하악골 재건을 위한 가상수술계획 시스템

김한나(Hannah Kim),김영준(Youngjun Kim),조현철(Hyunchul Cho),심응준(Eung June Shim),이득희(Deukhee Lee),김래현(Laehyun Kim),박세형(Sehyung Park),이정우(Jung-Woo Lee) (사)한국CDE학회 2016 한국CDE학회 논문집 Vol.21 No.2

In this paper, we propose a virtual surgical planning system specialized to mandible reconstruction surgery. Mandible reconstruction surgery is one of the most difficult surgeries, even for experienced surgeons. Compared to the traditional surgical procedures, virtual surgical planning can reduce the operation time in operating room while expecting better surgical outcome with optimized planning. However, with existing software systems, it requires much time and manual operations in virtual surgical planning. To reduce preparation time and improve accuracy of virtual surgical planning, we have developed optimized functions for virtual surgical simulation of mandible reconstruction with user-friendly interface. We found that the proposed system shortened the preparation time by half compared to the existing system from the experiments. The proposed system supports surgeons to make accurate plan faster and easier. The virtually planned results are used to make surgical cutting guide by 3D printing, and this will enhance surgical performance in operating room.

슬관절 전치환술(Total knee replacement)에서의 CT-based surgical planning의 유용성 평가

김창곤(Chang Kon Kim),허재윤(Jae Yoon Hue),박재훈(Jae Hoon Park),범희남(Hee Nam-Kim),선종백(Jong Back Sun),장영일(Yong Yil Chang) 대한CT영상기술학회 2007 대한CT영상기술학회지 Vol.9 No.1

Purpose This study is to compare the radiologic results of limb alignment after total knee replacement(TKR) using CT-based surgical planning system(Robodoc system) and conventional system. Materials and methods From July 2004 to December 2006, We selected that 25cases were operated TKR using CT-based surgical planning(group A) and conventional method(group B). We measured mechanical femoro-tibial angle, femoral and tibial component angle in coronal. and sagittal plane using the weight bearing whole leg radiograph taken 1-month postoperatively. Results Mechanical femoro-tibial angle was 0.73° of valgus in CT-based surgical planning group(group A) and 2.53° of valgus in conventional group(group B) on average. Mechanical femoro-tibial angle was significantly more accurate in group A than group B. Femoral and tibial component angle in the coronal plane was 91.09° and 89.49° in group A, 91.70° and 89.52° in group B on average. Femoral and tibial component angle in the sagittal plane was 89.12° and 88.29° in group A, 88.19° and 88.49° in group B on average. There were no signigicant differences between two groups in the femoral and tibial component angle in coronal and sagittal plane. Conclusion According to the results CT-based surgical planning system(Robodoc system) helped increase alignment accuracy of the lower extremity in total knee replacement(TKR).

Total joint reconstruction using computer-assisted surgery with stock prostheses for a patient with bilateral TMJ ankylosis

Rhee, Seung-Hyun,Baek, Seung-Hak,Park, Sang-Hun,Kim, Jong-Cheol,Jeong, Chun-Gi,Choi, Jin-Young Korean Association of Maxillofacial Plastic and Re 2019 Maxillofacial Plastic Reconstructive Surgery Vol.41 No.-

Backgrounds: The purpose of this study is to discuss the total joint reconstruction surgery for a patient with recurrent ankylosis in bilateral temporomandibular joints (TMJs) using three-dimensional (3D) virtual surgical planning, computer-aided manufacturing (CAD/CAM)-fabricated surgical guides, and stock TMJ prostheses. Case presentation: A 66-year-old female patient, who had a history of multiple TMJ surgeries, complained of severe difficulty in eating and trismus. The 3D virtual surgery was performed with a virtual surgery software (FACEGIDE, MegaGen implant, Daegu, South Korea). After confirmation of the location of the upper margin for resection of the root of the zygoma and the lower margin for resection of the ankylosed condyle, and the position of the fossa and condyle components of stock TMJ prosthesis (Biomet, Jacksonville, FL, USA), the surgical guides were fabricated with CAD/CAM technology. Under general anesthesia, osteotomy and placement of the stock TMJ prosthesis (Biomet) were carried out according to the surgical planning. At 2 months after the operation, the patient was able to open her mouth up to 30 mm without complication. Conclusion: For a patient who has recurrent ankylosis in bilateral TMJs, total joint reconstruction surgery using 3D virtual surgical planning, CAD/CAM-fabricated surgical guides, and stock TMJ prostheses may be an effective surgical treatment option.

