Maini Lalit, Verma Tarun, Sharma Amit, Sharma Ankur, Mishra Abhishek, Jha Sunil
Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
C-40, Omkar Society, Maneja, Vadodara, Gujarat, 390013, India.
Arch Orthop Trauma Surg. 2018 Apr;138(4):495-504. doi: 10.1007/s00402-018-2868-2. Epub 2018 Jan 24.
Acetabular fractures are amongst the most challenging fractures to treat because of complex anatomy. Open reduction and internal fixation remains the standard treatment for displaced acetabular fractures to achieve anatomical reduction as in any other intra-articular fracture. Patient-specific pre-contoured reconstruction plate template made by a pre-operative virtual surgical planning can be useful to respect patient's morphology, reduce surgical invasiveness and simplify the surgical procedure. Proper evaluation and surgical planning is necessary to achieve these goals. The goal of this study was to evaluate the outcomes of using virtual surgical planning and virtually pre-contoured plate template in comparison with the conventional method of intra-operative contouring of reconstruction plate for acetabular fracture fixation.
Twenty-five patients were categorized into group A and B by computerized randomization. In group A (12 patients), CT-based virtual surgical planning was done using Mimics and 3-Matic software to form virtually pre-contoured plates, which were 3D printed to act as templates over which 3.5 mm reconstruction plates were manually contoured pre-operatively and used for fixation. In group B (13 patient), conventional method of intra-operative contouring to adapt the plate to the fracture region was followed. Blood loss, surgical time, reduction on X-rays and post-operative computed tomography were compared between two groups.
Duration of surgery and total blood loss were found to be less while reduction was found to satisfactory/anatomical in higher percentage of Group A than Group B patients.
Virtual surgical planning, patient-specific virtually pre-contoured plate template and 3D printing technology improve the outcomes of acetabular fracture surgery by reducing duration and invasiveness of surgery and improving the quality of reduction. However, studies with larger sample size are required to further validate it.
髋臼骨折因其解剖结构复杂，是最难治疗的骨折之一。与其他关节内骨折一样，切开复位内固定仍然是移位髋臼骨折实现解剖复位的标准治疗方法。通过术前虚拟手术规划制作的患者特异性预塑形重建钢板模板，有助于尊重患者的形态，减少手术创伤并简化手术过程。要实现这些目标，进行适当的评估和手术规划是必要的。本研究的目的是评估与传统的术中塑形重建钢板治疗髋臼骨折固定方法相比，使用虚拟手术规划和虚拟预塑形钢板模板的效果。
通过计算机随机化将25例患者分为A组和B组。在A组（12例患者）中，使用Mimics和3-Matic软件基于CT进行虚拟手术规划，以形成虚拟预塑形钢板，将其3D打印作为模板，在其上术前手动塑形3.5mm重建钢板并用于固定。在B组（13例患者）中，采用传统的术中塑形方法使钢板适应骨折区域。比较两组之间的失血量、手术时间、X线片上的复位情况以及术后计算机断层扫描结果。
发现A组患者的手术时间和总失血量较少，且A组患者复位满意/解剖复位的比例高于B组。
虚拟手术规划、患者特异性虚拟预塑形钢板模板和3D打印技术通过减少手术时间和创伤并提高复位质量，改善了髋臼骨折手术的效果。然而，需要更大样本量的研究来进一步验证。
