Mediavilla-Santos L, García-Sevilla M, Calvo-Haro J A, Ruiz Alba M T, Pérez-Mañanes R, Pascau González J, Cuervo Dehesa M, Vaquero Martín F J
Sección de Oncología Musculoesquelética, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III, Leganés, Madrid, Spain.
Rev Esp Cir Ortop Traumatol. 2022 Sep-Oct;66(5):T403-T409. doi: 10.1016/j.recot.2022.07.011. Epub 2022 Jul 14.
Pelvic ring tumours pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies.
Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked.
The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis (5-8mm), being conditioned by the position of the rigid body.
The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.
骨盆环肿瘤由于难以获得足够的手术切缘而构成挑战。诸如手术导航或3D打印等工具,用于制作患者特异性手术定位模板,有助于术前规划和术中操作。它们在诸如骨盆等复杂部位的正确定位至关重要,因此有必要识别定位错误。本研究的目的是证明用于骨盆环截骨术的3D模板放置的可靠性。
对10个半骨盆尸体进行实验研究。进行CT扫描以获取三维模型、截骨术规划、坐骨耻骨(I)、髂耻骨(P)、髋臼上(S)和髂嵴(C)分支的定位模板设计;以及在C和S模板上用于导航的定位标记(刚体)。模板和刚体通过3D打印并根据预先规划进行定位。导航可检查植入物和截骨术的最终位置。
模板相对于术前规划的定位因位置而异,髂嵴模板的误差更大。使用导航时,除耻骨外(5 - 8mm),到切割平面的平均距离误差为3.5mm,这受刚体位置的影响。
使用3D打印的患者特异性模板是骨盆癌手术中进行截骨术的可靠工具。