정기구학 및 역기구학을이용한하지 교정절골술 계획 생성

정지원(Jiwon Jeong),이승열(Seung Yeol Lee),윤기범(Kibeom Youn),박문석(Moon Seok Park),이제희(Jehee Lee) 한국컴퓨터그래픽스학회 2014 컴퓨터그래픽스학회논문지 Vol.20 No.1

뇌성마비에서 나타나는 하지 변형은 정상 보행 및 자세 유지에 어려움을 준다. 이를 교정하기 위해 임상의는 변형 정도를 측정하여 교정 절골술 계획을 수립하고 계획된 정도만큼 절골술을 시행한다. 그러나 절골술 시행 후 원래 계획보다 더 적거나 더 많이 교정되는 상황이나 의도치 않았던 변형이 발견되는 상황이 종종 발생한다. 이러한 문제 상황들이 발생하는 이유는 절골술 계획수립 시, 기존의 방법이 하지골의 정확한 형태학적 정보를 반영하기 어렵고 하지골을 절골하여 회전 시키는 정도에 따라 최종 결과가 어떻게 나오는지 사전에 예측하는 것이 쉽지 않으며 효과적인 교정 결과를 얻을 수 있는 절골술 방법, 회전각도 등 다양한 입력 조건의 최적 조합을 찾기가 어렵기 때문이다. 본 논문은 이를 해결하기 위해 컴퓨터 그래픽스 분야의 정기구학, 역기구학 및 최적화 기법을 하지 교정 절골술에 적용하여 임상의가 최적의 절골술 계획을 수립할 수 있도록 하는 방법을 제안한다. 하지 골의 3차원 메쉬 모델을 입력으로 받아 이를 분석하여 하지 특징점을 추출하고 임상지표를 자동으로 계산하여 변형 정도를 파악하는 방법, 하지 골을 대상으로 하는 5가지 교정 절골술의 시뮬레이션을 통해 그 결과를 사전에 예측할 수 있는 방법 그리고 비선형 최적화 문제로 변환하여 최적 교정 절골술 계획을 자동으로 수립하는 방법을 제안한다. 이를 통해 하지 골 교정 절골술과 관련된 거의 모든 경우의 수를 사전에 확인해 볼 수 있어서 종래의 방법보다 훨씬 쉽고 효율적으로 절골술을 계획하고 실행할 수 있을 것이다. Patients with cerebral palsy or arthritis have deformities in lower limb which cause unstable gait or posture and pains. Surgeons perform a deformity correction osteotomy with surgical plan. But sometimes they find the unexpected angular or rotational deformation after surgery. The problems are that there is no method to predict the result of a surgical plan and also there are so many factors to must consider in surgical planning step such as clinical measurements, rotation angle, wedge angle, morphology of lower limb, etc. This paper presents new methods for planning the deformity correction osteotomy efficiently. There are two approaches based on the 3D mesh model and the accurate assessment of the patient’s lower limb. One is the manual presimulation of surgery using forward kinematics. And the other is the automatic surgical planning using inverse kinematics and nonlinear optimization. Using these methods, we can predict and verify the results of various surgical treatments and also we can find a more effective surgical plan easily compared to conventional methods.

