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Printed three-dimensional anatomic templates for virtual preoperative planning before reconstruction of old pelvic injuries: initial results.

Wu XB, Wang JQ, Zhao CP, Sun X, Shi Y, Zhang ZA, Li YN, Wang MY - Chin. Med. J. (2015)

Bottom Line: Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases.The results were excellent in two cases, good in five, and poor in two based on the Majeed score.The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Trauma, Beijing Jishuitan Hospital; Laboratory of Bone Tissue Engineering, Beijing Research Institute of Traumatology and Orthopaedics, Beijing 100035, China.

ABSTRACT

Background: Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures.

Methods: First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8-17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure.

Results: The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6-9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3-29 months (median: 5 months). The fracture healing time was 9-17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The results were excellent in two cases, good in five, and poor in two based on the Majeed score.

Conclusions: The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.

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Related in: MedlinePlus

The real acetabulum and the three-dimensional printed model.
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Figure 2: The real acetabulum and the three-dimensional printed model.

Mentions: Sixteen dried human cadaveric pelvises (supplied by Beijing Anatomic Association) were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. First, a section of a real cadaver pelvis was scanned using CT. A 3D printed model was then produced of the open section of the pelvis. The model was then validated by making measurements using digital electronic vernier calipers at defined intervals (from the tip of the ischial spine to the tip of the anterior inferior spine) along the model bones and at the same points on the real cadaver pelvis. Two observers independently measured the same segments three times each [Figure 2]. Differences between the pelvis and model measurements were assessed using a paired Student's t-test.


Printed three-dimensional anatomic templates for virtual preoperative planning before reconstruction of old pelvic injuries: initial results.

Wu XB, Wang JQ, Zhao CP, Sun X, Shi Y, Zhang ZA, Li YN, Wang MY - Chin. Med. J. (2015)

The real acetabulum and the three-dimensional printed model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836250&req=5

Figure 2: The real acetabulum and the three-dimensional printed model.
Mentions: Sixteen dried human cadaveric pelvises (supplied by Beijing Anatomic Association) were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. First, a section of a real cadaver pelvis was scanned using CT. A 3D printed model was then produced of the open section of the pelvis. The model was then validated by making measurements using digital electronic vernier calipers at defined intervals (from the tip of the ischial spine to the tip of the anterior inferior spine) along the model bones and at the same points on the real cadaver pelvis. Two observers independently measured the same segments three times each [Figure 2]. Differences between the pelvis and model measurements were assessed using a paired Student's t-test.

Bottom Line: Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases.The results were excellent in two cases, good in five, and poor in two based on the Majeed score.The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Trauma, Beijing Jishuitan Hospital; Laboratory of Bone Tissue Engineering, Beijing Research Institute of Traumatology and Orthopaedics, Beijing 100035, China.

ABSTRACT

Background: Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures.

Methods: First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8-17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure.

Results: The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6-9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3-29 months (median: 5 months). The fracture healing time was 9-17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The results were excellent in two cases, good in five, and poor in two based on the Majeed score.

Conclusions: The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.

Show MeSH
Related in: MedlinePlus