Application Of 3D Printing Technology In The Treatment Of Complex Acetabular Fractures

ObjectiveTo explore the clinical therapeutic effect of 3D printing technology assisted surgeries in the treatment of complex acetabular fractures.Method68 cases of patients with acetabular fractures,have undergone surgeries performed by one surgeon,since October 2013 to October 2015,in Zhengzhou orthopedic hospital.Including 43 males,25 females,mean 36.4y(24~56y).According to the classification of Judet-Letournel,there were 17 cases of double column fracture,22 cases of posterior wall and posterior column fracture,18 cases of posterior wall and transverse fracture,5 cases of “T” fracture,6 cases of anterior column and anterior wall fracture.Injury factors: traffic injury in 37 cases,21 cases of high altitude fall injury,10 cases of building injury.Concomitant injuries: 47 cases of limb fractures,53 cases of pelvic fractures,25 cases of brain injury,18 cases of shock,21 cases of urinary system injury,11 cases of viscera injury,8 cases of neuro-injury.The mean time of injury to surgery was 6.8days(2 ~ 14d).28 patients by spiral CT scanning and 3D printing technique,computer simulation and individual specimens of surgery simulation and according to the preoperative plan surgery(3D group);40 patients take routine examination and surgery(conventional group).The length of incision,operation time,blood loss,fracture reduction,surgical complications,and postoperative hip function recovery of the two groups were analysed and compared by statistical software.ResultIn this cohort,all the data showed after strictly requirements to collect,review and analysed.There are no statistical significance between the two groups(P>0.05),in gender,age,fracture,classification,time between injuries and surgeries,cause of injuries,concomitant injuries.Showing that the general data before surgeries of the two groups patients has no significant difference,which are comparable.Intraoperatice bleeding,operation time,incision length in 3D group were significantly lower than the conventional group,and the difference is statistically significant(P<0.05).Postoperative fracture reduction examination showed that the conventional group(20 cases)anatomical reduction,15 cases of good reduction,unsatisfy reduction of 5 cases,the excellent and good rate was 87.5%,3D group: 23 cases of anatomic reduction,4 cases of good reduction and dislocation in 1 case,the excellent and good rate was 96.4%(P<0.05),showing that the set of 3D fracture reduction was significantly better than the conventional group,and the difference is statistically significant(P<0.05).The clinic,video,telephone and other follows up means to be adopted to review the recovery of hip joint function after operation,the follow-up time was mean 12.6 months(6-18 months),no follows up losing.At the end of the follow-up of hip joint function score of conventional group showed that 17 cases were excellent,11 cases of good and 9 cases were fair,poor in 3 cases,the excellent and good rate was 70.0%,among 3D group,23 cases were excellent and 3 cases were good and 1 case were fair,poor in 1 case,the excellent and good rate was 92.9%,and the difference is statistically significant(P<0.05),indicating that the 3D group postoperative hip function score was significantly better than the conventional group.Complications:0,2 avascular necrosis of the femoral head in 3D group and conventional group respectively,underwent total hip replacement treatment,traumatic arthritis in 2 cases,7 cases,shift ossification in 2 cases,6 cases.8 cases of preoperative nerve injury at the end of the time were recovered.After operation,the patients in the two groups there were no wound infection,venous thrombosis and other complications,the data analysis showed that the complications of the two groups had significant difference(P<0.05),and the 3D printing group complications occurrence rate was 14.3%,the conventional group complications occurred rate was 37.5%,indicating the conventional group compared to 3D group complications occurred at a relatively low rate.Conclusion1.Compared with the conventional surgery,the 3D printing assisted surgery can improve the efficiency of surgical treatment of complex acetabular fractures,shorten operation time,reduce intraoperative blood loss,reduce the incidence of postoperative complications and favour postoperative functional restoration of the hip joint.It has a high chinical value to the diagnosis and treatment of the complex acetabular fracture.2.The application of 3D printing technology can improve the quality of surgical treatment of complex acetabular fracture,optimize the complex acetabular fracture surgical treatment,Inimize the "second hit" after a "hit" to the acetabular fracture patients.It has a good guiding significance to the clinical treatment of orthopaedic surgeons.