Digital design of standard parts database for distal femoral fractures treated with plating via three-dimensional printing

doi:10.3969/j.issn.2095-4344.2016.13.010

Chinese Journal of Tissue Engineering Research ›› 2016, Vol. 20 ›› Issue (13): 1895-1903.doi: 10.3969/j.issn.2095-4344.2016.13.010

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Digital design of standard parts database for distal femoral fractures treated with plating via three-dimensional printing

Wu Chang-fu, Zheng Zu-gao, Chen Xuan-huang, Yu Zheng-xi, Zhang Guo-dong, Chen Xu, Lin Hai-bin, Wu Xian-wei, Gao Xiao-qiang

Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University; Affiliated Putian Hospital of Southern Medical University; Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China

Received:2016-02-25 Online:2016-03-25 Published:2016-03-25
Contact: Chen Xuan-huang, Master, Associate chief physician, Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University; Affiliated Putian Hospital of Southern Medical University; Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
About author:Wu Chang-fu, Master, Physician, Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University; Affiliated Putian Hospital of Southern Medical University; Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
Supported by:
the Natural Science Foundation of Fujian Province, No. 2015J01507; the Middle-Aged and Young Backbone Talents Training Project of Health and Family Planning Health Systems in Fujian Province, No. 2014-ZQN-JC-39; the Science and Technology Program of Putian City in Fujian Province, No. 2013S03(6); the Scientific Research Project of Putian University in Fujian Province, No. 2015044

Abstract

Abstract:

BACKGROUND: On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fully meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation.
OBJECTIVE: To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing.
METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtually. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during follow-up.
RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. All patients were followed up. According to Schagzker criterion, the efficiency of 22 cases was excellent, 6 cases good and 2 cases average, and the excellent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via 3D printing navigation module is expected to achieve implant navigation and application.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Wu Chang-fu, Zheng Zu-gao, Chen Xuan-huang, Yu Zheng-xi, Zhang Guo-dong, Chen Xu, Lin Hai-bin, Wu Xian-wei, Gao Xiao-qiang. Digital design of standard parts database for distal femoral fractures treated with plating via three-dimensional printing[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(13): 1895-1903.

Figures/Tables 2

References

[1] Ellis HB, Ho CA, Podeszwa DA, et al. A comparison of locked versus nonlocked enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop.2011;31(8):825-833.

[2] 郑晓晖,张国栋,牛素生,等.术前数字化设计在成人股骨远端C1型骨折钢板内固定中的应用研究[J].中华创伤骨科杂志,2014,16(11):990-995.

[3] 陈宣煌,许卫红,黄文华,等. 基于3D打印的腰椎椎弓根螺钉数字化置入及临床应用[J] 中国组织工程研究,2015, 19(17):2752-2757.

[4] Rüedi TP, Murphy WM. 骨折治疗的AO 原则[M]. 2 版.王满宜,杨庆铭,曾炳芳,译.上海:上海科学技术出版社, 2010:470-473.

[5] Perren SM.The technology of minimally invasive percutaneous osteosynthesis(MIPO). Injury. 2002;33 Suppl 1: VI-VII．

[6] Schatzker J,Lambert DC. Supracondylar fractures of the femur. Clin Orthop Relat Res.1979;(138):77-83.

[7] Martinet O, Cordey J, Harder Y, et al. The epidemiology of fractures of the distal femur. Injury. 2000;31 (Suppl 3): C62-C63.

[8] Moore RE, Baldwin K, Austin MS,et al.A systematic review of open reduction and internal fixation of periprosthetic femur fractures with or without allograft strut, cerclage, and locked plates. J Arthroplasty. 2014;29(5):872-876.

[9] Li K,Langdale E,Tashman S,et al. Gender and condylar differences in distal femur morphometry clarified by automated computer analyses.J Orthop Res. 2012;30(5):686-692.

[10] Hu Y,Li H,Qiao G,et al.Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data.Injury.2011;42(10):1121-1124.

[11] Hu YL,Ye FG,Ji AY,et al. Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures.Injury. 2009;40(12):1282-1285.

[12] Messmer P,Brig G,Suhm N,et al.Three-dimensional fracture simulation for preoperative planning and education.Eur J Trauma. 2001;27:171-177.

[13] Osti M,Philipp H,Meusburger B,et al.Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J. 2011;20 (11):1915-1920.

[14] Shen F,Chen B,Guo Q,et al.Augmented reality patient-specific reconstruction plate design for pelvic and acetabular fracture surgery. Int J Comput Assist Radiol Surg.2013;8(2):169-179.

[15] Giannatsis J,Dedoussis V.Additive fabrication technologies applied to medicine and health care: a review. Int J Adv Manuf Technol. 2009;40:116-127.

[16] Brown GA,Firoozabakhsh K,DeCoster TA,et al.Rapid prototyping:the future of trauma surgery? J Bone Joint Surg(Am). 2003;85-A Suppl 4: 49-55.

