The Clinical Application Of 3D Printing Technology In The Surgical Treatment Of Acetabular Fractures

ObjectiveTo explore the clinical application and effect of 3D printing technology in surgical treatment of acetabular fractures,and to provide a precise and personalized treatment plan for acetabular fracture surgery.MethodsA retrospective analysis of 23 patients with acetabular fractures admitted between April 2016 and September 2018 was divided into 3D printing groups and conventional groups according to whether 3D printing technology was used before surgery.There were 11 cases in the 3D printing groups,including 10 males and 1 female;The range of patients' age is 31-57 years,with an average of(41.18±9.61)years.There were 6 cases of injuries caused by car accidents,4 cases of falls and 1 case of heavy objects.There were 3 cases with craniocerebral injury,4 cases with thoracic and abdominal injury and 5 cases with fractures in other parts.According to the classification of Judet-Letournel,there were 3 cases of double-column fracture,3 cases of posterior column and wall fracture,1 case of transverse and posterior wall fracture and 2 cases of transverse fracture,1 case of "T" shaped fracture and 1 case of posterior wall fracture;There were 12 cases in the conventional groups,including 9 males and 3 females.The range of patients' age is 20-67 years,with an average(47.33+15.74)years.There were 9 cases of injuries caused by car accidents,2 cases of falls and 1 case of heavy objects.There were 1 cases with craniocerebral injury,2 cases with thoracic and abdominal injury and 6 cases with fractures in other parts.Fracture types: 2 cases of double-column fracture,3 cases of posterior column and wall fracture,2 cases of transverse fracture,1 case of "T" shaped fracture,2 case of transverse and posterior wall fracture and 2 cases of posterior wall fracture.The time from injury to operation in the 3D group was(5 ~ 20)days,with an average of(9.18±5.36)days;the time from injury to operation in the conventional group was(3 ~ 16)days,with an average of(7.58±3.63)days.In the 3D printing group,the 64-slice spiral CT scan data of the pelvis of the patients including the fracture side of the acetabulum were obtained preoperative,and the data were imported to the Mimics software in Dicom format to reconstruction the model of the pelvis.The fracture reduction was simulated on the reconstruction model,and the appropriate surgical approach and internal fixation were also selected.Then,the reconstructed data in STL format were imported into the 3D printing software,and a 1:1 simulation model of the pelvis or the acetabulum on the affected side was printed with polylactic acid as the raw material.The simulation is repeated on the 3D printing simulation model with reference to the simulated surgical procedure,and the steel plate was pre-bent and molded.The conventional group followed conventional surgical methods.The general conditions of the two groups and fracture types,choice of surgical approach were compared preoperative,as well as the operation time,the amount of bleeding and the frequency of fluoroscopy of the two groups.The VAS score of the two groups was evaluated postoperatively.The reduction of the two groups was evaluated according to the Matta standard,and the Merled'Aubigne and Postel scores at the last follow-up were calculated.ResultsThere were no significant difference between the two groups in preoperative general data,fracture types and the choice of surgical approach.For the 3D group and the conventional group.operative time was 114.64±20.27 min versus 147.25±37.84 min.Blood Loss 354.55±212.67 mL versus 554.17±224.07 mL.And the intraoperative fluoroscopy 4.36±0.92 times versus 5.50±1.24 times.There were significant differenees between the two groups in the above indexes(P<0.05).The postoperative VAS scores were respectively3.00±0.632 points and 3.50±0.798 points and the Merled'Aubigne-Postel scores at the last followups were respectively 16.55±2.207 points and 16.42±1.676 points,showing no significant between group difference(P>0.05).According to Matta criteria,5 cases were excellent,5 cases were good,1 case was poor in 3D group,the excellent and good rate was 90.9%,while in the conventional group,5 cases were excellent,5 cases were good,2 cases were poor,and the excellent and good rate of reduction was 83.3%.ConclusionThe application of 3D printing technology in acetabular fractures can accurate printing of fracture models preoperation,which can improve doctors' understanding of acetabular fractures and their operations,To guide the surgeons to perform precise operations during the operation.Through 3D printing technology,simulated reduction and preoperation can be achieved,and the position and direction of screws can be designed by prebending the steel plate in advance,which can truly achieve precise and personalized treatment.The application of 3D printing can shortening the operation time,reduce surgical trauma,reduce intraoperative blood loss and intraoperative fluoroscopy.However 3D printing can only assist intraoperative precision and personalized treatment,and does not affect the prognosis.In conclusion,the surgical treatment of acetabular fractures is complicated,and the application of 3D printing makes the treatment of acetabular fractures relatively simple,which is worthy of clinical promotion and application.