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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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(a) Preoperative plain film X-ray; (b) Preoperative three-dimensional (3D) computed tomography; (c) 3D print model; (d and e) The preoperative osteotomy, reduction, and fixation virtual operation on the model; (f) After successful completion of the operation.
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Figure 3: (a) Preoperative plain film X-ray; (b) Preoperative three-dimensional (3D) computed tomography; (c) 3D print model; (d and e) The preoperative osteotomy, reduction, and fixation virtual operation on the model; (f) After successful completion of the operation.

Mentions: A 46-year-old female patient presented 8 months after being injured in a car accident. The CT scan showed a vertically displaced fracture involving the iliac blade starting 3 cm below the iliac crest and extending forward, reaching up to the acetabular roof and triradiate cartilage, involving both the anterior and posterior columns. There was a mild protrusion of the femoral head, and the fracture line extension was present until the superior pubic rami [Figure 3a–c].


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)

(a) Preoperative plain film X-ray; (b) Preoperative three-dimensional (3D) computed tomography; (c) 3D print model; (d and e) The preoperative osteotomy, reduction, and fixation virtual operation on the model; (f) After successful completion of the operation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (a) Preoperative plain film X-ray; (b) Preoperative three-dimensional (3D) computed tomography; (c) 3D print model; (d and e) The preoperative osteotomy, reduction, and fixation virtual operation on the model; (f) After successful completion of the operation.
Mentions: A 46-year-old female patient presented 8 months after being injured in a car accident. The CT scan showed a vertically displaced fracture involving the iliac blade starting 3 cm below the iliac crest and extending forward, reaching up to the acetabular roof and triradiate cartilage, involving both the anterior and posterior columns. There was a mild protrusion of the femoral head, and the fracture line extension was present until the superior pubic rami [Figure 3a–c].

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