目的 探讨计算机辅助导航系统(computer assisted navigation system,CANS)用于颞下颌关节强直手术的疗效.方法 对10个正常成人头颅标本的20侧颞下颌关节确定关节窝顶点、髁突头顶点等11个点作为测量点,用游标卡尺对头颅标本关节窝内外径、前后径等12个距离进行实际测量;对头颅标本行256排螺旋CT扫描,应用Surgicase5.0软件在CT影像测量上述距离.将实际测量数据与CT影像数据进行两两配对比较分析,差异无统计学意义(P＞0.05),验证了两种测量方法的等效性.在此基础上,选择2015年9月至2017年3月来中国医科大学附属口腔医院口腔颌面外科就诊的经临床及影像学检查确诊为双侧骨性颞下颌关节强直的患者10例,将其术前CT影像数据导入BrainLAB计算机导航系统工作站进行模拟设计,数字化重建关节窝形态并对相关指标进行测量.术后复查CT并测量相关数据,将测得数据与术前模拟数据进行比较分析,评价CANS引导颞下颌关节骨性强直手术的应用疗效.结果 10例患者术后均无并发症发生,张口度为35～ 40 mm,未发现复发病例.术后CT测量数据与术前设计吻合,实际截骨数据与术前模拟截骨数据相比,差异无统计学意义(P＞0.05).结论 在颞下颌关节成形术中,CANS可明确截骨范围,对周围重要解剖结构可进行定位及保护,减少术中和术后并发症的发生.%Objective To investigate the effect of computer assisted navigation system in temporomandibular joint ankylosis.Methods Totally l0 adult cadaveric heads (20 sides)were studied to sign glenoid fossa in temporomandibular joint,including 11 points,such as vertex of joint fossa and vertex of condylar head,and measure internal and external diameter of 12 distances,such as joint fossa and anteroposterior diameter of joint fossa.The skull was scanned by 256 row spiral CT,and the Surgicase5.0 software was used to measure the distances.The actual measurement data were compared with the CT image data to evaluate the equivalence of two measuring methods.On this basis,the data of preoperative CT image of temporomandibular joint ankylosis patients were input into BrainLAB computer navigation system workstation for digital design,and digital reconstruction of articular fossa morphology and articular fossa data were measured.Postoperative review of CT and measurement of relevant data,and the measured data were compared with the preoperative simulation data to investigate the effect of computer assisted navigation system in temporomandibular joint ankylosis.Results Compared with the actual measurement data,the CT image measurement data were not statistically different.There was no statistical difference between the postoperative CT image and the preoperative simulated data.Conclusion In arthroplasty of temporomandibular joint,computer assisted navigation system can define the range of osteotomy,locate and protect important anatomic structures and reduce intraoperative and postoperative complications.
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