基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究

doi:10.7518/hxkq.2022.06.008

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (6): 676-684.doi: 10.7518/hxkq.2022.06.008

基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究

林承重¹(), 张勇², 董韶³, 吴锦阳², 张楚茜², 万新军³, 张诗雷²()

^1.上海交通大学医学院附属第九人民医院口腔第二门诊部，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011
^2.上海交通大学医学院附属第九人民医院口腔颅颌面科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011
^3.上海理工大学光电信息与计算机工程学院，上海 200011

收稿日期:2022-06-26 修回日期:2022-10-25 出版日期:2022-12-01 发布日期:2022-11-23
通讯作者: 张诗雷 E-mail:Evan-lin@sjtu.edu.cn;leinnymd@hotmail.com
作者简介:林承重，主治医师，博士，E-mail：Evan-lin@sjtu.edu.cn
基金资助:
上海市科委科技支撑项目(20S31902200)

Application of mixed reality-based surgical navigation system in craniomaxillofacial trauma bone reconstruction

Lin Chengzhong¹(), Zhang Yong², Dong Shao³, Wu Jinyang², Zhang Chuxi², Wan Xinjun³, Zhang Shilei²()

^1.The 2nd Dental Center, Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine; College of Stomatology, Shanghai JiaoTong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
^2.Dept. of Oral and Cranio-Maxillofacial Surgery, Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine; College of Stomatology, Shanghai JiaoTong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
^3.School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200011, China

Received:2022-06-26 Revised:2022-10-25 Online:2022-12-01 Published:2022-11-23
Contact: Zhang Shilei E-mail:Evan-lin@sjtu.edu.cn;leinnymd@hotmail.com
Supported by:
Science and Technology Suppont Project of Shanghai Science and Technology Committee(20S31902200);Correspondence: Zhang Shilei, E-mail: leinnymd@hotmail.com

摘要/Abstract

摘要：

目的搭建基于混合现实（MR）及红外光学定位的手术导航系统，并评估其在颅颌面创伤骨整复中的临床适用性。方法集成基于MR技术和光学定位追踪的软硬件系统，并完善系统工作流程；通过3D打印头颅模型实验，分析该系统的系统误差、目标配准误差和截骨应用误差；进一步通过颧上颌骨复合体（ZMC）复位的模型实验和额骨缺损修复的初步临床应用，探讨该系统的适用性。结果本MR手术导航系统的系统误差为（1.23±0.52）mm，目标配准误差为（2.83±1.18）mm，截骨应用误差为（3.13±1.66）mm；ZMC模型虚拟手术规划流畅，复位顺利；本系统引导下的额骨缺损修复重建手术过程顺利，重建效果满意。结论本研究搭建的MR手术导航系统具有虚实融合效果佳、动态导航稳定性好的优点，其在颅颌面外科的医患沟通、医学教育、术前规划和术中导航等各方面都具有应用潜力。

关键词: 颅颌面外科, 混合现实, 手术导航, 虚拟手术, 修复重建

Abstract:

Objective This study aimed to build a surgical navigation system based on mixed reality (MR) and optical positioning technique and evaluate its clinical applicability in craniomaxillofacial trauma bone reconstruction. Me-thods　We first integrated the software and hardware platforms of the MR-based surgical navigation system and explored the system workflow. The systematic error, target registration error, and osteotomy application error of the system were then analyzed via 3D printed skull model experiment. The feasibility of the MR-based surgical navigation system in craniomaxillofacial trauma bone reconstruction was verified via zygomatico-maxillary complex (ZMC) reduction experiment of the skull model and preliminary clinical study. Results The system error of this MR-based surgical navigation system was 1.23 mm±0.52 mm, the target registration error was 2.83 mm±1.18 mm, and the osteotomy application error was 3.13 mm±1.66 mm. Virtual surgical planning and the reduction of the ZMC model were successfully conducted. In addition, with the guidance of the MR-based navigation system, the frontal bone defect was successfully reconstructed, and the clinical outcome was satisfactory. Conclusion The MR-based surgical navigation system has its advantages in virtual reality fusion effect and dynamic navigation stability. It provides a new method for doctor-patient communications, education, preoperative planning, and intraoperative navigation in craniomaxillofacial surgery.

Key words: craniomaxillofacial surgery, mixed reality, surgical navigation, virtual surgery, reconstruction

中图分类号:

R 782.05

林承重, 张勇, 董韶, 吴锦阳, 张楚茜, 万新军, 张诗雷. 基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究[J]. 华西口腔医学杂志, 2022, 40(6): 676-684.

Lin Chengzhong, Zhang Yong, Dong Shao, Wu Jinyang, Zhang Chuxi, Wan Xinjun, Zhang Shilei. Application of mixed reality-based surgical navigation system in craniomaxillofacial trauma bone reconstruction[J]. West China Journal of Stomatology, 2022, 40(6): 676-684.

