| Objective: Using 3D(Three-dimensional,3D)printing technology to make combined sacroiliac joint external nail guide plate for the treatment of pelvic fracture,and compared with the traditional perspective of percutaneous sacroiliac joint screw implantation for pelvic fracture.Methods: Guide plate production: a.Preoperative placement of positioning needle: lidocaine local infiltration anesthesia,two 2.5 mm Kirschner needles were placed at a certain angle near the column of the middle gluteal muscle of the iliac spine,and then the pelvis was scanned by CT(Computed Tomography,CT).The CT number obtained was imported into the computer according to DICOM(Digital Imagingand Communications in Medieine,DICOM)format for channel planning and guide plate design.b.Path planning of channel screws: the CT data of pelvis were imported into MIMICS(Materialise's Interactive Medical Image Control System,MIMICS)21,the 3D models of pelvis and skin were reconstructed respectively,and the screw placement channel of sacroiliac joint,needle entry point and length was planned,so that the passage did not penetrate the bone cortex in any view.c.Computer aided design and 3D printing to make external guide plate: using MIMICS software to design the module connecting the positioning needle and the sacroiliac joint nail path module with iliac outer plate support column,the two can be riveted and locked as a whole,and an extension sleeve is designed at the positioning needle,and the length and shape are based on the distance to the iliac spine surface and its local shape matching.The combined sacroiliac joint screw external screw guide plate with positioning and guiding sleeve and strengthening stable support column is obtained by Boolean operation.Model verification: the preoperative pelvic CT scan and 3D reconstruction data were extracted,and the combined guide plate was designed by MIMICS software.The guide plate model and pelvic model were printed,and the sacroiliac joint screw implantation II operation was simulated on the model.Clinical application: With the approval of the Medical Ethics Committee of our hospital,25 cases of pelvic fracture hospitalized in our department from March 1,2018 to December 31,2019 were selected and randomly divided into two groups: guide plate group(n=13)and non-guide plate group(n=12).The guide plate group uses the above method to make a sacroiliac joint screw external nail guide plate.During the operation,the guide plate is used to assist the placement of the sacroiliac joint screw,and the operation time,fluoroscopy number,penetration rate,and bleeding volume are recorded.The percutaneous sacroiliac joint screw was placed under line fluoroscopy,and the recording index was the same as above.The recorded data was analyzed using SPSS25.0 statistical software to compare whether there was a statistical difference between the two.Results: Both groups of patients successfully completed the operation,and no vascular nerve injury,nail breakage,nail withdrawal,or internal fixation failure occurred.There was no significant difference in age,sex,mechanism of injury,Tile classification of fracture,combined injury,time from injury to operation and other general data between the two groups.The operation time,fluoroscopy times and bleeding volume in the guide plate group were lower than those in the traditional group,and the difference was statistically significant(P < 0.05).There was no significant difference in screw penetration rate between the two groups(P > 0.05).Conclusion:Combined 3D printed sacroiliac joint external nail guide plate for the treatment of pelvic fractures,which increases the accuracy of auxiliary nail placement,reduces the number of fluoroscopy of the guide needle during the operation,the operation time and the amount of bleeding,and has certain clinical application value. |
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