1
|
Tao F, Li L, Wang D, Dong J, Zhou D, Song W. Three-dimensional printing versus traditional surgery for inveterate pelvic and acetabular fractures: A retrospective study of 37 patients. Medicine (Baltimore) 2023; 102:e36149. [PMID: 37986284 PMCID: PMC10659720 DOI: 10.1097/md.0000000000036149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Treatment of deformed pelvic and acetabular fractures is a considerable challenge for orthopedic surgeons. The aim of this study was to assess the availability of a three-dimensional (3D) printing model used in patients with inveterate pelvic and acetabular fractures by comparing 3D printing technology with conventional surgery. We conducted a retrospective review of patients with inveterate pelvic and acetabular fractures treated in our department between January 2008 and June 2020. The patients were divided into 2 groups according to their willingness. Perioperative data and clinical outcomes were compared to evaluate clinical efficacy. The t-test, Fisher exact test, and multivariable logistic regression analysis were conducted. A P value of .05 or less was considered to be statistically significant (two-tailed). Thirty-seven patients were enrolled in our study. Seventeen patients were divided into the case group treated by 3D printing model-assisted preoperative planning, and 20 patients were divided into the control group treated by conventional surgery. Patients treated with the 3D printing model had significantly shorter operation times, less blood loss, and shorter fluoroscopy times. Patients in the case group also showed better pain relief according to visual analog scale scores. However, the elevations in pelvis and hip joint functional outcomes were similar between the 2 groups, and no significant difference was shown in the radiological result. The usage of 3D printing techniques in patients with inveterate pelvic and acetabular fractures is of great importance in preoperative preparation and optimization of surgery but cannot improve postoperative function compared with conventional treatment.
Collapse
Affiliation(s)
- Fulin Tao
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lin Li
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopedic Surgery, Tengzhou Central People’s Hospital Affiliated to Jining Medical University, Tengzhou, Shandong, China
| | - Dawei Wang
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wenhao Song
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| |
Collapse
|
2
|
Shaikh HJF, Hasan SS, Woo JJ, Lavoie-Gagne O, Long WJ, Ramkumar PN. Exposure to Extended Reality and Artificial Intelligence-Based Manifestations: A Primer on the Future of Hip and Knee Arthroplasty. J Arthroplasty 2023; 38:2096-2104. [PMID: 37196732 DOI: 10.1016/j.arth.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Software-infused services, from robot-assisted and wearable technologies to artificial intelligence (AI)-laden analytics, continue to augment clinical orthopaedics - namely hip and knee arthroplasty. Extended reality (XR) tools, which encompass augmented reality, virtual reality, and mixed reality technology, represent a new frontier for expanding surgical horizons to maximize technical education, expertise, and execution. The purpose of this review is to critically detail and evaluate the recent developments surrounding XR in the field of hip and knee arthroplasty and to address potential future applications as they relate to AI. METHODS In this narrative review surrounding XR, we discuss (1) definitions, (2) techniques, (3) studies, (4) current applications, and (5) future directions. We highlight XR subsets (augmented reality, virtual reality, and mixed reality) as they relate to AI in the increasingly digitized ecosystem within hip and knee arthroplasty. RESULTS A narrative review of the XR orthopaedic ecosystem with respect to XR developments is summarized with specific emphasis on hip and knee arthroplasty. The XR as a tool for education, preoperative planning, and surgical execution is discussed with future applications dependent upon AI to potentially obviate the need for robotic assistance and preoperative advanced imaging without sacrificing accuracy. CONCLUSION In a field where exposure is critical to clinical success, XR represents a novel stand-alone software-infused service that optimizes technical education, execution, and expertise but necessitates integration with AI and previously validated software solutions to offer opportunities that improve surgical precision with or without the use of robotics and computed tomography-based imaging.
