Application of preoperative virtual simulation plan based on three-dimensional printing technology for complex acetabular fractures: a prospective randomized controlled study

doi:10.12307/2021.336

Abstract

Abstract: BACKGROUND: The treatment of complex acetabular fractures is still one of the most challenging tasks for orthopedic surgeons. Accurate fracture assessment and preoperative planning are very important for good reduction. Computer-aided virtual surgery program and three-dimensional (3D) printing of patient-specific pre-contoured plates provide an accurate and reasonable surgical plan for complex acetabular fractures.
OBJECTIVE: To evaluate the feasibility, accuracy and effectiveness of preoperative virtual simulation plan based on 3D printing technology in the surgical treatment of complex acetabular fractures.
METHODS: From March 2018 to August 2020, 28 patients with complicated acetabular fractures were selected from Department of Orthopedic Trauma, Tengzhou Central People’s Hospital and randomly divided into two groups. The 13 cases in the experimental group were treated with preoperative virtual simulation plan based on 3D printing technology; pre-contoured plates for open reduction and internal fixation of steel plate. The 15 cases in the control group were treated with traditional treatment plan: open reduction and internal fixation of steel plate. Intraoperative condition and postoperative curative effect were compared between the two groups.
RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss, intraoperative blood transfusion, intraoperative fluoroscopy times and intraoperative instrument time of the experimental group were all less than those of the control group, with significant difference (P < 0.05). There was no significant difference in hospitalization time between the two groups (P > 0.05). (2) Patients in both groups were followed up for 6-18 months. The incidence of complications and fracture healing time in the experimental group were better than those in the control group, and the difference was statistically significant (P < 0.05). (3) Matta imaging score of fracture reduction quality immediately after operation and Merle d’Aubigne & Postel score of hip joint function at the last follow-up in the experimental group were higher than those in the control group, with significant difference (P < 0.05). (4) It is suggested that the preoperative virtual simulation plan based on 3D printing technology is feasible and accurate, which provides an effective means for preoperative planning and precise fixation of complex acetabular fractures, thus improving the postoperative effect.

Key words: three-dimensional printing, acetabular fracture, computer-aided, virtual simulation, preoperative planning, pre-contoured plates, reduction of fracture, hip joint function

CLC Number:

Song Yuanzheng, Ma Hongli, Li Wei, Man Jia, Lin Feng, Zhang Yudong. Application of preoperative virtual simulation plan based on three-dimensional printing technology for complex acetabular fractures: a prospective randomized controlled study[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(36): 5747-5752.