Computer-Aided Surgical Planning을 이용한 안면비대칭 III급 환자의 조기 양악 수술

최혜리(He-Li Choi),최태현(Tae-Hyun Choi),윤필영(Pil-Young Yun),이남기(Nam-Ki Lee) 대한치과교정학회 2024 대한치과교정학회 임상저널 Vol.14 No.1

Surgical-orthodontic treatment is aimed to restore occlusal function, harmonize a maxillofacial complex, and improve facial esthetics. As patients with dentofacial deformities desire an immediate improvement of appearance, surgery-first or surgery-early approach with minimal presurgical orthodontics has been reported. In addition, three-dimensional analysis using CBCT and computer-aided surgical planning (CASP) have made it possible to perform more accurate treatment plans for orthognathic surgery. This case report describes a successful surgery-early approach in a Class III patient with facial asymmetry. A 23-year-old male patient presented to our clinic with facial asymmetry and mandibular prognathism. The three-dimensional analysis showed mandibular deviation to the right side due to overgrowth of the left mandibular body, and the dentition presented canting of the occlusal plane to the left side with dental compensation of the maxillary right molars. Minimal presurgical orthodontic treatment was performed to improve arch coordination and eliminate premature contacts to achieve stable postoperative maxillo-mandibular relation. Afterward, canting correction and superior impaction of the posterior maxilla, and differential setback of the mandible were planned using CASP. Early bimaxillary surgery was performed with a 3D printed wafer. After a total of 20 months, the patient achieved a favorable facial profile and functional occlusion as planned. (Clin J Korean Assoc Orthod 2024;14(1):21-32)

Computed Tomography-Based Preoperative Simulation System for Pedicle Screw Fixation in Spinal Surgery

Woochan Wi,박상민,신병석 대한의학회 2020 Journal of Korean medical science Vol.35 No.18

Background: A preoperative planning system facilitates improving surgical outcomes that depend on the experience of the surgeons, thanks to real-time interaction between the system and surgeons. It visualizes intermediate surgical planning results to help surgeons discuss the planning. The purpose of this study was to demonstrate the use of a newly- developed preoperative planning system for surgeons less experienced in pedicle-screw fixation in spinal surgery, especially on patients with anatomical variations. Methods: The marching cubes algorithm, a typical surface extraction technique, was applied to computed tomography (CT) images of vertebrae to enable three-dimensional (3D) reconstruction of a spinal mesh. Real-time processing of such data is difficult, as the surface mesh extracted from high-resolution CT data is rough, and the size of the mesh is large. To mitigate these factors, Laplacian smoothing was applied, followed by application of a quadric error metric-based mesh simplification to reduce the mesh size for the level-of-detail (LOD) image. Taubin smoothing was applied to smooth out the rough surface. On a multiplanar reconstruction (MPR) cross-sectional image or a 3D model view, the insertion position and orientation of the pedicle screw were manipulated using a mouse. The results after insertion were then visualized in each image. Results: The system was used for pre-planning pedicle-screw fixation in spinal surgery. Using any pointing device such as a mouse, surgeons can manipulate the position and angle of the screws. The pedicle screws were easy to manipulate intuitively on the MPR images, and the accuracy of screw fixation was confirmed on a trajectory view and 3D images. After surgery, CT scans were performed again, and the CT images were checked to ensure that the screws were inserted properly. Conclusion: The preoperative planning system allows surgeons and students who are not familiar with pedicle-screw fixation to safely undertake surgery following preoperative planning. It also provides opportunities for screw-fixation training and simulation.

3D 프린팅을 활용한 인공슬관절 전치환술 계획수립

전용태(Yongtae Jun),임은하(Eun-Ha Lim) (사)한국CDE학회 2015 한국 CAD/CAM 학회 학술발표회 논문집 Vol.2015 No.동계

Generally, the pre-operative planning for TKR (Total Knee Replacement) surgery is accomplished based upon the X-ray, CT, or MRI scans of the patient’s knee conditions. However the existence of the 3D knee and the surgical instruments such as jigs and fixtures enables us to make an efficient surgical plan. In this work we shows the procedure of pre-operative plans using the 3D physical models of the patient’s knee and the surgical apparatus using 3D printing technology.

