Zeng Canjun, Xing Weirong, Wu Zhanglin, Huang Huajun, Huang Wenhua
Department of Orthopedics, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics Guangdong Province, Guangzhou, Guangdong 510630, China; Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong 510515, China.
Musculoskeletal Disease Center, Jerry L. Pettis Memorial VA Medical Center, Research Service, 11201 Benton St, Loma Linda, CA 92357, USA.
Injury. 2016 Oct;47(10):2223-2227. doi: 10.1016/j.injury.2016.03.015. Epub 2016 Mar 17.
Treatment of acetabular fractures remains one of the most challenging tasks that orthopaedic surgeons face. An accurate assessment of the injuries and preoperative planning are essential for an excellent reduction. The purpose of this study was to evaluate the feasibility, accuracy and effectiveness of performing 3D printing technology and computer-assisted virtual surgical procedures for preoperative planning in acetabular fractures. We hypothesised that more accurate preoperative planning using 3D printing models will reduce the operation time and significantly improve the outcome of acetabular fracture repair.
Ten patients with acetabular fractures were recruited prospectively and examined by CT scanning. A 3-D model of each acetabular fracture was reconstructed with MIMICS14.0 software from the DICOM file of the CT data. Bone fragments were moved and rotated to simulate fracture reduction and restore the pelvic integrity with virtual fixation. The computer-assisted 3D image of the reduced acetabula was printed for surgery simulation and plate pre-bending. The postoperative CT scan was performed to compare the consistency of the preoperative planning with the surgical implants by 3D-superimposition in MIMICS14.0, and evaluated by Matta's method.
Computer-based pre-operations were precisely mimicked and consistent with the actual operations in all cases. The pre-bent fixation plates had an anatomical shape specifically fit to the individual pelvis without further bending or adjustment at the time of surgery and fracture reductions were significantly improved. Seven out of 10 patients had a displacement of fracture reduction of less than 1mm; 3 cases had a displacement of fracture reduction between 1 and 2mm.
The 3D printing technology combined with virtual surgery for acetabular fractures is feasible, accurate, and effective leading to improved patient-specific preoperative planning and outcome of real surgery. The results provide useful technical tips in planning pelvic surgeries.
髋臼骨折的治疗仍是骨科医生面临的最具挑战性的任务之一。准确评估损伤情况和进行术前规划对于实现良好的复位至关重要。本研究的目的是评估3D打印技术和计算机辅助虚拟手术操作在髋臼骨折术前规划中的可行性、准确性和有效性。我们假设使用3D打印模型进行更准确的术前规划将减少手术时间并显著改善髋臼骨折修复的效果。
前瞻性招募10例髋臼骨折患者并进行CT扫描。利用MIMICS14.0软件从CT数据的DICOM文件重建每个髋臼骨折的三维模型。移动和旋转骨碎片以模拟骨折复位并通过虚拟固定恢复骨盆完整性。将复位后的髋臼的计算机辅助3D图像打印出来用于手术模拟和钢板预弯。术后进行CT扫描，通过MIMICS14.0中的三维叠加比较术前规划与手术植入物的一致性，并采用Matta方法进行评估。
所有病例中基于计算机的术前操作均被精确模拟且与实际手术一致。预弯的固定钢板具有适合个体骨盆的解剖形状，手术时无需进一步弯曲或调整，骨折复位明显改善。10例患者中有7例骨折复位移位小于1mm；3例骨折复位移位在1至2mm之间。
3D打印技术结合髋臼骨折虚拟手术是可行、准确且有效的，可改善针对患者的术前规划和实际手术效果。研究结果为骨盆手术规划提供了有用的技术提示。