Figures/Tables 6

References

[1] MAINI L, VERMA T, SHARMA A, et al. Evaluation of accuracy of virtual surgical planning for patient-specific pre-contoured plate in acetabular fracture fixation. Arch Orthop Trauma Surg. 2018;138:495-504.
[2] 柳鑫,曾参军,卢键森,等.3D打印计算机虚拟辅助技术在髋臼骨折术前规划中的应用[J].南方医科大学学报,2017,37(3):378-382.
[3] A third industrial revolution. Economist. 2012;403(8781):a3-a4.
[4] MAINI L, SHARMA A, JHA S, et al. Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation? .Eur J Trauma Emerg Surg. 2018;44:215-224.
[5] CHEN K, YANG F, YAO S, et al. Application of computer-assisted virtual surgical procedures and three-dimensional printing of patient-specific pre-contoured plates in bicolumnar acetabular fracture fixation. Orthop Traumatol Surg Res. 2019;105(5):877-884.
[6] MATTA JM. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg. 1996;78-A:1632-1645.
[7] CIMERMAN M, KRISTAN A. Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury. 2007;38:442-449.
[8] YOU W, LIU LJ, CHEN HX, et al. Application of 3D printing technology on the treatment of complex proximal humeral fractures (Neer3-part and 4-part) in old people. Orthop Traumatol Surg Res. 2016;102:897-903.
[9] UPEX P, JOUFFROY P, RIOUALLON G. Application of 3D printing for treating fractures of both columns of the acetabulum: benefit of pre-contouring plates on the mirrored healthy pelvis. Orthop Traumatol Surg Res. 2017;103:331-334.
[10] CAFFREY JP, JEFFORDS ME, FARNSWORTH CL, et al.Comparison of 3 Pediatric Pelvic Osteotomies for Acetabular Dysplasia Using Patient-specific 3D-printed Models. J Pediatr Orthop. 2019;39(3):e159-e164.
[11] PUNYARATABANDHU T, LIACOURAS PC, PAIROJBORIBOON S. Using 3D models in orthopedic oncology: presenting personalized advantages in surgical planning and intraoperative outcomes. 3D Print Med. 2018; 4(1):12.
[12] 张忠岩,祁同宁,穆怀昭,等.髋臼骨折固定中3D打印技术辅助虚拟手术计划的疗效评价[J].中国组织工程研究,2020,24(15):2405-2409.
[13] 侯志勇.骨盆、髋臼骨折治疗的创新之路[J].中华创伤杂志,2020, 36(11):961-965.
[14] SEBAALY A, RIOUALLON G, ZARAA M, et al. Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop. 2018;42(8):1957-1965.
[15] HSU CL, CHOU YC, LI YT, et al. Pre-operative virtual simulation and three-dimensional printing techniques for the surgical management of acetabular fractures. Int Orthop. 2019;43(8):1969-1976.
[16] MEREMA BJ, KRAEIMA J, TEN DUIS K, et al. The design, production and clinical application of 3D patient-specific implants with drilling guides for acetabular surgery. Injury. 2017;48(11):2540-2547.
[17] AWAN OA, SHETH M, SULLIVAN I, et al. Efficacy of 3D Printed Models on Resident Learning and Understanding of Common Acetabular Fracturers. Acad Radiol. 2019;26(1):130-135.
[18] HUNG CC, LI YT, CHOU YC, et al. Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture. Int Orthop. 2019;43(2):425-431.
[19] 黄复铭,樊仕才.3D打印技术辅助治疗骨盆髋臼骨折的研究进展[J].中国临床解剖学杂志,2019,37(3):347-350.
[20] SHON HC, CHOI S, YANG JY. Three-dimensional printing-assisted surgical technique with limited operative exposure for both-column acetabular fractures. Ulus Travma Acil Cerrahi Derg. 2018;24:369-375.
[21] Bagaria V, Deshpande S, Rasalkar DD, et al. Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures. Eur J Radiol. 2011;80:814-820.
[22] BROWN GA, MILNER B, FIROOZBAKHSH K. Application of computer-generated stereolithography and interpositioning template in acetabular fractures: A report of eight cases. J Orthop Trauma. 2002;16:347-352.
[23] BOUDISSA M, COURVOISIER A, CHABANAS M, et al. Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art. Expert Rev Med Devices. 2018;15(1): 81-89.
[24] BATTIATO C, BASIGLINI L, GIOVANNINI F. Traumatological Application of 3D Model in Complex Acetabular Fractures. Trauma Cases Rev. 2017; 3:1-4.
[25] PRABHU SP. From CT and MR images to 3D printed models-Software Basics for the Surgeon in 3D. 3D Print Orthop Surg. 2019:31-40.
[26] BI C, JI X, WANG F, et al. Digital anatomical measurements and crucial bending areasof the fixation route along the inferior border of the arcuate line for pelvic and acetabularfractures. BMC Musculoskelet Disord. 2016;17:125.
[27] YU AW, DUNCAN JM, DAURKA JS, et al. A feasibility study into the use of three-dimensional printer modelling in acetabular fracture surgery. Adv Orthop. 2015;2015:617046.
[28] HAO S, WANG F, LIU Z, et al. 3D printing mirror model to assist MIPPO technology in the treatment of displaced midshaft clavicle fracture: A case report. Int. J Clin Exp Med. 2019;11:2717-2720
[29] YAO LF, WANG HQ, ZHANG F, et al. Minimally invasive treatment of calcaneal fractures via the sinus tarsi approach based on a 3D printing technique. Math Biosci Eng. 2019;16:1597-1610.
[30] CHUNG KJ, HONG DY, KIM YT, et al. Preshaping Plates for Minimally Invasive Fixation of Calcaneal Fractures Using a Real-Size 3D-Printed Model asa Preoperative and Intraoperative Tool. Foot Ankle Int. 2014; 35:1231-1236.
[31] LI YT, HUNG CC, CHOU YC, et al. Surgical Treatment for Posterior Dislocation of HipCombined with Acetabular Fractures Using Preoperative Virtual Simulation and Three-Dimensional Printing Model-Assisted Precontoured Plate Fixation Techniques. Biomed Res Int. 2019; 2019:3971571.