Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy.
Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, BS, Italy.
Eur J Orthop Surg Traumatol. 2024 Oct;34(7):3627-3635. doi: 10.1007/s00590-024-04109-z. Epub 2024 Sep 27.
Pelvic osteotomies present a surgical option to restore pelvic alignment, improve function and pain in sequelae of pelvic ring fractures. Understanding the three-dimensional deformity is a crucial step within preoperative planning; furthermore, accurate intraoperative execution of the planning can be challenging. In recent years, patient-specific guides and 3D modeling have emerged as promising technologies in orthopedic and trauma surgery to enhance surgical precision and facilitate intraoperative decision-making.
We present the case of a 41-year-old male patient with a pelvic malunion, resulting from a vertical shear fracture occurring 8 years prior. The patient presented with a 4-cm cranial displacement of the right hemipelvis, accompanied by pubic symphysis disruption and fusion of S1 to L5 vertebra. Severely altered posture in the coronal and sagittal plane was associated with sitting imbalance, impaired gait, and chronic pain.
We analyzed the deformity and planned the surgical correction on a 3D interactive virtual model. Moreover, we developed 2 patient-specific cutting guides and one patient-specific reduction guide, allowing accurate bilateral pelvic osteotomies, subsequent realignment, and restoration of the pelvic anatomy.
For the first time, 3D modeling and 3D-printed patient-specific guides were effectively employed in pelvic malunion surgery, enhancing the precision of preoperative planning, and providing valuable assistance during intraoperative procedures.
骨盆截骨术是一种恢复骨盆对线、改善功能和缓解骨盆环骨折后遗症疼痛的手术选择。理解三维畸形是术前规划的关键步骤；此外，准确执行规划的术中操作具有挑战性。近年来，患者特异性引导器和 3D 建模已成为矫形和创伤外科中提高手术精度和促进术中决策的有前途的技术。
我们介绍了一位 41 岁男性患者的病例，他患有骨盆畸形愈合，这是 8 年前发生的垂直剪切骨折所致。患者出现右侧半骨盆向前 4cm 移位，伴有耻骨联合分离和 S1 到 L5 椎体融合。冠状面和矢状面严重的姿势改变与坐姿不平衡、步态受损和慢性疼痛有关。
我们在 3D 交互式虚拟模型上分析了畸形并规划了手术矫正。此外，我们还开发了 2 个患者特异性截骨引导器和 1 个患者特异性复位引导器，实现了双侧骨盆截骨的精确性，随后进行了重新对线和骨盆解剖结构的恢复。
首次在骨盆畸形愈合手术中有效应用了 3D 建模和 3D 打印的患者特异性引导器，提高了术前规划的精度，并在术中过程中提供了有价值的帮助。
