Chana Rodríguez F, Pérez Mañanes R, Narbona Cárceles F J, Gil Martínez P
Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2018 Jul-Aug;62(4):231-239. doi: 10.1016/j.recot.2018.02.007. Epub 2018 May 25.
Preoperative 3D modelling enables more effective diagnosis and simulates the surgical procedure.
We report twenty cases of acetabular fractures with preoperative planning performed by pre-contouring synthesis plates on a 3D printed mould obtained from a computarized tomography (CT) scan. The mould impression was made with the DaVinci 1.0 printer model (XYZ Printing). After obtaining the printed hemipelvis, we proceeded to select the implant size (pelvic Matta system, Stryker) that matched the characteristics of the fracture and the approach to be used.
Printing the moulds took a mean of 385minutes (322-539), and 238grams of plastic were used to print the model (180-410). In all cases, anatomic reduction was obtained and intra-operative changes were not required in the initial contouring of the plates. The time needed to perform the full osteosynthesis, once the fracture had been reduced was 16.9minutes (10-24). In one case fixed with two plates, a postoperative CT scan showed partial contact of the implant with the surface of the quadrilateral plate. In the remaining cases, the contact was complete.
In conclusion, our results suggest that the use of preoperative planning, by printing 3D mirror imaging models of the opposite hemipelvis and pre-contouring plates over the mould, might effectively achieve a predefined surgical objective and reduce the inherent risks in these difficult procedures.
术前三维建模有助于更有效的诊断，并能模拟手术过程。
我们报告了20例髋臼骨折病例，术前规划是在通过计算机断层扫描（CT）获得的三维打印模具上使用预塑形合成板进行的。模具印记由达芬奇1.0打印机型号（XYZ Printing）制作。获得打印的半骨盆后，我们开始选择与骨折特征和拟采用的入路相匹配的植入物尺寸（骨盆马塔系统，史赛克）。
打印模具平均耗时385分钟（322 - 539分钟），打印模型使用了238克塑料（180 - 410克）。在所有病例中，均实现了解剖复位，并且在钢板的初始塑形过程中无需术中更改。骨折复位后进行完整接骨术所需的时间为16.9分钟（10 - 24分钟）。在一例使用两块钢板固定的病例中，术后CT扫描显示植入物与四边形板表面部分接触。在其余病例中，接触是完全的。
总之，我们的结果表明，通过打印对侧半骨盆的三维镜像成像模型并在模具上预塑形钢板来进行术前规划，可能有效地实现预定的手术目标，并降低这些复杂手术中的固有风险。
