Digital simulation and clinical application of acetabular anterior column fracture fixation with plate

doi:10.3969/j.issn.2095-4344.0183

Abstract

Abstract:

BACKGROUND: The anatomical structure of the pelvis is complex, and it is difficult to be fixed. Misplacement of screws can lead to severe complications. Therefore, exploring an efficient, simple, and economic individualized design of surgical staple parameters has become a key issue in the fixation of the acetabular anterior column fracture.

OBJECTIVE: To design parameters on the anterior column of acetabulum fracture reconstruction plate internal fixation for preoperative design using CT scan data, and to compare with conventional steel plate fixation.

METHODS: Forty patients with acetabular anterior column fracture were randomly assigned to two groups: digital design group (n=20) and conventional surgery group (n=20). The digital design group received pelvic CT scanning for data acquisition. Materialise Mimics Innovation Suite 16.0 software was used for digital simulation of anterior acetabular fracture plate fixation. The conventional surgery group received conventional steel plate fixation. Operation time, blood loss and healing time were compared between the two groups. Anatomic reduction ratio and hip function score were compared between the two groups at postoperative 16 weeks.

RESULTS AND CONCLUSION: (1) Operation time, blood loss, healing time, anatomic reduction ratio and hip function score were better in the digital design group than in the conventional surgery group (P=0.00). (2) Results suggest that compared with the conventional surgery group, acetabular anterior column fractures of digital three-dimensional operation design has a good effect on reducing operation time and blood loss and elevating fixation effect, and can provide reference data for clinical diagnosis and treatment of acetabular anterior column fracture.

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

Key words: Acetabulum, Fractures, Bone, Internal Fixators, Tissue Engineering

CLC Number:

R318

Wang Jian, Yun Wen-ke, Li Ge-dang, Cai Yong-qiang, Li Xiao-he. Digital simulation and clinical application of acetabular anterior column fracture fixation with plate [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(15): 2378-2383.

Figures/Tables 5

References

[1] 肖建德,王大平,陆伟,等.严重骨盆骨折的诊治[J].中华创伤骨科杂志,2006,8(1):31-33.

[2] Chesser TJ, Eardley W, Mattin A,et al. The modified ilioinguinal and anterior intrapelvic approaches for acetabular fracture fixation: indications, quality of reduction, and early outcome.J Orthop Trauma. 2015;29 Suppl 2:S25-28.

[3] Mehin R, Jones B, Zhu Q, et al. A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg. 2009;52(3): 221-228.

[4] Camack DB,Moed BR,McCarrol K,et al. Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy and computed tomography.J Bone Joint Surg Am. 2001;83(9):1370-1375.

[5] 洪华兴,潘志军,陈海啸,等.髋臼前柱螺钉固定解剖学研究及导向器的设计[J].中国修复重建外科杂志,2006,20(6):651-654.

[6] 蓝旭,梁军,文益民,等.髋臼骨折手术并发症分析[J].中国现代手术学杂志,2007,11(5):373-376.

[7] 陈忠恒,刘丰春,丁士海.髋骨弓状线的解剖学观测及其临床意义[J].中国临床解剖学杂志,2002,20(5):377-379.

[8] 宋朝辉,张英泽,彭阿钦,等.髋臼在前柱投影的解剖学研究[J].中国骨伤,2004,17(11):647-649.

[9] Kumar A, Shah NA, Kershaw SA, et al. Operative management of acetabular fractures. A review of 73 fractures.Injury. 2005;36 (5):605-612.

[10] Matta JM,Merritt PO. Displaced acetabular fracture. Clin Orthop Relat Res. 1988;(230):83-97.

[11] Matta JM,Anderson LM, Epstein HC, et al. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res. 1986;(205):230-240.

[12] Wolf H, Wieland T, Pajenda G,et al. Minimally invasive ilioinguinal approach to the acetabulum. Injury. 2007;38(10): 1170-1176.

[13] Li M, Hu Y, Xie J.Analysis of the complications of the collum femoris preserving (CFP) prostheses.Acta Orthop Traumatol Turc. 2014;48(6):623-627.

[14] Li W, Li H, Wang D,et al.Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials.J Orthop Surg Res. 2015;10(1):8-10.

[15] Citak M,Gardner MJ,Kendoff D,et al. Virtual 3D planning of acetabular fracture reduction. J Orthop Res. 2008;26(4): 547-552.