Collapse
Affiliation(s)
| | - Sayyida S Hasan
- Donald and Barbara Zucker School of Medicine at Hofstra, Uniondale, New York
| | | | | | | | - Prem N Ramkumar
- Hospital for Special Surgery, New York, New York; Long Beach Orthopaedic Institute, Long Beach, California
| |
Collapse
|
3
|
Management of Complex Acetabular Fractures by Using 3D Printed Models. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121854. [PMID: 36557056 PMCID: PMC9785751 DOI: 10.3390/medicina58121854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Using 3D printed models in orthopaedics and traumatology contributes to a better understanding of injury patterns regarding surgical approaches, reduction techniques, and fracture fixation methods. The aim of this study is to evaluate the effectiveness of a novel technique implementing 3D printed models to facilitate the optimal preoperative planning of the surgical treatment of complex acetabular fractures. Materials and Methods: Patients with complex acetabular fractures were assigned to two groups: (1) conventional group (n = 12) and (2) 3D printed group (n = 10). Both groups included participants with either a posterior column plus posterior wall fracture, a transverse plus posterior wall fracture, or a both-column acetabular fracture. Datasets from CT scanning were segmented and converted to STL format, with separated bones and fragments for 3D printing in different colors. Comparison between the two groups was performed in terms of quality of fracture reduction (good: equal to, or less than 2 mm displacement, and fair: larger than 2 mm displacement), functional assessment, operative time, blood loss, and number of intraoperative x-rays. Results: A significant decrease in operative time, blood loss, and number of intraoperative x-rays was registered in the 3D printed group versus the conventional one (p < 0.01), with 80% of the patients in the former having good fracture reduction and 20% having fair reduction. In contrast, 50% of the patients in the conventional group had good reduction and 50% had fair reduction. The functional score at 18-month follow-up was better for patients in the 3D printed group. Conclusions: The 3D printing technique can be considered a highly efficient and patient-specific approach for management of complex acetabular fractures, helping to restore patient′s individual anatomy after surgery.
Collapse
|
4
|
Dang J, Fu J, Liu D, Zhang Z, Mi Z, Cheng D, Liu X, Zhang Y, Zhu D, Wang L, Shi Y, Fan H. Clinical application of 3D-printed patient-specific guide plate combined with computer navigation in acetabular reconstruction following resection of periacetabular tumors. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:76. [PMID: 35282055 PMCID: PMC8848447 DOI: 10.21037/atm-21-7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022]
Abstract
Background The precise acetabular reconstruction has historically been a challenging procedure. 3D-printed patient-specific guide (PSG) and computer navigation (CN) technologies have been used to assist acetabular component positioning and pelvic reconstruction. This precise reconstruction approach may translate into clinical benefit. Methods The clinical data of 84 patients who underwent periacetabular malignant tumor resection and screw-rod-acetabular cage system reconstruction in our center from January 2013 to December 2020 were retrospectively analyzed. Patients were divided into four groups: free hand (FH) group, PSG group, CN group, and PSG combined with computer navigation (PSG + CN) group. The operation time, intraoperative blood loss, and number of fluoroscopy views were recorded. The oncological prognosis, radiographic measurements of the acetabulum, limb function data, and postoperative complications were compared among groups. And finally, we evaluated the risk factors for mechanical failure of the prosthesis. Results The postoperative X-ray and computed tomography (CT) scan revealed that the vertical offset discrepancy (VOD) between affected side and contralateral side was 8.4±1.9, 5.9±2.2, 4.1±1.3, and 2.4±1.2 mm in each groups; the horizontal offset discrepancy (HOD) was 9.0±1.9, 6.1±2.2, 3.2±1.3, and 2.1±1.2 mm, correspondingly; the abduction angle discrepancy (ABAD) was 8.6°±1.8°, 5.6°±2.0°, 2.5°±1.3°, and 1.8°±0.9°, respectively; the anteversion angle discrepancy (ANAD) was 5.9°±1.6°, 3.6°±1.7°, 2.9°±1.6°, and 1.9°±0.9°, correspondingly. Statistical results show that the PSG + CN group was superior to the FH group and the PSG group in terms of acetabular position and limb function (P<0.05). Body mass index (P=0.040) and resection type (P=0.042) were found to be the high-risk factors for mechanical failure of the prosthesis. Conclusions PSG + CN has potential advantages in improving the accuracy and safety of acetabular positioning and reconstruction.
