计算机辅助计划和眼眶手术：眼球突出复位中截骨大小的患者相关预测
Computer assisted planning and orbital surgery: patient-related prediction of osteotomy size in proptosis reduction
摘要：
背景：眼球突出的特征是由于眼眶组织体积增加而导致眼球突出。为了恢复正常的眼球定位，最常见的手术技术包括眶壁截骨术结合眼球上的手动加载。目前只有一个粗略的临床规则可供外科医生使用，但它对这项技术毫无用处。第一个生物力学模型处理眼球突出减少，在一个病人的验证，已提出了作者。方法：本文提出了一个规则，改善术前计划的截骨大小在眼球突出减少。患者相关的多孔弹性有限元模型结合敏感性研究，提出了两个临床规则，以改善术前计划的眼球突出减少。该多孔弹性模型在12名患者上运行。敏感性研究允许建立骨切除术大小、患者相关眼眶体积、减压组织体积和眼球后移之间的关系。结果：眼球位移和截骨大小呈非线性关系：提出了指数规律。患者相关的眼眶体积显示出显著的影响：已经建立了像截骨大小、眼眶体积和目标眼球突出的双二次分析方程。解释：从患者相关的生物力学有限元模型推导出的两个过程规则已被提出用于眼球突出复位计划。由于只需要矢状位X线摄影，因此将过程规则实施到临床环境中很容易。可以使用光学引导仪器监测截骨术尺寸。
英文摘要：
BACKGROUND: Proptosis is characterized by a protrusion of the eyeball due to an increase of the orbital tissue volume. To recover a normal eyeball positioning, the most frequent surgical technique consists in the osteotomy of orbital walls combined with the manual loading on the eyeball. Only a rough clinical rule is currently available for the surgeons but it is useless for this technique. The first biomechanical model dealing with proptosis reduction, validated in one patient, has been previously proposed by the authors. METHODS: This paper proposes a rule improving the pre-operative planning of the osteotomy size in proptosis reduction. Patient-related poroelastic FE models combined with sensitivity studies were used to propose two clinical rules to improve the pre-operative planning of proptosis reduction. This poroelastic model was run on 12 patients. Sensitivity studies permitted to establish relationships between the osteotoemy size, the patient-related orbital volume, the decompressed tissue volume and the eyeball backward displacement. FINDINGS: The eyeball displacement and the osteotomy size were non-linearly related: an exponential rule has been proposed. The patient-related orbital volume showed a significant influence: a bi-quadratic analytical equation liking the osteotomy size, the orbital volume and the targeted eyeball protrusion has been established. INTERPRETATION: Two process rules derived from patient-related biomechanical FE models have been proposed for the proptosis reduction planning. The implementation of the process rules into a clinical setting is easy since only a sagittal radiography is required. The osteotomy size can be monitored using optical guided instruments.
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