4]	凌观汉, 欧志学, 姚兰, 等. 中日友好医院分型的L型股骨头坏死仿真三维模型建立[J]. 中国组织工程研究, 2017, 21(7):1074-1079.
[5]	Singh GD, Singh M. Virtual surgical planning: Modeling from the present to the future[J]. J Clin Med, 2021, 10(23):5655. doi: 10.3390/jcm10235655
[6]	孙坚. 虚拟手术计划及术中导航辅助的下颌骨重建: 从精确走向微创[J]. 中国修复重建外科杂志, 2018, 32(7):821-826.
[7]	Patel SY, Kim DD, Ghali GE. Maxillofacial reconstruction using vascularized Fibula free flaps and endosseousimplants[J]. Oral Maxillofac Surg Clin North Am, 2019, 31(2):259-284. doi: 10.1016/j.coms.2018.12.005
[8]	Moro A, Pelo S, Gasparini G, et al. Virtual surgical planning for reconstruction of giant ameloblastoma of the mandible[J]. Ann Plast Surg, 2020, 85(1):43-49. doi: 10.1097/SAP.0000000000002390
[9]	Ding Q, Fu ZZ, Yue J, et al. Virtual surgical planning and three-dimensional printing to aid the anatomical reduction of an old malunitedfracture of the mandible[J]. J Craniofac Surg, 2021, 32(7):e647-e649. doi: 10.1097/SCS.0000000000007653
[10]	Maloney KD, Rutner T. Virtual surgical planning and hardware fabrication prior to open reduction and internal fixation of atrophic edentulous mandible fractures[J]. Craniomaxillofac Trauma Reconstr, 2019, 12(2):156-162. doi: 10.1055/s-0039-1677723 pmid: 31073367
[11]	Oh HJ, Moon JH, Ha H, et al. Virtually-planned orthognathic surgery achieves an accurate condylar position[J]. J Oral MaxillofacSurg, 2021, 79(5):1146.e1-1146.e25.
[12]	Shakya S, Li KD, Huang D, et al. Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures[J]. Chin J Traumatol, 2022, 25(3):151-155. doi: 10.1016/j.cjtee.2021.12.002
[13]	Kraeima J, Glas HH, Merema BBJ, et al. Three-dimensional virtual surgical planning in the oncologic treatment of the mandible[J]. Oral Dis, 2021, 27(1):14-20. doi: 10.1111/odi.v27.1
[14]	Olsson P, Nysjö F, Rodríguez-Lorenzo A, et al. Haptics-assisted virtual planning of bone, soft tissue, and vessels in Fibulaosteocutaneous free flaps[J]. Plast Reconstr Surg Glob Open, 2015, 3(8):e479. doi: 10.1097/GOX.0000000000000447
[15]	Nilsson J, Nysjö F, Nyström I, et al. Evaluation of in-house, haptic assisted surgical planning for virtual reduction of complex mandibular fractures[J]. Int J Comput Assist Radiol Surg, 2021, 16(6):1059-1068. doi: 10.1007/s11548-021-02353-w pmid: 33905085
[16]	苏丽, 黄晓峰. 牙颌数字化三维建模的研究进展[J]. 口腔医学研究, 2019, 35(1):16-19. doi: 10.13701/j.cnki.kqyxyj.2019.01.004
[17]	Wen X, Wang XY, Qin SQ, et al. Three-dimensional analysis of upper airway morphology in skeletal Class Ⅲ patients with and without mandibular asymmetry[J]. Angle Orthod, 2017, 87(4):526-533. doi: 10.2319/120116-866.1 pmid: 28418700
[18]	Lai HC, Denadai R, Ho CT, et al. Effect of le fort Ⅰ maxillary advancement and clockwise rotation on the anteromedial cheek soft tissue change in patients with skeletal class Ⅲ pattern and midface deficiency: A 3D imaging-based prediction study[J]. J Clin Med, 2020, 9(1):262. doi: 10.3390/jcm9010262
[19]	Ghai S, Sharma Y, Jain N, et al. Use of 3-D printing technologies in craniomaxillofacial surgery: A review[J]. Oral Maxillofac Surg, 2018, 22(3):249-259. doi: 10.1007/s10006-018-0704-z pmid: 29797107
[20]	Chew KY, Kok YO, Pek WS, et al. Surgical planning using facial fracture 3D models: The role of cyanoacrylate glue and miniplating for anatomical reduction[J]. JPRAS Open, 2021, 28: 19-24. doi: 10.1016/j.jpra.2021.01.001
[21]	King BJ, Park EP, Christensen BJ, et al. On-site 3-dimensional printing and preoperative adaptation decrease operative time for mandibular fracture repair[J]. J Oral Maxillofac Surg, 2018, 76(9):1950.e1-1950.e8.
[22]	Alagarsamy R, Lal B, Sagar S, et al. Digital workflow for treating comminuted anterior mandibular fracture-A technical note[J]. JStomatol Oral Maxillofac Surg, 2021, 122(4):453-455.