Collapse
Affiliation(s)
- Jingyi Dang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Fu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dong Liu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhao Zhang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhenzhou Mi
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Debin Cheng
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xincheng Liu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yushen Zhang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dongze Zhu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Wang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yubo Shi
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongbin Fan
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
5
|
Meesters AML, Trouwborst NM, de Vries JPPM, Kraeima J, Witjes MJH, Doornberg JN, Reininga IHF, IJpma FFA, ten Duis K. Does 3D-Assisted Acetabular Fracture Surgery Improve Surgical Outcome and Physical Functioning?-A Systematic Review. J Pers Med 2021; 11:966. [PMID: 34683107 PMCID: PMC8541524 DOI: 10.3390/jpm11100966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022] Open
Abstract
Three-dimensional technology is increasingly being used in acetabular fracture treatment. No systematic reviews are available about the added clinical value of 3D-assisted acetabular fracture surgery compared to conventional surgery. Therefore, this study aimed to investigate whether 3D-assisted acetabular fracture surgery compared to conventional surgery improves surgical outcomes in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy usage, complications, and postoperative fracture reduction, and whether it improves physical functioning. Pubmed and Embase databases were searched for articles on 3D technologies in acetabular fracture surgery, published between 2010 and February 2021. The McMaster critical review form was used to assess the methodological quality. Differences between 3D-assisted and conventional surgery were evaluated using the weighted mean and odds ratios. Nineteen studies were included. Three-dimensional-assisted surgery resulted in significantly shorter operation times (162.5 ± 79.0 versus 296.4 ± 56.0 min), less blood loss (697.9 ± 235.7 mL versus 1097.2 ± 415.5 mL), and less fluoroscopy usage (9.3 ± 5.9 versus 22.5 ± 20.4 times). The odds ratios of complications and fracture reduction were 0.5 and 0.4 for functional outcome in favour of 3D-assisted surgery, respectively. Three-dimensional-assisted surgery reduces operation time, intraoperative blood loss, fluoroscopy usage, and complications. Evidence for the improvement of fracture reduction and functional outcomes is limited.
Collapse
Affiliation(s)
- Anne M. L. Meesters
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Neeltje M. Trouwborst
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Joep Kraeima
- 3D Lab, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Max J. H. Witjes
- 3D Lab, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Job N. Doornberg
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Kaj ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| |
Collapse
|
6
|
Xiao K, Xu B, Ding L, Yu W, Bao L, Zhang X, Chen M, Liu X, Lin H, Li T. Traditional versus mirror three-dimensional printing technology for isolated acetabular fractures: a retrospective study with a median follow-up of 25 months. J Int Med Res 2021; 49:3000605211028554. [PMID: 34187209 PMCID: PMC8258767 DOI: 10.1177/03000605211028554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the outcomes of traditional three-dimensional (3D) printing technology (TPT) versus mirror 3D printing technology (MTT) in treating isolated acetabular fractures (IAFs). Methods Consecutive patients with an IAF treated by either TPT or MTT at our tertiary medical centre from 2012 to 2018 were retrospectively reviewed. Follow-up was performed 1, 3, 6, and 12 months postoperatively and annually thereafter. The primary outcome was the Harris hip score (HHS), and the secondary outcomes were major intraoperative variables and key orthopaedic complications. Results One hundred fourteen eligible patients (114 hips) with an IAF (TPT, n = 56; MTT, n = 58) were evaluated. The median follow-up was 25 months (range, 21–28 months). At the last follow-up, the mean HHS was 82.46 ±14.70 for TPT and 86.30 ± 13.26 for MTT with a statistically significant difference. Significant differences were also detected in the major intraoperative variables (operation time, intraoperative blood loss, number of fluoroscopic screenings, and anatomical reduction number) and the major orthopaedic complications (loosening, implant failure, and heterotopic ossification). Conclusion Compared with TPT, MTT tends to produce accurate IAF reduction and may result in better intraoperative variables and a lower rate of major orthopaedic complications.
