Department of Orthopaedic and Trauma Surgery, Grenoble University Hospital, University Grenoble-Alpes, 38700 La-Tronche, France; TIMC-IMAG lab, CNRS UMR 5525, University Grenoble-Alpes, 38700 La-Tronche, France.
TIMC-IMAG lab, CNRS UMR 5525, University Grenoble-Alpes, 38700 La-Tronche, France.
Orthop Traumatol Surg Res. 2021 Oct;107(6):103004. doi: 10.1016/j.otsr.2021.103004. Epub 2021 Jun 30.
The first patient-specific biomechanical model for planning the surgical reduction of acetabular fractures was developed in our institution and validated retrospectively. There are no prior studies showing its effectiveness in terms of reduction quality, operative duration and intraoperative bleeding. Therefore, we performed a case control study aiming to: 1) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the operating time and intraoperative bleeding; 2) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the quality of reduction.
All patients operated on between January 2019 and June 2019 after planning by biomechanical simulation were included in this case-control study. Each patient included was matched to 2 controls from our database (2015-2018) according to age and fracture-type. DICOM data were extracted from the preoperative high-resolution scanners to build a three-dimensional model of the fracture by semi-automatic segmentation. A biomechanical model was built to virtually simulate the different stages of surgical reduction. Surgery was then performed according to simulation data. Surgical duration, blood loss, radiological findings and intraoperative complications were recorded, analysed and compared.
Thirty patients were included, 10 in the simulation group and 20 in the control group. The two groups were comparable in terms of age, time from accident to surgery, fracture-type and surgical approach. The mean operative time was significantly reduced in the simulation group: 113min±33 (60-180) versus 196min±32 (60-260) (p=0.01). Mean blood loss was significantly reduced in the simulation group: 505mL±189 (100-750) versus 745mL±130 (200-850) (p<0.01). However, no significant difference was found in the radiological results according to Matta's criteria, although an anatomical reduction was obtained for 9 patients in the simulation group (90%) versus 12 patients in the control group (60%) (p=0.26). A postoperative neurological complication was recorded in the control group (sensory deficit of the lateral cutaneous nerve of thigh).
This study confirms the promising results of preoperative planning in acetabular trauma surgery based on patient-specific biomechanical simulation as well as its feasibility in routine clinical practice. By providing a better understanding of the fracture and its behavior, a reduction in intraoperative bleeding and in operative duration is achieved.
III; case-control study.
我们机构开发了第一个用于规划髋臼骨折手术复位的患者特异性生物力学模型，并进行了回顾性验证。目前尚无研究表明其在复位质量、手术时间和术中出血量方面的有效性。因此，我们进行了一项病例对照研究，旨在：1）评估术前通过患者特异性生物力学模拟器进行模拟对手术时间和术中出血量的影响；2）评估术前通过患者特异性生物力学模拟器进行模拟对复位质量的影响。
所有在 2019 年 1 月至 6 月期间通过生物力学模拟进行规划并进行手术的患者均纳入本病例对照研究。从术前高分辨率扫描仪中提取 DICOM 数据，通过半自动分割构建骨折的三维模型。构建生物力学模型以虚拟模拟手术复位的不同阶段。然后根据模拟数据进行手术。记录、分析和比较手术时间、失血量、影像学发现和术中并发症。
共纳入 30 例患者，其中模拟组 10 例，对照组 20 例。两组在年龄、事故至手术时间、骨折类型和手术入路方面具有可比性。模拟组的手术时间明显缩短：113min±33（60-180）与 196min±32（60-260）（p=0.01）。模拟组的失血量明显减少：505mL±189（100-750）与 745mL±130（200-850）（p<0.01）。然而，根据 Matta 标准，影像学结果无显著差异，尽管模拟组有 9 例（90%）患者获得解剖复位，而对照组有 12 例（60%）患者（p=0.26）。对照组发生术后神经并发症（大腿外侧皮神经感觉缺陷）。
本研究证实了基于患者特异性生物力学模拟的髋臼创伤手术术前规划的有前景的结果及其在常规临床实践中的可行性。通过更好地了解骨折及其行为，可以减少术中出血和手术时间。
III；病例对照研究。
