目标:尽管人们对计算机引导的微型船员的安置感兴趣,很少有研究考虑了可能影响准确性的关键因素。这项研究的目的是评估动态计算机辅助手术(d-CAS)中pal穹顶形态和微型船员长度对微型船员插入准确性的影响。
方法:将24名受试者分为三组,根据他们的腭穹顶形态(A组:中等;B组:陡峭/高;C组:低/平坦)和使用的微型船员的长度。对于每个主题,使用动态导航系统插入了两个小型机器人。为了评估插入的准确性,进行了术后CBCT,和术前和术后扫描叠加。评估了五个变量:Entry-3D,Entry-2D,Apex-3D,顶点垂直和角度偏差。描述性统计,夏皮罗-威尔克,使用Kruskal-Wallis和Dunn检验进行统计分析。显著性水平为P≤0.05。
结果:平均角度偏差值显示各组之间存在很大差异(A组:7.11°±5.70°;B组:13.30°±7.76°;C组:4.92°±3.15°),在Apex-3D(P=0.036)和角度偏差(P=0.008)方面存在显着差异。Dunn检验显示,中/高/陡腭组之间的角度偏差存在差异(P=0.004),在低/平坦和高/陡峭的腭组之间(P=0.01),但没有证实Apex-3D参数的任何显着差异(A-B组P=0.10;B-C组,P=0.053;A-C组,P=1.00)。关于小条的长度没有发现显着差异。
结论:Palatal拱顶形态是影响d-CAS中微型船员插入准确性的因素。在有陡峭和高腭拱顶的受试者中,当考虑角度偏差值时,插入精度较低。Miniscrew长度不影响准确性。
结论:尽管计算机引导的手术可以帮助临床医生防止对附近解剖结构的损伤,个体解剖变异性是一个需要考虑的关键变量。在高/陡腭的受试者中,在规划阶段应给予更多关注,以便与相邻解剖结构保持较大的距离,从而获得更好的结果.
The aim of this study was to evaluate the influence of palatal vault morphology and screw length on the accuracy of miniscrew insertion in dynamic computer-assisted surgery (d-CAS).
Twenty-four subjects were allocated into three groups, according to their palatal vault morphology (Group A: medium; Group B: steep/high; Group C: low/flat) and the length of miniscrew used. For each subject, two miniscrews were inserted using a dynamic navigation system. To assess the accuracy of insertion, a postoperative CBCT was performed, and the pre- and post-operative scans were superimposed. Five variables were evaluated: Entry-3D, Entry-2D, Apex-3D, Apex-vertical and angular deviation. Descriptive statistics, Shapiro-wilk, Kruskal-Wallis and Dunn\'s tests were used for the statistical analysis. The level of significance was P ≤ 0.05.
The mean angular deviation values revealed strong discrepancies amongst the groups (Group A:7.11°±5.70°; Group B:13.30°±7.76°; Group C:4.92°±3.15°) and significant differences were found regarding the Apex-3D (P = 0.036) and angular deviations (P = 0.008). A Dunn\'s test revealed differences in angular deviation between the medium and high/steep palate group (P = 0.004), and between low/flat and high/steep palate group (P = 0.01) but did not confirm any significant difference in the Apex-3D parameter (Group A-B P = 0.10; Group B-C, P = 0.053; Group A-C, P = 1.00). No significant differences were found regarding the length of the miniscrews.
Palatal vault morphology is a factor that influences the accuracy of miniscrew insertion in d-CAS. In subjects with steep and high palatal vaults, insertion accuracy is lower when considering the angular deviation value. Miniscrew length does not influence accuracy.
Although computer-guided surgery assists the clinician in preventing damage to nearby anatomical structures, individual anatomical variability is a crucial variable. In subjects with a high/steep palate, greater attention should be paid during the planning phase in order to allow for a wide margin from adjacent anatomical structures to achieve better outcomes.