Collapse
Affiliation(s)
- Kai Xiao
- Department of Anesthesiology, 12443Huazhong University of Science and Technology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 473, Hanzheng Street, Qiaokou District, Wuhan, China
| | - Bo Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Lin Ding
- Department of Rehabilitation Medicine, 577528The Central Hospital of Wuhan, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Jiang'an District, Wuhan, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Lei Bao
- Department of Anesthesiology, 12443Huazhong University of Science and Technology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 473, Hanzheng Street, Qiaokou District, Wuhan, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Huanyi Lin
- Department of Urology Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Tengfei Li
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| |
Collapse
|
7
|
Yu C, Yu W, Mao S, Zhang P, Zhang X, Zeng X, Han G. Traditional three-dimensional printing technology versus three-dimensional printing mirror model technology in the treatment of isolated acetabular fractures: a retrospective analysis. J Int Med Res 2021; 48:300060520924250. [PMID: 32466684 PMCID: PMC7263167 DOI: 10.1177/0300060520924250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study was performed to compare the clinical outcomes of traditional three-dimensional (3D) printing technology and 3D printing mirror model technology in the treatment of isolated acetabular fractures. METHODS Prospectively maintained databases were reviewed to retrospectively compare patients with an isolated acetabular fracture who were treated with traditional 3D printing technology (Group T) or 3D printing mirror model technology (Group M) from 2011 to 2017. In total, 146 advanced-age patients (146 hips) with an isolated acetabular fracture (Group T, n = 72; Group M, n = 74) were assessed for a mean follow-up period of 29 months (range, 24-34 months). The primary endpoint was the postoperative Harris hip score (HHS). The secondary endpoints were the operation time, intraoperative blood loss, fluoroscopy screening time, fracture reduction quality, and incidence of postoperative complications at the final follow-up. RESULTS The HHS, operation time, intraoperative blood loss, fluoroscopy screening time, and incidence of postoperative complications were significantly different between the groups, with Group M showing superior clinical outcomes. CONCLUSION In patients with an isolated acetabular fracture, 3D printing mirror model technology might lead to more accurate and efficient treatment than traditional 3D printing technology.
Collapse
Affiliation(s)
- Cong Yu
- Department of Anesthesiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuai Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peiru Zhang
- Department of Anesthesiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guowei Han
- Department of Anesthesiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
8
|
Marinescu R, Popescu D, Laptoiu D. A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery. J Clin Med 2020; 9:E2908. [PMID: 32916844 PMCID: PMC7565448 DOI: 10.3390/jcm9092908] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
This paper is a systematic review of the literature on 3D-printed anatomical replicas used as templates for precontouring the fixation plates in orthopedic surgery. Embase, PubMed, Cochrane, Scopus and Springer databases were consulted for information on design study, fracture anatomical location, number of patients, surgical technique, virtual modeling approach and 3D printing process. The initial search provided a total of 496 records. After removing the duplicates, the title and abstract screening, and applying exclusion criteria and citations searching, 30 papers were declared eligible and included in the final synthesis. Seven studies were identified as focusing on retrospective non-randomized series of clinical cases, while two papers presented randomized case control studies. Two main approaches were highlighted in developing 3D-printed anatomical models for precontouring fixation plates: (a.) medical reconstruction, virtual planning and fracture reduction followed by 3D printing the model; (b.) medical reconstruction followed by 3D printing the model of the mirrored uninjured side. Revised studies reported advantages such as surgical time and blood loss reduction, while the reduction quality is similar with that of the conventional surgery. During the last couple of years there was an increase in the number of studies focused on precontouring orthopedic plates using 3D printing technology. Three-dimensionally-printed templates for plate precontouring were mostly used for acetabular fractures. Knowledge on medical virtual modeling and reconstruction is mandatory.
Collapse
Affiliation(s)
- Rodica Marinescu
- Department of Orthopedics, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania;
| | - Diana Popescu
- Department of Robotics and Production Systems, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Dan Laptoiu
- Department of Orthopedics 2, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| |
Collapse
|
9
|
Zhao B, Sun Z, Zhang W, Xu Z, Yang X, Mu W. Digital anatomical study and clinical application of screw placement for quadrilateral plate fractures in the danger zone. BMC Musculoskelet Disord 2020; 21:222. [PMID: 32278348 PMCID: PMC7149894 DOI: 10.1186/s12891-020-03265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Direct screw placement for quadrilateral plate fractures in the danger zone of the acetabulum is very difficult. This study was performed to simulate the surgical procedure and try to obtain effective and safe screw angles through the middle window of the ilioinguinal approach in Chinese patients. METHODS We randomly collected the pelvic computed tomography (CT) scans of 100 adults. DICOM-formatted CT-scan images were imported into Mimics software. The three-dimensional reconstruction (3D) digital model of the semi-pelvis was established. A 3.5 mm cylinder was used to simulate the pathway of the screw from the designated insertion point. The angles of insertion and intersex differences were explored by statistical analyses. RESULTS The screws could be inserted via three angles: medial inclination, anterior inclination and posterior inclination. The mean minimum medial inclination angle (MIMIA) of insertion point A was 4.96° ± 1.11° in males and 8.66° ± 3.40° in females, and the intersex difference was significant. The mean minimum medial inclination angle (MIMIA) of insertion point B was - 5.31° ± 3.69° in males and 1.75° ± 8.95° in females, and the intersex difference was significant. There were no differences between any of the angles for males and females at insertion point O. CONCLUSIONS Preoperative measurement and calculation by digital tools before screw placement for quadrilateral plate fractures of the acetabulum are feasible. Double cortical screws could be placed safely in the danger zone through the middle window of the ilioinguinal approach to increase the stability of the acetabulum.
