Abstract：
OBJECTIVE: Virtual surgical planning (VSP) has gained acceptance because of its benefits in obtaining adequate resection, achieving cephalometric accuracy, and reducing operative time. The aim of this study is to compare the rate of union between VSP and free-hand surgery (FHS), identify predictors of non-union and evaluate the difference in operative time.
METHODS: Post-operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS. Each apposition was graded as complete, partial or non-union. The rate of union, risk difference and inter-rater reliability were calculated. The difference in operative time was assessed. Predictors of non-union were identified using logistic regression.
RESULTS: A total of 326 appositions were graded (VSP n = 150; FHS n = 176). The rates of complete and partial union were higher with VSP than FHS (74.7% vs. 65.3%; 18% vs. 15.9%, respectively, p = 0.01). Non-union was found at a higher rate with FHS than with VSP (18.7% vs. 7.3%). The non-union risk difference was 11.4. FHS, major complications and apposition at the native bone were predictors of non-union (OR 2.9, p = 0.02; OR 3.4, p = 0.01; OR 2.5, p = 0.05, respectively). The mean surgical time was shorter with VSP than with FHS (265.3 vs. 381.5 min, p < 0.001). The inter-rater agreement was high (k = 0.85; ICC = 0.86).
CONCLUSIONS: VSP demonstrated significantly higher bony union rates and shorter operative time. FHS, development of major complications and apposition with native bone correlated with non-union.
METHODS: Post-operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS. Each apposition was graded as complete, partial or non-union. The rate of union, risk difference and inter-rater reliability were calculated. The difference in operative time was assessed. Predictors of non-union were identified using logistic regression.
RESULTS: A total of 326 appositions were graded (VSP n = 150; FHS n = 176). The rates of complete and partial union were higher with VSP than FHS (74.7% vs. 65.3%; 18% vs. 15.9%, respectively, p = 0.01). Non-union was found at a higher rate with FHS than with VSP (18.7% vs. 7.3%). The non-union risk difference was 11.4. FHS, major complications and apposition at the native bone were predictors of non-union (OR 2.9, p = 0.02; OR 3.4, p = 0.01; OR 2.5, p = 0.05, respectively). The mean surgical time was shorter with VSP than with FHS (265.3 vs. 381.5 min, p < 0.001). The inter-rater agreement was high (k = 0.85; ICC = 0.86).
CONCLUSIONS: VSP demonstrated significantly higher bony union rates and shorter operative time. FHS, development of major complications and apposition with native bone correlated with non-union.
摘要：
目的：虚拟手术计划（VSP）已被接受，因为它在获得足够的切除方面具有优势，达到头颅测量的准确性，减少手术时间。这项研究的目的是比较VSP和徒手手术（FHS）之间的结合率，确定不愈合的预测因素并评估手术时间的差异。
方法：回顾性分析了在2014年至2021年间使用VSP或FHS进行上颌骨或下颌骨重建的123例患者的术后CT。每个并置都被分级为完整的，部分或非联合。工会的速度，计算了风险差异和评估者间的可靠性。评估手术时间的差异。使用逻辑回归确定不愈合的预测因子。
结果：共对326个并置进行了分级（VSPn=150；FHSn=176）。VSP的完全和部分结合率高于FHS(74.7%vs.65.3%；18%与15.9%,分别,p=0.01)。FHS的不愈合率高于VSP（18.7％vs.7.3%）。非工会风险差异为11.4。FHS,主要并发症和天然骨并置是不愈合的预测因素(分别为OR2.9,p=0.02;OR3.4,p=0.01;OR2.5,p=0.05).VSP的平均手术时间短于FHS（265.3vs.381.5min,p<0.001)。评估者之间的协议很高(k=0.85；ICC=0.86)。
结论：VSP表现出较高的骨愈合率和较短的手术时间。FHS,主要并发症的发展和与天然骨的并置与不愈合相关。
方法：回顾性分析了在2014年至2021年间使用VSP或FHS进行上颌骨或下颌骨重建的123例患者的术后CT。每个并置都被分级为完整的，部分或非联合。工会的速度，计算了风险差异和评估者间的可靠性。评估手术时间的差异。使用逻辑回归确定不愈合的预测因子。
结果：共对326个并置进行了分级（VSPn=150；FHSn=176）。VSP的完全和部分结合率高于FHS(74.7%vs.65.3%；18%与15.9%,分别,p=0.01)。FHS的不愈合率高于VSP（18.7％vs.7.3%）。非工会风险差异为11.4。FHS,主要并发症和天然骨并置是不愈合的预测因素(分别为OR2.9,p=0.02;OR3.4,p=0.01;OR2.5,p=0.05).VSP的平均手术时间短于FHS（265.3vs.381.5min,p<0.001)。评估者之间的协议很高(k=0.85；ICC=0.86)。
结论：VSP表现出较高的骨愈合率和较短的手术时间。FHS,主要并发症的发展和与天然骨的并置与不愈合相关。
