Virtual Surgical Planning: The Pearls and Pitfalls.
Virtual Surgical Planning: The Pearls and Pitfalls.
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DOI：
10.1097/gox.0000000000001443
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Borsuk DE
中科院分区：
文献类型：
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作者：
Efanov JI;Roy AA;Huang KN;Borsuk DE
在过去的几年里，虚拟手术计划（VSP）已经发展成为颅面外科医生的有用工具。虚拟规划和计算机辅助设计和制造（CAD/CAM）可以协助颅面骨骼的正颌、颅眶、创伤和显微外科手术。尽管它越来越受欢迎，但很少强调学习曲线。2012年7月至2016年10月在蒙特利尔大学教学医院对连续虚拟手术进行了回顾性分析。分析中包括颌外科手术和带血管的游离骨瓣手术。在分析的时间段内完成了54例虚拟手术。共行正颌手术46例，游离骨移植8例。对错误进行了分析。85%的正颌虚拟计划完全遵守，4%的计划被放弃，11%的计划部分遵守。75%的虚拟手术游离组织转移坚持，而25%的部分坚持。放弃计划的原因是（1）外科医生和工程师之间沟通不良，（2）术前扫描对髁突放置的评价不佳，（3）软组织对骨运动的阻抗，（4）肿瘤进展迅速，（5）术前解剖评估不佳。虚拟手术计划是颅面外科手术的有用工具，但有外科医生必须意识到的固有问题。随着时间的推移和经验的积累，这些手术计划可以作为强有力的辅助手段，以良好的临床判断。
Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little emphasis has been placed on the learning curve. A retrospective analysis of consecutive virtual surgeries was done from July 2012 to October 2016 at the University of Montreal Teaching Hospitals. Orthognathic surgeries and free vascularized bone flap surgeries were included in the analysis. Fifty-four virtual surgeries were done in the time period analyzed. Forty-six orthognathic surgeries and 8 free bone transfers were done. An analysis of errors was done. Eighty-five percentage of the orthognathic virtual plans were adhered to completely, 4% of the plans were abandoned, and 11% were partially adhered to. Seventy-five percentage of the virtual surgeries for free tissue transfers were adhered to, whereas 25% were partially adhered to. The reasons for abandoning the plans were (1) poor communication between surgeon and engineer, (2) poor appreciation for condyle placement on preoperative scans, (3) soft-tissue impedance to bony movement, (4) rapid tumor progression, (5) poor preoperative assessment of anatomy. Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement.