3D Printing For The Treatment Of Complex Acetabular Fractures

Objective: To explore the feasibility and therapeutic effect of 3D printing in the treatment of complex acetabular fractures.Methods: A retrospective analysis was made of complex acetabular fractures treated in our hospital from 2015-01 to 2017-07.By having the 64 slice pelvic spiral CT scanning of each group,we get the two-dimensional image data of DICOM format,and import it into Mimics 17 software,and get the 3D model digital information and form the image through extraction,integration and processing.The digital information of the3 D model is introduced into the 3D model printer to make the entity model consistent with the size of the real pelvis.According to the contrast of the shape of the healthy side acetabulum,the steel plate was reconstructed.The obtained entity model is marked,disassembled,reset and fixed.After shaping,the steel plate is sterilized.All patients in the operation were chosen according to the different types of fracture,and the reposition was firmly fixed with the pre-molded reconstructive plate.Operation time,perioperative total blood loss and blood transfusion volume were recorded.Matta standard and Majeed scoring system were used to evaluate fracture reduction and postoperative function.Results: By observing the 3D printing model,we rapidly classified 13 acetabular fractures,including 6 cases of double column fractures,4 cases of anterior column +Half transverse fractures,and 3 cases of T fractures.The pelvis model that is printed by3 D is basically the same as the actual conditions in the intraoperative fracture.Two simulated operations before the operation have fully understood the overall situation,reduce the time needed for the reset,and achieve a satisfactory reduction in the most convenient way.Besides,for anatomical steel plate,we only need to fine tune the angle in the early stage after shaping,which saves more operation time.The consumption time of shaping steel plate is from 1 minutes to nearly 5 minutes,with an average of 3minutes each.The average operation time of the group was 140(100-200)min,the average bleeding amount was about 790(500-1400)ml,and the average blood transfusion was 600(200-1000)ml during the perioperative period.The average follow-up time was 14.7(6-24)months,all with bone healing,and the average fracture healing time was 3.3(3-5)months.After referring to the images,according to the situation of the quality of reduction,in accordance with the Matta standard for evaluation score: in 6 cases of double column fractures in 4 cases,1 cases with anatomic reduction in 1 cases,satisfactory reduction,reduction and poor;4 cases of anterior column with posterior transverse fracture,anatomical reduction in 1 cases in 3cases,satisfactory reduction;3 cases of type T fractures in 2 cases of anatomical reduction,satisfactory reduction in 1 cases.The total anatomic reduction rate was 70%.According to the Majeed scoring system,the most recent follow-up results were excellent in 7 cases,good in 4 cases,fair in 2 cases,excellent in 85%,poor in 2 cases,poor in function,delayed in 1 cases,and complicated in double column fractures with acetabular roof compression in 1 cases.There is still a short follow-up of postoperative follow-up,which may lead to a number of traumatic arthritis that have not been found,affecting the results of the functional score.Conclusion: The 3D printing model helps young Department of orthopedics doctors to better understand the type of acetabular fracture and the local anatomical characteristics.Through 3D printing model pre operation preoperative plan in surgical results(including operative time,perioperative total bleeding volume and quality of fracture reduction),compared with before surgery,only through experience preparation surgery,temporary intraoperative temporary shaping method of steel plate is superior.Based on patient specific contralateral prefabricated steel plate,the anatomical morphology after fracture reduction is precisely matched,avoiding the attempt of multiple molding in traditional methods,which not only saves operation time,but also helps maintain implant strength.The exact advantage of another 3D print model is that it can simulate the difficult operation of the acetabular fracture to facilitate clinical practice to shorten the learning curve.However,pre-operation preparation is a very time-consuming process,and an additional cost of treatment is added to the traditional way.Moreover,when the acetabulum complex fracture is severe or with the compression of the acetabulum top,even after a comprehensive preoperative plan and the restoration of anatomy as far as possible,the postoperative effect may not be ideal.3D printing is a rapid development technology in the era of digital information.The application of 3D printing and related technology has achieved satisfactory results in all fields of surgery.In this study,3D printing assisted in the treatment of complex acetabular fractures has a good effect,and it is in line with the mainstream minimally invasive and accurate medical concept.However,the sample size of this study is small,and large sample data and similar control cases are still needed for further validation of our results.