[16] Khoury A,Kreder H,Skrinskas T,et al. Lateral compression fracture of the pelvis represents a heterogeneous group of complex 3D patterns of displacement. Injury. 2008;39(8): 893-902.

[17] Øvre S,Madsen JE,Røise O. Acetabular fracture displacement roof arc angles and 2 years outcome. Injury. 2008;39(8):922-931.

[18] Davis JW,Moore FA,McIntyre RC Jr,et al. Western traumaassociation critical decisions in trauma:management of pelvic fracture with hemodynamic instability. J Trauma. 2008; 65(5):1012-1015.

[19] Lefaivre KA,Padalecki JR,Starr AJ. What constitutes a Young and Burgess lateral compression-I (OTA 61-B2) pelvic ring disruption? A description of computed tomography-based fracture anatomy and associated injuries. J Orthop Trauma. 2008;23(1):16-21.

[20] Shahulhameed A, Roberts CS, Pomeroy CL, et al. Mapping the columns of the acetabulum implications for percutaneous fixation.Injury. 2010;41(4):339-342.

[21] 董建东,王友,朱振安,等. 成人髋臼骨计算机三维重建及形态学测量[J]. 中华外科杂志,2005,43(24):1583-1586.

[22] 王先泉,张进禄,周东生.沿骨盆界线放置内固定物的临床解剖学研究[J].中国临床解剖学杂志,2005,23(2):153-156.

[23] 郑琦,廖胜辉,石仕元,等. 髋臼前柱螺钉内固定的最优化计算机辅助测量[J]. 解剖学杂志,2007,30(5): 602-605.

[24] 魏伟明,郑建河,叶握球,等.三维 CT 重建影像增加髋臼骨折分型的可靠性[J]．中国骨与关节损伤杂志,2012,27(6):514-515．

[25] 高巍,彭阿钦,陈百成,等.髋臼螺钉固定安全性的解剖学研究[J].中国矫形外科杂志,2005,13(11):840-842.

[26] Wang ZF, Hong ZH, Wang MZ,et al.A reduction clamp for an aiming component in associated acetabular fractures.Indian J Orthop. 2015;49(1):101-104.

[27] 王庆贤,张英泽,潘进社,等.髋臼前柱拉力螺钉内固定的定量解剖学研究[J].中国临床解剖学杂志,2004,22(2):133-135.

[28] Kanda A, Kaneko K, Obayashi O,et al.A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed 22 years earlier: a case report.J Med Case Rep. 2015;9(1):17-19.

[29] 王先泉,蔡锦芳,曹学成,等. 髋臼后柱钢板内固定技术的解剖学研究[J]. 中华外科杂志,2009,47(15):1182-1184.

[30] 吴淑琴,潘宏侠,裴葆青. 髋臼横断骨折后柱长/短钢板内固定的有限元建模及分析[J]. 北京生物医学工程,2011,30(1):1-4.

[31] 吴啸波,张奇,郭明珂,等. 髋臼后柱骨折模型建立及髋臼后柱骨折钢板内固定和拉力螺钉内固定稳定性比较[J].中国组织工程研究与临床康复,2009,13(52):10236-10240.

[32] Bogdan D, Radu P, Dan C,et al.Combined bilateral femoral head necrosis and pertrochanteric fracture: a case report.J Med Case Rep. 2015;9(1):25.

[33] Malviya A, Dandachli W, Beech Z,et al.The incidence of stress fracture following peri-acetabular osteotomy: an under-reported complication.Bone Joint J. 2015;97-B(1): 24-28.

[34] Rogers BA, Kuchinad R, Garbedian S, et al.Cement augmentation of the acetabulum for revision total hip arthroplasty for infection.J Arthroplasty. 2015;30(2):270-271.

[35] Pierce TP, Cherian JJ, Jauregui JJ, et al. Outcomes of post-operative periprosthetic acetabular fracture around total hip arthroplasty.Expert Rev Med Devices. 2014;9(1):1-9.

[36] Collinge CA, Lebus GF.Techniques for reduction of the quadrilateral surface and dome impaction when using the anterior intrapelvic (modified stoppa) approach.J Orthop Trauma. 2015;29 (Suppl 2):S20-24.

[37] Archdeacon MT.Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum.J Orthop Trauma. 2015;29 (Suppl 2):S6-9.