Purpose

The management of complex mandible fractures, i.e. severely comminuted or fractures of edentulous/atrophic mandibles, can be challenging. This is due to the three-dimensional loss of bone, which limits the possibility for accurate anatomic reduction. Virtual surgery planning (VSP) can provide improved accuracy and shorter operating times, but is often not employed for trauma cases because of time constraints and complex user interfaces limited to two-dimensional interaction with three-dimensional data.

Methods

In this study, we evaluate the accuracy, precision, and time efficiency of the haptic assisted surgery planning system (HASP), an in-house VSP system that supports stereo graphics, six degrees-of-freedom input, and haptics to improve the surgical planning. Three operators performed planning in HASP on computed tomography (CT) and cone beam computed tomography (CBCT) images of a plastic skull model and on twelve retrospective cases with complex mandible fractures.

Results

The results show an accuracy and reproducibility of less than 2 mm when using HASP for virtual fracture reduction, with an average planning time of 15 min including time for segmentation in the software BoneSplit.

Conclusion

This study presents an in-house haptic assisted planning tool for cranio-maxillofacial surgery with high usability that can be used for preoperative planning and evaluation of complex mandible fractures.

中文翻译：

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内部触觉辅助手术计划的评估，可有效减少复杂的下颌骨骨折

目的

复杂的下颌骨骨折（即严重粉碎或无牙/萎缩性下颌骨骨折）的治疗可能具有挑战性。这是由于骨骼的三维损失，这限制了精确解剖复位的可能性。虚拟手术计划（VSP）可以提高准确性，缩短手术时间，但是由于时间限制和复杂的用户界面（仅限于与三维数据进行二维交互），通常不用于创伤情况。

方法

在这项研究中，我们评估了触觉辅助手术计划系统（HASP）的准确性，精度和时间效率，该系统是内部VSP系统，支持立体图形，六自由度输入和触觉以改善手术效果规划。三名操作员在HASP中进行了塑料颅骨模型的计算机断层扫描（CT）和锥束计算机断层扫描（CBCT）图像以及十二例复杂的下颌骨骨折回顾性病例的计划。

结果

结果显示，使用HASP进行虚拟骨折复位时，准确性和可重复性不到2毫米，平均计划时间为15分钟，其中包括在BoneSplit软件中进行分割的时间。

结论

这项研究为颅颌面外科手术提供了一种内部触觉辅助计划工具，具有很高的可用性，可用于术前计划和评估复杂的下颌骨骨折。