Department of Orthopaedics and Traumatology, Grenoble University Hospital, Grenoble Alpes University, 38700, La Tronche, France.
TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France.
Int J Comput Assist Radiol Surg. 2021 Aug;16(8):1305-1317. doi: 10.1007/s11548-021-02352-x. Epub 2021 Mar 24.
A simple, patient-specific biomechanical model (PSBM) is proposed in which the main surgical tools and actions can be simulated, which enables clinicians to evaluate different strategies for an optimal surgical planning. A prospective and comparative clinical study was performed to assess early clinical and radiological results.
From January 2019 to July 2019, a PSBM was created for every operated acetabular fracture (simulation group). DICOM data were extracted from the pre-operative high-resolution CT scans to build a 3D model of the fracture using segmentation methods. A PSBM was implemented in a custom software allowing a biomechanical simulation of the surgery in terms of reduction sequences. From July 2019 to December 2019, every patient with an operated for acetabular fracture without PSBM was included in the standard group. Surgery duration, blood loss, radiological results and per-operative complications were recorded and compared between the two groups.
Twenty-two patients were included, 10 in the simulation group and 12 in the standard group. The two groups were comparable regarding age, time to surgery, fracture pattern distribution and surgical approaches. The mean operative time was significantly lower in the simulation group: 113 min ± 33 (60-180) versus 184 ± 58 (90-260), p = 0.04. The mean blood loss was significantly lower in the simulation group, p = 0.01. No statistical significant differences were found regarding radiological results (p = 0.16). No per-operative complications were recorded.
This study confirms that pre-operative planning in acetabular surgery based on a PSBM results in a shorter operative time and a reduction of blood loss during surgery. This study also confirms the feasibility of PSBM planning in daily clinical routine.
II: prospective study.
提出了一种简单的、针对患者的生物力学模型（PSBM），可以模拟主要的手术工具和操作，使临床医生能够评估不同策略以实现最佳手术规划。进行了一项前瞻性和对照临床研究，以评估早期临床和影像学结果。
从 2019 年 1 月至 2019 年 7 月，为每例接受手术治疗的髋臼骨折患者创建 PSBM（模拟组）。从术前高分辨率 CT 扫描中提取 DICOM 数据，使用分割方法构建骨折的 3D 模型。在定制软件中实现了 PSBM，允许根据复位序列对手术进行生物力学模拟。从 2019 年 7 月至 2019 年 12 月，每例接受髋臼骨折手术而无 PSBM 的患者均纳入标准组。记录并比较两组的手术持续时间、失血量、影像学结果和术中并发症。
共纳入 22 例患者，模拟组 10 例，标准组 12 例。两组在年龄、手术时间、骨折模式分布和手术入路方面具有可比性。模拟组的手术时间明显更短：113±33 分钟（60-180 分钟）比 184±58 分钟（90-260 分钟），p=0.04。模拟组的失血量明显更少，p=0.01。影像学结果无统计学差异（p=0.16）。术中无并发症记录。
本研究证实，基于 PSBM 的髋臼手术术前规划可缩短手术时间并减少手术过程中的失血量。本研究还证实了 PSBM 规划在日常临床实践中的可行性。
II 级：前瞻性研究。