[17] Paiva WS,Amorim R,Bezerra DA,et al.Aplication of the stereolithography technique in complex spine surgery. Arq Neuropsiquiatr. 2007;65(2B): 443-445.

[18] Doornberg JN,Rademakers MV,van den Bekerom MP,et al.Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures. Injury. 2011;42(12):1416-1425.

[19] Wu ZX,Huang LY,Sang HX,et al. Accuracy and safety assessment of pedicle screw placement using the rapid prototypingtechnique in severe congenital scoliosis. Spinal Disord Tech.2011;24(7):444-450.

[20] Uehara M,Takahashi J,Hirabayashi H,et al. Computer-assisted C1-C2 Transarticular Screw Fixation "Magerl Technique" for Atlantoaxial Instability. Asian Spine J.2012;6(3):168-177.

[21] Xie A,Fang C,Huang Y,et al.Application of three-dimensionalreconstruction and visible simulation technique in reoperation of hepatolithiasis. Gastroenterol Hepatol.2013;28(2):248-254.

[22] Bagaria V,Deshpande S,Rasalkar DD,et a1.Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures.Eur J Radiol. 2011;80(3):814-820．

[23] Motiei-Langroudi R, Sadeghian H. Assessment of pedicle screw placement accuracy in thoracolumbosacral spine using freehand technique aided by lateral fluoroscopy: results of postoperative computed tomography in 114 patients. Spine J. 2015;15(4):700-704.

[24] Sugimoto Y, Ito Y, Tomioka M, et al. Clinical accuracy of three-dimensional fluoroscopy (IsoC-3D)-assisted upper thoracic pedicle screw insertion. Acta Med Okayama.2010;64(3):209-212.

[25] Ravi B, Zahrai A, Rampersaud R. Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws.Spine. 2011;36(1):84-91.

[26] Fuster S, Vega A, Barrios G, et al. Accuracy of pedicle screw insertion in the thoracolumbar spine using image-guided navigation. Neurocirugia.2010; 21(4): 306-311.

[27] Eck JC, Lange J, Street J, et al. Accuracy of intraoperative computed tomography-based navigation for placement of percutaneous pedicle screws. Global Spine J. 2013;3(2):103-108.

[28] Ammirati M, Salma A. Placement of thoracolumbar pedicle screws using O-arm-based navigation: technical note on controlling the operational accuracy of the navigation system. Neurosurg Rev. 2013;36(1): 157-162.

[29] Togawa D, Kayanja MM, Reinhardt MK, et al. Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: part 2--Evaluation of system accuracy. Neurosurgery. 2007; 60: 129-139.

[30] Bourgeois AC, Faulkner AR, Bradley YC, et al. Improved Accuracy of Minimally Invasive Transpedicular Screw Placement in the Lumbar Spine with Three-dimensional Stereotactic Image Guidance: A Comparative Meta-analysis. J Spinal Disord Tech. 2015;28(9):324-329.

[31] Lu S, Zhang YZ, Wang Z, et al. Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient- specific drill template. Med Biol Eng Comput. 2012; 50(7):751-758.

[32] Scheufler KM, Cyron D, Dohmen H,et al. Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome. Neurosurgery. 2010;67: 1609-1621.

[33] Lee GY, Massicotte EM, Rampersaud YR. Clinical accuracy of cervicothoracic pedicle screw placement: a comparison of the "open" lamino-foraminotomy and computer-assisted techniques. J Spinal Disord Tech. 2007;20(1):25-32.

[34] Ito Y, Sugimoto Y, Tomioka M, et al. Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine. 2008;9(5):450-453.

[35] Rath SA, Moszko S, Schäffner PM, et al. Accuracy of pedicle screw insertion in the cervical spine for internal fixation using frameless stereotactic guidance. J Neurosurg Spine. 2008;8(3):237-245.

[36] Hsieh JC, Drazin D, Firempong AO, et al. Accuracy of intraoperative computed tomography image-guided surgery in placing pedicle and pelvic screws for primary versus revision spine surgery. Neurosurgical Focus. 2014;36(3): E2.

[37] Tian NF, Huang QS, Zhou P, et al. Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J. 2011;20(6):846-859.

[38] Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2012;21(2):247-255.

[39] Mason A, Paulsen R, Babuska JM, et al. The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine. 2014;20(2): 196-203.

[40] Smith HE, Welsch MD, Sasso RC, et al. Comparison of radiation exposure in lumbar pedicle screw placement with fluoroscopy vs computer-assisted image guidance with intraoperative three-dimensional imaging. J Spinal Cord Med.2008;31(5): 532-537.

[41] Tricot M, Duy KT, Docquier PL. 3 D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity.Acta Orthop Belg. 2012; 78(4): 538-542.

Digital design of standard parts database for distal femoral fractures treated with plating via three-dimensional printing

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