| BackgroundInjury of unstable pelvic ring is serious which is often caused by high energy injuries such as car accidents and fall from heights.Due to unstable hemodynamics and other associated injury,the mortality is high.Pelvic fixation is needed in order to maitain the stability when life-rescuing is completed in clinical practice.The theory of minimal fixation and biological reduction is based on reducing the injury of operation in maximum.The application of minimal surgery is not extensive because of the complexity.The application of laparoscopy in the field of pelvic fractures can reduce surgery trauma greatly and no evident scars are found. Simulated operation based on 3D printing technique can make operarion more accurate.However,the software is complicated and only those who have been trained can manage it.Recently,Open reduction and internal fixation is the tradional way to treat pelvic fractures which is often compicated by more bleeding,long time to recover.The treatment of unstable pelvic fractures is complicated.Failure of operation is often caused by 2 reasons.the first is unstable internal fixation and the second is infinite comprehension of anatomy of the lelvis.Recently,More and more research has been focused on the minimal invasive surgery of pelvic fractures.However,The expensive equipment has liminted the use of this method in underdeveloped regions.The virtual surgical simulation consists of three consecutive steps, including the Image segmentation, the fracture reduction and the internal fixation.Image segmentation is the fundament of the virtual surgery. The fractured model without the femoral head was a great help for surgeons to gain deeper understanding of the fracture including judging the fracture type and choosing the proper operative approach.The main implication of the reduction is to explore the sequence of reduction and perform more accurate reduction in real operation. Virtual internal fixation especially the optimum position of the internal implants is the core part of the surgical plan. It’s a great learning experience for the younger doctor to understand the fixation patterns, especially the complex fractures.The other advantage of the virtual surgery is the high degrees of sharing. For the designer, design is a shared process with the surgical team, which is conducive to enhance the cooperative during the procedure. In addition, the virtual surgery is a repeatable process, so that the surgeon can try different plans to find the best fixation pattern for patients. The educational aspects of the procedure should also be considered. Younger or less experienced surgeons, even the medical student would profit from virtual surgery.The application of 3D printing in surgery is beneficial in diagnosis, preoperative planning and intraoperative navigation system especially for complex cases. For example,there have been reports about its application and benefit in spine surgery, maxillofacial surgery, cardiovascular surgery and pelvic surgery. In this study, the 3D-printed models were used to simulate complicated surgical steps before surgery for validating the surgical planas well as patient-specific pre-bent plates. Compared with the virtual simulation, the simulation with 3D-printed models is more realistic and the pre-bent plates based on physical models have anatomical shapes matched with the reduced pelvis perfectly. The excellent outcomes have shown its potential advantage for improving the security and accuracy of the orthopaedic surgery. Therefore,a reasonable and safe operation is urgently required. Objectives1 To illucidate the anatomical characteristics of para-rectus abdominis approach and evaluate it’s application value and feasibility.2 To provide scientific evidence for modified surgical approaches based on para-rectus abdominis/K-L approach assisted with 3D printing technique.3 To illucidate the anatomical characteristics anterior ring of pelvis with laparoscopic assisted and provide scientific evidence for fractured pelvis with laparoscopic assisted.To demonstrate the clinical application of laparoscopic assisted surgery with 3D printing technique.Methods1 Patients with pevic fracture were collected from Sep 2013 to June 2015.First,simulated reduction and internal fixation pre-bent steel plates were performed.Then realistic surgery was performed according to the simulated results.Average operation time,amount of bleeding and incision length were observed.The effectiveness is evaluated by Matta and Majeed scores.The recovery of the reduction is assessed by radiology.2 Patients with pevic fracture were collected from Sep 2013 to June 2015.First,simulated reduction and internal fixation pre-bent steel plates were performed.Then realistic surgery was performed according to the simulated results through para-rectus abdominis approach or/and K-L approach.Average operation time,amount of bleeding and incision length were observed.The effectiveness is evaluated by Matta and Majeed scores.The recovery of the reduction is assessed by radiology.The number of screws between simulated surgery and realistic surgery was compared.The displacement distances of pelvis were recorded before and after surgery.3 A patient with anterior pelvic fracture was selected. First,simulated reduction and internal fixation pre-bent steel plates were performed.Then realistic surgery was performed according to the simulated results with laparoscopy. Average operation time,amount of bleeding and incision length were observed.The effectiveness is evaluated by Matta and Majeed scores.The recovery of the reduction is assessed by radiology.Results1 Treatment of pelvic fractures through para-rectus abdominis approach with 3D printing technique.The excellent and good ratio of reduction was 96% and 94% based on Matta and Majeed scores.Consitency was observed between simulated and realistic surgery according to radiology. All patients were clinically healed without abnormalities and complications with average healing time of 8 weeks.2 Treatment of pelvic fractures through para-rectus abdominis approach or/and K-L approach with 3D printing technique.The number of screws were consistent between simulated and realistic surgery.The orientation of steel plates and screws were also consistent and no screws was found on cavity.There was statistical significance between maximum displacement before and after surgery.7 cases were reducted anatomically,3 cases were reducted excellent.The excellent and good ratio of reduction were 100% based on Matta and Majeed scores.3. Treatment of anterior ring of pelvic fractureswith laparoscope and 3D printing technique.Compared with traditional methods,this method has the advantage of less injury,small incision,less bleeding and pain.Patients can perform functional exercise at an early stage.Conclusion1.Compared with traditional methods,this method has the advantage of less injury,small incision,less bleeding and pain.Patients can perform functional exercise at an early stage2. Simulated surgery with 3D printing technique can make operation more safe and accurate. The application and laparoscope technique of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs. |
PDF Full Text Request