Application of multi-slice spiral CT combined with 3D printing in the treatment of rotationally unstable pelvic fractures

doi:10.12307/2023.602

Abstract

Abstract: BACKGROUND: Pelvic fractures are a serious type of fracture, and there are limitations in the two-dimensional plane display effect of pure multi-slice spiral CT three-dimensional images, and there is a lack of preoperative planning guidance for pelvic fractures.
OBJECTIVE: To analyze clinical effect of multi-slice spiral CT combined with 3D printing in patients with rotationally unstable pelvic fractures.
METHODS: From January 2017 to December 2020, clinical data of 90 patients with rotationally unstable pelvic fractures admitted to the First People’s Hospital of Kashgar were included. They were grouped according to the random number table method. In the study group, 47 patients underwent multi-slice spiral CT combined with 3D printing technology to guide the operation. In the control group, 43 patients used multi-slice spiral CT for preoperative guidance before open reduction and internal fixation. After 1 year of follow-up, the fracture healing time of the two groups was recorded to evaluate the quality of pelvic reduction. The pelvic function recovery results were evaluated with reference to the Majeed pelvic quantitative scoring standard. The postoperative adverse event rate in the two groups was calculated.
RESULTS AND CONCLUSION: (1) The screw dislocation rate in the study group was lower than that in the control group (P < 0.05), and the fracture healing time was shorter than that in the control group (P < 0.05). The excellent and good rate of pelvic fracture reduction 3 months after operation was higher in the study group than that of the control group (P < 0.05). (2) Compared with 3 months after operation, the pelvic function scores of the two groups at 6 and 12 months after operation were higher (P < 0.05). There was no significant difference in pelvic function scores between the two groups at 3, 6, and 12 months after operation (P > 0.05). (3) Among the 47 cases in the study group, 1 case of fracture displacement and 2 cases of traumatic arthritis occurred, and the incidence of adverse events was 6%. Among the 43 cases in the control group, malunion occurred in 1 case, heterotopic ossification in 1 case, fracture displacement in 2 cases, traumatic arthritis in 2 cases, and pelvic instability in 2 cases, with an adverse event rate of 19%. There was no significant difference in the adverse event rate between the two groups (P > 0.05). (4) It is suggested that for rotationally unstable pelvic fractures, compared with multi-slice spiral CT alone, the use of multi-slice spiral CT combined with 3D printing technology in the guidance of the surgical plan can improve the quality of fracture reduction, shorten the fracture healing time and reduce the screw dislocation rate.

Key words: slice spiral CT, 3D printing technology, pelvic fracture, unstable pelvic fracture, internal fixation of steel plate, reduction quality, surgical index

CLC Number:

Alimu·Keremu, Liang Zhilin, Pazila·Aila, Maimaitiaili·Abulikemu, Aikebaier·Tuxun. Application of multi-slice spiral CT combined with 3D printing in the treatment of rotationally unstable pelvic fractures[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(27): 4345-4350.