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参考文献 29

1	Juergens P, Beinemann J, Zandbergen M, et al. A computer-assisted diagnostic and treatment concept to increase accuracy and safety in the extracranial correction of cranial vault asymmetries[J]. J Oral Maxillofac Surg, 2012, 70(3): 677-684.
2	Schramm A, Suarez-Cunqueiro MM, Barth EL, et al. Computer-assisted navigation in craniomaxillofacial tumors[J]. J Craniofac Surg, 2008, 19(4): 1067-1074.
3	Chen Q, Zhao Y, Shen G, et al. Etiology and pathogenesis of hemifacial microsomia[J]. J Dent Res, 2018, 97(12): 1297-1305.
4	Gui H, Wu J, Shen SG, et al. Navigation-guided lateral gap arthroplasty as the treatment of temporomandibular joint ankylosis[J]. J Oral Maxillofac Surg, 2014, 72(1): 128-138.
5	Yu H, Shen SG, Wang X, et al. The indication and application of computer-assisted navigation in oral and maxillofacial surgery—Shanghai's experience based on 104 cases[J]. J Craniomaxillofac Surg, 2013, 41(8): 770-774.
6	Demian N, Pearl C, Woernley TC 3rd, et al. Surgical navigation for oral and maxillofacial surgery[J]. Oral Maxillofac Surg Clin North Am, 2019, 31(4): 531-538.
7	Tepper OM, Rudy HL, Lefkowitz A, et al. Mixed reality with holoLens: where virtual reality meets augmented reality in the operating room[J]. Plast Reconstr Surg, 2017, 140(5): 1066-1070.
8	Andrews C, Southworth MK, Silva JNA, et al. Extended reality in medical practice[J]. Curr Treat Options Cardiovasc Med, 2019, 21(4): 18.
9	Hu HZ, Feng XB, Shao ZW, et al. Application and prospect of mixed reality technology in medical field[J]. Curr Med Sci, 2019, 39(1): 1-6.
10	Pelanis E, Kumar RP, Aghayan DL, et al. Use of mixed reality for improved spatial understanding of liver anatomy[J]. Minim Invasive Ther Allied Technol, 2020, 29(3): 154-160.
11	Brun H, Bugge RAB, Suther LKR, et al. Mixed reality holograms for heart surgery planning: first user experience in congenital heart disease[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(8): 883-888.
12	Noorlag R, de Bree R, Witjes MJH. Image-guided surgery in oral cancer: toward improved margin control[J]. Curr Opin Oncol, 2022, 34(3): 170-176.
13	Lee GK, Moshrefi S, Fuertes V, et al. What is your reality? Virtual, augmented, and mixed reality in plastic surgery training, education, and practice[J]. Plast Reconstr Surg, 2021, 147(2): 505-511.
14	O’Reilly MK, Heagerty PJ, Gold LS, et al. Augmented reality[J]. AJNR Am J Neuroradiol, 2020, 41(8): E67-E68.
15	Verhey JT, Haglin JM, Verhey EM, et al. Virtual, augmented, and mixed reality applications in orthopedic surgery[J]. Int J Med Robot, 2020, 16(2): e2067.
16	Widmann G, Stoffner R, Bale R. Errors and error management in image-guided craniomaxillofacial surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 107(5): 701-715.
17	Sun Q, Mai Y, Yang R, et al. Fast and accurate online calibration of optical see-through head-mounted display for AR-based surgical navigation using Microsoft HoloLens[J]. Int J Comput Assist Radiol Surg, 2020, 15(11): 1907-1919.
18	Tu P, Gao Y, Lungu AJ, et al. Augmented reality based navigation for distal interlocking of intramedullary nails utilizing Microsoft HoloLens 2[J]. Comput Biol Med, 2021, 133: 104402.
19	Koivukangas T, Katisko JP, Koivukangas JP. Technical accuracy of optical and the electromagnetic tracking systems[J]. Springerplus, 2013, 2(1): 90.
20	Mahmoud N, Grasa ÓG, Nicolau SA, et al. On-patient see-through augmented reality based on visual SLAM[J]. Int J Comput Assist Radiol Surg, 2017, 12(1): 1-11.
21	Wu Y, Tang F, Li H. Image-based camera localization: an overview[J]. Vis Comput Ind Biomed Art, 2018, 1(1): 8.
22	Incekara F, Smits M, Dirven C, et al. Clinical feasibility of a wearable mixed-reality device in neurosurgery[J]. World Neurosurg, 2018, 118: e422-e427.
23	McJunkin JL, Jiramongkolchai P, Chung W, et al. Deve-lopment of a mixed reality platform for lateral skull base anatomy[J]. Otol Neurotol, 2018, 39(10): e1137-e1142.
24	Fotouhi J, Unberath M, Song T, et al. Co-localized augmented human and X-ray observers in collaborative surgical ecosystem[J]. Int J Comput Assist Radiol Surg, 2019, 14(9): 1553-1563.
25	Gibby W, Cvetko S, Gibby A, et al. The application of augmented reality-based navigation for accurate target acquisition of deep brain sites: advances in neurosurgical guidance[J]. J Neurosurg, 2021, 17: 1-7.
26	House PM, Pelzl S, Furrer S, et al. Use of the mixed reality tool “VSI Patient Education” for more comprehensible and imaginable patient educations before epilepsy surgery and stereotactic implantation of DBS or stereo-EEG electrodes[J]. Epilepsy Res, 2020, 159: 106247.
27	Wu X, Liu R, Yu J, et al. Mixed reality technology launches in orthopedic surgery for comprehensive preoperative management of complicated cervical fractures[J]. Surg Innov, 2018, 25(4): 421-422.
28	Radtke A, Sotiropoulos GC, Molmenti EP, et al. Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8-year period[J]. Ann Surg, 2010, 252(5): 876-883.
29	Coelho G, Figueiredo EG, Rabelo NN, et al. Development and evaluation of pediatric mixed-reality model for neuroendoscopic surgical training[J]. World Neurosurg, 2020, 139: e189-e202.

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基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究

Application of mixed reality-based surgical navigation system in craniomaxillofacial trauma bone reconstruction

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