| Background:Surgical treatment of both-column acetabular fractures is challenging because of the complex acetabular fracture patterns and the curved surface of the acetabulum.Seldom study has compared the application of three-dimensional(3D)printing technology and traditional methods of contouring plates intraoperatively for the surgical treatment of both-column acetabular fractures We present the use of 3D printing technology and a virtual simulation in preoperative planning for both-column acetabular fractures.We hypothesized that 3D printing technology will assist orthopedic surgeons in shortening the surgical time and improving the clinical outcomes.Objective:To explore the feasibility and effectiveness of the Surgical treatment for both-column acetabular fractures using 3D printing techniques by comparing the clinical outcomes of the 3D printing group and the conventional method group.Methods:Forty patients with both-column acetabular fractures were recruited in this prospective study from September 2013 to September 2017.We divided the patients into two groups(3D printing group,n=20;conventional method group,n=20).In the 3D printing group,the 1:1 scale pelvic models were acquired using 3D printing technique and the plates were pre-contoured according to the pelvic models.The plates of the conventional method group were contoured during operation without 3D printing pelvic model.Operation time,Instrumentation time,Time of intra-operative fluoroscopy,blood loss,number of the approach,blood transfusion,post-operative fracture reduction quality,hip joint function,and complications were recorded and compared between the two groups.Results:The operation and instrumentation time in the 3D printing group was significantly shorter(130.8±29.2 minutes,t=-7.5,P<0.001 and 32.1±9.5 minutes,t=-6.5,P<0.001,respectively)than those in the conventional method group.The blood loss and blood transfusion in the 3D printing group was significantly less(mean rank 13.5,Mann-Whitney U=74.5,P<0.001 and mean rank 14.2,Mann-Whitney U=59.5,P<0.001,respectively)than those in the conventional method group.The number of the approach in the 3D printing group was significantly less than that in the conventional method group(pararectus+ K-L approach rate:35%vs 85%;χ2=10.43 P<0.05).The time of intra-operative fluoroscopy in the 3D printing group was significantly shorter than that in the conventional method group(4.2±1.8 vs 7.7±2.6 seconds;t=-5.0,P<0.001).The post-operative fracture reduction quality in the 3D printing group was significantly better than that in the conventional method group(good reduction rate:80%vs 30%;χ2=10.1,P<0.05).The hip joint function(based on the Harris score one year after the operation)in the 3D printing group was significantly better than that in the conventional method group(excellent/good rate:75%vs 30%;χ2＝8.1,P<0.05).The complication rate was similar in both groups(5%vs 25%;χ2=3.1,P=0.182).Conclusions:Preoperative virtual simulation with three-dimensional printing technology is a more effective method to treated both-column acetabular fractures.This method can shorten the operation and instrumentation time,reduce the blood loss,blood transfusion and the time of intra-operative fluoroscopy,and improve the post-operative fracture reduction quality. |
