| Objective The aim of this study is to investigate the application of 3D printing technology in the surgical treatment of acetabular fracture and provide accurate and individualized operation plan and personalized surgical treatment for patients. We also aim to analyze retrospectively the value and advantages of 3D printing technology in acetabular fracture treatment, so as to provide an effective assistance for clinical treatment of acetabular fractures.Methods Part one: The surgery plan was formulated by 3D printing technology based on 51 patients which were suffered acetabular fractures. The image date of acetabular fractures were obtained through PACS system in the form of Dicom. Then, the image date was inputed to the Mimics software and disposed by threshold segmentation, region growing and 3D reconstruction. Reduction of fractures was simulated by the function of 3D editing in the software. The models of acetabular fractures were printed by Maker Bot software. According the operation strategy, layout and shape of the internal fixation device was performed. The preoperative optimal preoperative design was selected individualization in the acetabular fractures models.Part two: Based on the standards of inclusion, exclusion, rejection and falling, the data of patients which were treated by surgeon between Sep 2010 to Dec 2015 in Wuhan General Hospital of Guangzhou Military Command was collected. The patients were divided into two research objects according to the type of fractures:(1)There were 53 cases suffered acetabular fracture invo lving posterior wall, They were 27 men and 26 women, ranging from 20 to 65 years old. According to the Letournel-Judet classification, there were 27 cases of posterior wall fractures, 16 cases of posterior column + posterior wall fracture, and 10 cases of transverse + posterior wall fracture. Among them, 20 used 3D printing technology, including 20 men and 9 women, with an average age of 44.3 ± 13.1 years. The other 33 cases, without aiding by 3D printing technology, included 18 men and 15 women, with an average age of 42.6 ± 11.8 years.(2)There were 74 cases suffered complex acetabular fractures. They were 39 men and 35 women, ranging from 19 to 65 years old. According to the Letournel-Judet classification, there were 18 cases of T-shaped fractures, 14 cases of anterior column plus posterior hemitransverse fracted, and 42 cases of double-column fractures.Among them, 31 used 3D printing technology, including 19 men and 12 women, with an average age of 44.3 ± 11.7 years. The other 43 cases, without aid by 3D printing technology, included 20 men and 23 women, with an average age of 41.5 ± 11.5 years. All the patients in the 3D printing technology group received operation under the assistance of 3D printing technique, including printing the physical models of acetabular fractures, designing preoperatively and formulating individualized operative plan. The patients in conventional group were operated by preoperative X-ray and three dimensional CT reconstruction. The operation time, intraoperative bleeding, intraoperative fluoroscopy frequency, fracture reduction, hip joint function at the time of the last follow-up and postoperative complications were compared between this two groups.Results Part one: Pelvic 3d virtual model could be established and operation strategy was completed with the help of Mimics software. Moreover, excellent simulation model of pelvic fractures and accurate diagnosis can be obtained with the application of 3D printing technology. In order to guide the operation performing accurately and safely, we could verify the operation strategy and practice repeatly on the Pelvic 3 d virtual model preoperative. The operation plans of 51 patients suffered acetabular fractures including surgical approach, reset sequence of complex acetabular fracture, the layout and preliminary shaping of internal fixation and the length and direction of screw were designed. All operations were completed smoothly, actual operation situation be consistent with preoperative design. There was no joint penetration by postoperative review.Part two:(1) The patients with acetabular fracture involving posterior wall were followed up for an average of 11.8 months(range from 6 to 30 months).The operation time for the 3D group(84.4 ± 14.4 min) was significantly shorter than that for the conventional group(98.3 ± 15.2 min), the intraoperative bleeding(258.5 ± 66.8 m L) and the intraoperative fluoroscopy frequency(2.7 ± 0.8 times)in the 3D group were significantly less than those in the conventional group(323.4 ± 75.8 m L; 3.3 ± 0.8 times)(P< 0.05). There were no significant differences between the 3D and conventional groups in the good to excellent rate of reduction [ 95%(19/20) versus 90.9%(30/33)], the modified Merle d’Aubigné- Postel scores at the last follow-up(16.4±1.5 versus 16.1±1.6), or incidence of complications [20%(5/20) and 30.3%(10/33)](P < 0.05).(2)The patients with complex acetabular fractures were followed up for an average of 13.3 months(range from 6 to 32 months).In the 3D group, 25 cases were operated via the ilioinguinal approach solely, the other 6 cases were disposed through the combined anterior and posterior approach; 24 cases were operated via the ilioinguinal approach and 19 cases were adopted with combined anterior and posterior approach in the conventional group. The operation time for the 3D group(171.8 ± 27.9 min) was significantly shorter than that for the conventional group(200.9 ± 31.3 min), the intraoperative bleeding(563.7±154.4 m L) and the intraoperative fluoroscopy frequency(2.7±0.8 times)in the 3D group were significantly less than those in the conventional group( 696.4±214.9 m L; 3.4±0.9 times)(P < 0.05). There were no significant differences between the 3D and conventional groups in the good to excellent rate of reduction [90.3%(28/31) versus 86.1%(37/43) ],the modified Merle d’Aubigné-Postel scores at the last follow-up(16.2±1.4 versus 15.8 ± 1.5), or incidence of complications [35.4%(11/31)and 62.8%(27/43)](P < 0.05).Conclusion Accurate operation strategy of acetabular fracture is formulated with the assistance of 3D printing technology. In addition, the operation time, intraoperative bleeding loss, and intraoperative fluoroscopy frequency are reduced obviously. The security and feasibility of surgery to treatment acetabulum fractures are improved by a single iliac inguinal approach. The 3D printing technology is an effective adjuvant technology for treating the acetabular factures. |
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