摘要目的:研究导航辅助下颌骨修复重建下颌骨三维形态变化量及下颌骨缺损位置和注册配准方法对修复重建精确性的影响。方法:2011年8月至2019年10月,纳入导航辅助下颌骨修复重建共41例,在术前、术后CT三维图像上选取未受病变破坏的特定解剖标志点,统计分析导航辅助下颌骨修复重建三维形态变化量。根据下颌骨重建侧与非重建侧、缺损是否包括髁突以及注册配准的方法进行分组,对比下颌骨术前、术后三维形态变化量,分析其影响因素。本研究采用独立样本 t检验为统计学方法,设定显著性水平为 P<0.05。 结果:下颌骨三维形态变化量平均值范围为1.710～4.977 mm。当下颌骨缺损涉及髁突时,三维形态变化量（1.671～5.587） mm大于缺损未涉及髁突时的变化量（1.346～4.358） mm,其中下颌角宽度、髁突内侧距离及髁突外侧距离差异有统计学意义（ P<0.05）。导航辅助下颌骨修复重建中,标志点注册组在髁突内侧宽度与非重建侧下颌骨长重建精确性优于表面注册组（ P<0.05）,其余下颌骨三维形态变化指标两种注册方法差异无统计学意义。 结论:导航技术辅助下的下颌骨修复重建,能较为精确的实现下颌骨三维形态的恢复。当下颌骨缺损涉及髁突位置时,会明显降低下颌骨修复重建精确性,标志点注册在下颌骨髁突位置修复重建精确性优于表面注册。

abstractsObjective:To study the change of mandibular morphology in image navigation guided mandibular reconstruction surgery and the influence of the methods for mandibular defect location and registration.Methods:Forty-one cases were included from August, 2011 to October, 2019. Specific anatomical landmarks were marked on the preoperative and postoperative 3D CT images, and the morphological changes of navigation-assisted mandibular reconstruction were recorded. Different groups were divided according to the reconstruction side and the non-reconstruction side of the mandible, whether the defect included the condyle and the registration method, then the 3D morphological changes of the mandible were compared, and the influencing factors were studied. Data was analyzed by independent t-test, and the difference was considered as statistically significant if P<0.05. Results:The mean value of 3D morphological changes of mandible ranged from 1.710 to 4.977 mm. When the condyle was involved in the mandibular defect, the change of 3D morphology [(1.671-5.587) mm] was greater than that when the condyle was not involved in a defect [(1.346-4.358) mm]. The difference of width of mandibular angle and medial distance and lateral distance of condyle was statistically significant ( P<0.05). In the navigation-assisted mandibular reconstruction, the accuracy of mandibular condyle and the length of mandible on non-reconstructed side in the group of bone-implanted fiducial marker registration was better than that in the surface registration ( P<0.05), and there was no significant statistical difference in other indexes. Conclusion:The image navigation guided mandibular reconstruction surgery can accurately restore the 3D configuration of mandible. When the mandibular defect involving condylar can significantly reduce the mandibular reconstruction accuracy, the fiducial maker registration is superior to the surface registration in the reconstruction of mandibular condyle.