컴퓨터 보조 기반 치아 지지 서지컬 템프레이트를 이용한 상악구치부 임플란트 식립

김성민,김명주,이지호,명훈,이종호,김명진,Kim, Soung Min,Kim, Myung Joo,Lee, Jee Ho,Myoung, Hoon,Lee, Jong Ho,Kim, Myung Jin 대한악안면성형재건외과학회 2013 Maxillofacial Plastic Reconstructive Surgery Vol.35 No.6

Two patients with partial edentulous maxilla were scheduled to undergo installation of implant fixtures using a tooth-supported surgical template based on computer assisted treatment planning. After 3-dimensional (3D) computed tomographic scanning was transferred to the OnDemand3D (Cybermed Co., Seoul, Korea) software program for virtual planning, fixtures of MK III Groovy RP implant of the Br${\aa}$nemark System (Nobel Biocare AB Co., G$\ddot{o}$teborg, Sweden) was installed using the In2Guide (CyberMed Co., Seoul, Korea) tooth-supported surgical template with a Quick Guide Kit (Osstem Implant Co., Seoul, Korea) system in the posterior maxilla of each patient. Sinus floor elevation with a xenogenic bone graft procedure was also performed simultaneously in one patient. Fixture installations were completed successfully without complications, such as sinus mucosa perforation, bony bleedings, fenestrations, or others. During the last two-year follow-up period after prosthetics delivery, each implant was found to be fine with no other minor complications. The entire procedures are reported and the literatures on use of tooth-supported surgical template was reviewed.

Zonal analysis in contemporary aesthetic orthognathic surgical planning

Mehmet Manisali,Farhad B. Naini 대한악안면성형재건외과학회 2023 Maxillofacial Plastic Reconstructive Surgery Vol.45 No.-

Background The purpose of this article is to introduce the concept of zonal analysis in orthognathic surgical planning. Case presentation The importance of developing this concept of facial zonal analysis is because grouping together elements of aesthetic importance in a region in a systematic manner allows for accurate diagnosis and logical treatment planning. An orthognathic case presentation is described to demonstrate this concept. Discussion The three facial zones described are related in terms of the presenting problem and in relation to the changes envisaged with each planned surgical movement. The importance of developing this concept of facial zonal analysis is because grouping together elements of aesthetic importance in a region in a systematic manner allows for accurate diagnosis and logical treatment planning. Consideration is given to the negative features that require improvement and the positive features that the clinician and patient would prefer not to alter. It also provides an organised tool for postoperative comparison of results. The analysis and synthesis of the information provided from this approach can aid contemporary orthognathic surgical planning.

In the Extraordinary Times of Coronavirus Disease 2019: Clinical Strategies for Performing Spinal Surgery

Barry Tan Wei Loong,Jeanette Tan Sze Lyn Jasmin,Ashokka Balakrishnan,Lopez Keith Gerard,Thambiah Joseph,Kumar Naresh 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5

The coronavirus disease 2019 (COVID-19) pandemic has caused pronounced strain on global healthcare systems, forcing the streamlining of clinical activities and conservation of health resources. There is a pressing need for institutions to present discipline-specific strategies for the management of COVID-19 patients. We present the comprehensive considerations at the National University Hospital, Singapore from the surgeon’s and anesthetist’s perspectives in the performance of spinal surgery in COVID-19 patients. These are based on national guidelines and overarching principles of protection for the healthcare workers (HCWs) and efficiency in surgical planning. The workflow begins with the emergency department screening that has been adapted to the local epidemiology of COVID-19 in order to identify suspected/confirmed cases. If patient history cannot be obtained, demographic, clinical, and imaging data are used. Designated orthopedic “contaminated teams” are available 24/7 with an activation time of <30 minutes for review. In cases where sub-specialty spine surgeons were required, these professionals were inducted into the “contaminated team” and quarantined until cleared to return to work. Indications for emergency spine surgery were determined pre-emptively. Preoperative surgical considerations included the minimization of manpower, limited dissection, reduced operative time, and judicious use of equipment, leading to reduced aerosolization. Anesthesia considerations include preoperative screening for COVID-19–related concerns that influence surgery, operating room process planning and induction, intraoperative, reversal, recovery, and resuscitation considerations. Focused multi-disciplinary preoperative briefing facilitates familiarization. Surgical, anesthetic, and postoperative workflows were designed to reduce the risk of transmission and protect HCWs while effectively performing spinal surgery. The COVID-19 pandemic has necessitated paradigm shifts in healthcare planning, hospital workflows, and operative protocols. The viral burden does not discriminate between surgeons and physicians, and it is crucial that we, as medical professionals, adapt practices to be malleable and fluid to address the ever-changing developments.