Figures/Tables 9

References

[1] LIN SS, ZHOU SG, HE LS, et al. The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures. Chin J Traumatol. 2021;24(2):100-103.
[2] CAVALCANTI KUßMAUL A, GREINER A, KAMMERLANDER C, et al. Biomechanical comparison of minimally invasive treatment options for Type C unstable fractures of the pelvic ring. Orthop Traumatol Surg Res. 2020;106(1):127-133.
[3] AL-DULIMI Z, WALLIS M, TAN DK, et al. 3D printing technology as innovative solutions for biomedical applications. Drug Discov Today. 2021;26(2):360-383.
[4] PARK JW, KANG HG, KIM JH, et al. The application of 3D-printing technology in pelvic bone tumor surgery. J Orthop Sci. 2021;26(2): 276-283.
[5] 中华医学会骨科学分会创伤骨科学组,中华医学会骨科学分会外固定与肢体重建学组,中华医学会创伤学分会,等.中国骨盆骨折微创手术治疗指南(2021)[J].中华创伤骨科杂志,2021,23(1):4-14.
[6] TORNETTA P 3RD, MATTA JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res. 1996;(329): 186-193.
[7] MAJEED SA. Grading the outcome of pelvic fractures. J Bone Joint Surg Br. 1989;71(2): 304-306.
[8] 沈红雷,冯德宏,许宏俊,等.CT三维重建技术判断骨盆骨折Tile分型与二维CT及X线的对比研究[J].河北医学,2019,25(6): 982-986.
[9] SKITCH S, ENGELS PT. Acute management of the traumatically injured pelvis. Emerg Med Clin North Am. 2018;36(1):161-179.
[10] PAVLIČEV M, ROMERO R, MITTEROECKER P. Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma. Am J Obstet Gynecol. 2020;222(1):3-16.
[11] DUTTON RA. Stress fractures of the hip and pelvis. Clin Sports Med. 2021;40(2):363-374.
[12] LUK L, TAFFEL MT. Cross-sectional anatomy of the male pelvis. Abdom Radiol (NY). 2020;45(7):1951-1960.
[13] SUAREZ-WEISS KE, HEROLD A, GERVAIS D, et al. Hybrid imaging of the abdomen and pelvis. Radiologe. 2020;60(Suppl 1):80-89.
[14] BURNER JM, DYER RB. The champagne glass pelvis. Abdom Radiol (NY). 2018;43(11):3190-3191.
[15] DRYLEWICZ MR, LUBNER MG, PICKHARDT PJ, et al. Fatty masses of the abdomen and pelvis and their complications. Abdom Radiol (NY). 2019;44(4):1535-1553.
[16] HAMMOND KE, KNEER L, CICINELLI P. Rehabilitation of soft Tissue injuries of the hip and pelvis. Clin Sports Med. 2021;40(2):409-428.
[17] CHAN BY, LEE KS. Ultrasound intervention of the lower extremity/pelvis. Radiol Clin North Am. 2018;56(6):1035-1046.
[18] ZULFIQAR M, LIN M, RATKOWSKI K, et al. Imaging features of neurofibromatosis type 1 in the abdomen and pelvis. AJR Am J Roentgenol. 2021;216(1):241-251.
[19] ZULFIQAR M, SHETTY A, TSAI R, et al Diagnostic approach to benign and malignant calcifications in the abdomen and pelvis. Radiographics. 2020;40(3):731-753.
[20] LEA WB, TUTTON SM, ALSAIKHAN N, et al. Pelvis weight-bearing ability after minimally invasive stabilizations for periacetabular lesion. J Orthop Res. 2021;39(10):2124-2129.
[21] SUKERKAR PA, FAST AM, RILEY G. Extreme sports injuries to the pelvis and lower extremity. Radiol Clin North Am. 2018;56(6):1013-1033.
[22] ZHENG Y, ELSAYES KM, WARANCH C, et al. IgG4-related disease in the abdomen and pelvis: atypical findings, pitfalls, and mimics. Abdom Radiol (NY). 2020;45(8):2485-2499.
[23] Alyaev YG, Sirota ES, Bezrukov EA, et al. Non-biological 3D printed simulator for training in percutaneous nephro-lithotripsy. Urologiia. 2018;(1):10-14.
[24] 苗鹏.多层螺旋CT三维重建辅助3D打印技术对复杂髋臼骨折手术的分析[J].中国CT和MRI杂志,2021,19(12):163-166.
[25] WANG J, WANG X, WANG B, et al. Comparison of the feasibility of 3D printing technology in the treatment of pelvic fractures: a systematic review and meta-analysis of randomized controlled trials and prospective comparative studies. Eur J Trauma Emerg Surg. 2021; 47(6):1699-1712.
[26] LUGO-FAGUNDO C, GHODASARA N, FISHMAN EK, et al. CT evaluation of self-induced and retained foreign bodies in the abdomen and pelvis. Clin Imaging. 2021;80:26-35.
[27] BRANCH KRH, STROTE J, GUNN M, et al. Early head-to-pelvis computed tomography in out-of-hospital circulatory arrest without obvious etiology. Acad Emerg Med. 2021;28(4):394-403.
[28] HAIMS AH, WANG A, YOO BJ, et al. Negative predictive value of CT for occult fractures of the hip and pelvis with imaging follow-up. Emerg Radiol. 2021;28(2):259-264.
[29] ALEXANDER LF, HANNA TN, LEGOUT JD, et al. Multidetector CT findings in the abdomen and pelvis after damage control surgery for acute traumatic injuries. Radiographics. 2019;39(4):1183-1202.
[30] TORRADO-CARVAJAL A, VERA-OLMOS J, IZQUIERDO-GARCIA D, et al. Dixon-VIBE deep learning (DIVIDE) pseudo-CT synthesis for pelvis PET/MR attenuation correction. J Nucl Med. 2019;60(3):429-435.
[31] ROTHMAN RK, WEINREB J, ZUCCONI W, et al. Diagnostic value of CT of chest, abdomen, and pelvis in patients with solitary and multiple brain lesions. AJR Am J Roentgenol. 2020;214(3):636-640.