Salazar David A, Cramer Justin, Markin Nicholas W, Hunt Nathaniel H, Linke Gabe, Siebler Justin, Zuniga Jorge
Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA.
Ann Transl Med. 2022 Apr;10(7):391. doi: 10.21037/atm-21-5069.
Acetabular fractures account for 10% of pelvis injuries, which are especially difficult to treat in developing countries with less access to resources. 3D printing has previously been shown to be a beneficial method of surgical planning, however the steep initial costs associated with purchasing a 3D printer may prevent some facilities form utilizing this technique. The purpose of this study was to develop 3D printed models for acetabular surgery using methodologies of varying cost to determine differences in model accuracy and overall quality.
Five acetabular fracture models were developed from de-identified CT data using (I) proprietary and open-source segmentation software and (II) fused deposition modeling (FDM) and stereolithography (SLA) 3D printing methods. The distance between the posterior inferior iliac spine (PIIS) and the ischial spine as well as a unique fracture fragment for each model was compared between the different printing methodologies. The models were then given to 5 physicians and assessed on their overall accuracy compared to traditional 2D images.
Printing methodology did not affect the distance from PIIS to ischial spine (P=0.263). However, fracture fragment representation differed across 3D printed models, with the most accurate model produced by the high-end resin-based printer (P=0.007). The survey analysis showed that the low-cost printing methods produced models that were not as accurate in their representation of the fractured region (P=0.008).
The differences between models developed using traditional methods and low-cost methods have slight differences but may still provide useful information when developing a surgical plan.
髋臼骨折占骨盆损伤的10%，在资源获取较少的发展中国家，这类骨折尤其难以治疗。三维打印此前已被证明是一种有益的手术规划方法，然而，购买三维打印机的高昂初始成本可能会阻碍一些医疗机构采用这项技术。本研究的目的是使用成本各异的方法开发用于髋臼手术的三维打印模型，以确定模型准确性和整体质量的差异。
使用（I）专有和开源分割软件以及（II）熔融沉积建模（FDM）和立体光刻（SLA）三维打印方法，从去识别化的CT数据中开发了五个髋臼骨折模型。比较了不同打印方法之间髂后下棘（PIIS）与坐骨棘之间的距离以及每个模型的独特骨折碎片。然后将这些模型交给5名医生，并与传统二维图像相比，评估其整体准确性。
打印方法不影响从PIIS到坐骨棘的距离（P = 0.263）。然而，三维打印模型的骨折碎片表现各不相同，高端树脂基打印机制作的模型最准确（P = 0.007）。调查分析表明，低成本打印方法制作的模型在骨折区域表现方面不够准确（P = 0.008）。
使用传统方法和低成本方法开发的模型之间存在细微差异，但在制定手术计划时仍可能提供有用信息。
