利用影像融合技術評估三維電腦輔助設計／電腦輔助製造（3D CAD/CAM）下頷骨重建手術準確度

手術中電腦斷層作為神經外科、骨科手術以及整形外科的手術導引方式外，也可用於手術中來掃描手術部位以確認手術情形。下頷骨重建手術常用於外傷或是惡性腫瘤之病人進行部分切除導致顏面骨頭缺損，若無進行重建手術，除導致外觀歪斜之外，該病人剩下的健康部位無法適當的進行咬合，對其日常生理機能常造成巨大的困擾。三維電腦輔助設計／電腦輔助製造（3D CAD/CAM）列印技術是目前常用自體骨移植下頷骨重建手術的輔助方法，本研究提出一種以術後下頷骨體積交集於術前3D列印體積百分比作為量化驗證方法，以術後下頷骨與3D列印模型進行影像融合之後方可進行交集體積邏輯運算，故其交集體積百分比越大則可視為越接近最佳之手術結果。故本研究同樣會將軟體本身之自動化分割之交集體積結果與手動修正後處理進行分析比較，選擇出一種效率與準確度較高之方法來輔助手術結果判讀。本研究收集八名個案年齡介於33至64歲，皆為惡性腫瘤侵犯到下頷骨進行部分骨頭切除術。在手術後，以術前3D列印假體與術後下頷骨影像融合，以自動分割加手動修正建立物件後可得病人術後之顏面骨體積與立體圖形，並以交集體積換算交集體積百分比即得手術準確度。本方法提供臨床醫師一個可信度極高的數據，可以更容易的輔助醫師手術，同時也可以大幅提升病人的預後，增進病人術後的良好生活型態。

關鍵字

手術中電腦斷層；三維電腦輔助設計／電腦輔助製造；下頷骨重建手術

並列摘要

Intra-operative computed tomography is not only used as a guide method for neurosurgery, orthopedic surgery, and plastic, but also can be used during surgery to scan the surgical site to confirm the surgical situation. Mandibular reconstruction surgery is often used in facial bone defects after traumatic injuries or in patients with malignant tumors receiving partial resection. If reconstruction surgery is not performed, the remaining healthy parts of the patient cannot be properly occluded, this not only results in the appearance of skew but also the impairment of daily physiological function. Three-dimensional computer-aided design / computer-aided manufacturing (3D CAD / CAM) printing technology is currently an alternative method for autograft mandibular reconstruction surgery. The present study provided a quantitative verification method. After the image fusion between the postoperative mandible and the preoperative 3D printing model, the intersection volume could be performed. Consequently, the larger the intersection volume percentage, the closer to the best surgical result was suspect. Meanwhile, we also compared the intersection volume calculating by the automatic segmentation in the software with the volume calculating by manual correction. Then we chose one of the two methods with higher efficiency and accuracy to assist in the interpretation of the surgical results. In this study, eight cases aged between 33 and 64 years old were collected, and all of them received bone resection owing to the mandible bone invaded by malignant tumors. After the operation, the image of preoperative 3D printed prosthesis was fused with the postoperative mandible image. After automatic segmentation and manual correction to create the object, the postoperative volume and three-dimensional images of facial bone could be obtained. The accuracy of surgery could also be evaluated by converting the intersection volume percentage to the intersection volume. This method provides clinicians with highly reliable data, which can more easily assist doctors in surgery, greatly improve the patient's prognosis, and the patient's postoperative quality of life.

並列關鍵字

Intra-operative computed tomography ； 3D CAD/CAM ； Mandible reconstruction surgery

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利用影像融合技術評估三維電腦輔助設計／電腦輔助製造（3D CAD/CAM）下頷骨重建手術準確度

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