[23]	Abreu ME, Viegas VN, Ibrahim D, et al. Treatment of comminuted mandibular fractures: A critical review[J]. Med Oral Patol Oral Cir Bucal, 2009, 14(5):E247-E251.
[24]	Zhao LY, Zhang XJ, Guo ZY, et al. Use of modified 3D digital surgical guides in the treatment of complex mandibular fractures[J]. J Craniomaxillofac Surg, 2021, 49(4):282-291. doi: 10.1016/j.jcms.2021.01.016 pmid: 33581958
[25]	陆友正, 王志勇, 席洪, 等. 导板外科应用于下颌骨粉碎性骨折精准复位[J]. 口腔医学, 2019, 39(8):714-718.
[26]	Ren J, Zhou Z, Li P, et al. Three-dimensional planning in maxillofacial fracture surgery: Computer-aided design/computer-aided manufacture surgical splints by integrating cone beam computerized tomography images into multislice computerized tomography images[J]. J Craniofac Surg, 2016, 27(6):1415-1419. doi: 10.1097/SCS.0000000000002718 pmid: 27300464
[27]	Ramanathan M, Panneerselvam E, Raja VBKK. 3D planning inmandibular fractures using CAD/CAM surgical splints—a prospectiverandomized controlled clinical trial[J]. J Craniomaxillofac Surg, 2020, 48(4):405-412. doi: S1010-5182(20)30042-1 pmid: 32127304
[28]	Ma JL, Ma LM, Wang ZF, et al. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: A case report[J]. Medicine, 2017, 96(27):e7250. doi: 10.1097/MD.0000000000007250
[29]	Sukegawa S, Kanno T, Furuki Y. Application of computer-assisted navigation systems in oral and maxillofacial surgery[J]. Jpn Dent Sci Rev, 2018, 54(3):139-149. doi: 10.1016/j.jdsr.2018.03.005
[30]	Shan XF, Chen HM, Liang J, et al. Surgical navigation-assisted mandibular reconstruction with Fibulaflaps[J]. Int J Oral Maxillofac Surg, 2016, 45(4):448-453. doi: 10.1016/j.ijom.2015.08.1006
[31]	Abbate V, Orabona GDA, Solari D, et al. Mandibular surgical navigation: An innovative guiding method[J]. J Craniofac Surg, 2017, 28(8):2122-2126. doi: 10.1097/SCS.0000000000003816 pmid: 28906331
[32]	Yamamoto S, Taniike N, Takenobu T. Application of an open position splint integrated with a reference frame and registration markers for mandibular navigation surgery[J]. Int J Oral Maxillofac Surg, 2020, 49(5):686-690. doi: 10.1016/j.ijom.2019.09.015
[33]	Yang CY, Yang RT, He SG, et al. Removal of a large number of foreign bodies in the maxillofacial region with navigation system[J]. Dent Traumatol, 2017, 33(3):230-234. doi: 10.1111/edt.2017.33.issue-3
[34]	张芷豪, 商冠宁. 混合现实技术在骨科的研究进展[J]. 中华实验外科杂志, 2021, 38(7):1382-1385.
[35]	Meng FH, Zhu ZH, Lei ZH, et al. Feasibility of the application of mixed reality in mandible reconstruction with Fibula flap: A cadaveric specimen study[J]. J Stomatol Oral Maxillofac Surg, 2021, 122(4):e45-e49. doi: 10.1016/j.jormas.2021.01.005 pmid: 33434746
[36]	Tang ZN, Hu LH, Soh HY, et al. Accuracy of mixed reality combined with surgical navigation assisted oral and maxillofacial tumor resection[J]. Front Oncol, 2022, 11: 715484.
[37]	周飞燕, 金林鹏, 董军. 卷积神经网络研究综述[J]. 计算机学报, 2017, 40(6):1229-1251.
[38]	任相阁, 任相颖, 李绪辉, 等. 医疗领域人工智能应用的研究进展[J]. 世界科学技术-中医药现代化, 2022, 24(2):762-770.
[39]	Qiu BJ, Guo JP, Kraeima J, et al. Automatic segmentation of the mandible from computed tomography scans for 3D virtual surgical planning using the convolutional neural network[J]. Phys Med Biol, 2019, 64(17):175020.
[40]	Qiu X, Han W, Dai L, et al. Assessment of an artificial intelligence mandibular osteotomy design system: A retrospective study[J]. Aesthetic Plast Surg, 2022: 2022Jan20.
[41]	Lo LJ, Yang CT, Ho CT, et al. Automatic assessment of 3-dimensional facial soft tissue symmetry before and after orthognathic surgery using a machine learning model: A preliminary experience[J]. Ann Plast Surg, 2021, 86(3SSuppl 2):S224-S228. doi: 10.1097/SAP.0000000000002687