Collapse
Affiliation(s)
- Bei Zhao
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250012 Shandong China
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Zhongye Sun
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Wei Zhang
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Zhongbao Xu
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Xiaofei Yang
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Weidong Mu
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250012 Shandong China
| |
Collapse
|
10
|
Woo SH, Sung MJ, Park KS, Yoon TR. Three-dimensional-printing Technology in Hip and Pelvic Surgery: Current Landscape. Hip Pelvis 2020; 32:1-10. [PMID: 32158723 PMCID: PMC7054078 DOI: 10.5371/hp.2020.32.1.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
The use of three-dimensional (3D) printing is becoming more common, including in the field of orthopaedic surgery. There are currently four primary clinical applications for 3D-printing in hip and pelvic surgeries: (i) 3D-printed anatomical models for planning and surgery simulation, (ii) patient-specific instruments (PSI), (iii) generation of prostheses with 3D-additive manufacturing, and (iv) custom 3D-printed prostheses. Simulation surgery using a 3D-printed bone model allows surgeons to develop better surgical approaches, test the feasibility of procedures and determine optimal location and size for a prosthesis. PSI will help inform accurate bone cuts and prosthesis placement during surgery. Using 3D-additive manufacturing, especially with a trabecular pattern, is possible to produce a prosthesis mechanically stable and biocompatible prosthesis capable of promoting osseointergration. Custom implants are useful in patients with massive acetabular bone loss or periacetabular malignant bone tumors as they may improve the fit between implants and patient-specific anatomy. 3D-printing technology can improve surgical efficiency, shorten operation times and reduce exposure to radiation. This technology also offers new potential for treating complex hip joint diseases. Orthopaedic surgeons should develop guidelines to outline the most effective uses of 3D-printing technology to maximize patient benefits.
Collapse
Affiliation(s)
- Seong-Hwan Woo
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Myung-Jin Sung
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| |
Collapse
|
11
|
Weidert S, Andress S, Linhart C, Suero EM, Greiner A, Böcker W, Kammerlander C, Becker CA. 3D printing method for next-day acetabular fracture surgery using a surface filtering pipeline: feasibility and 1-year clinical results. Int J Comput Assist Radiol Surg 2020; 15:565-575. [PMID: 31897965 PMCID: PMC7973705 DOI: 10.1007/s11548-019-02110-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
Introduction In orthopedic surgery, 3D printing is a technology with promising medical applications. Publications show promising results in acetabular fracture surgery over the last years using 3D printing. However, only little information about the workflow and circumstances of how to properly derive the 3D printed fracture model out of a CT scan is published.
Materials and methods We conducted a retrospective analysis of patients with acetabular fractures in a level 1 trauma center. DICOM data were preoperatively used in a series of patients with acetabular fractures. The 3D mesh models were created using 3D Slicer (https://www.slicer.org) with a newly introduced surface filtering method. The models were printed using PLA material with FDM printer. After reduction in the printed model, the acetabular reconstruction plate was bent preoperatively and sterilized. A clinical follow-up after 12 months in average was conducted with the patients. Results In total, 12 patients included. Mean printing time was 8:40 h. The calculated mean printing time without applying the surface filter was 25:26 h. This concludes an average printing time reduction of 65%. Mean operation time was 3:16 h, and mean blood loss was 853 ml. Model creation time was about 11 min, and mean printing time of the 3D model was 8:40 h, preoperative model reduction time was 5 min on average, and preoperative bending of the plate took about 10 min. After 12 months, patients underwent a structured follow-up. Harris Hip Score was 75.7 points, the Modified Harris Hip Score 71.6 points and the Merle d’Aubigne Score 11.1 points on average. Conclusions We presented the first clinical practical technique to use 3D printing in acetabular fracture surgery. By introducing a new surface filtering pipeline, we reduced printing time and cost compared to the current literature and the state of the art. Low costs and easy handling of the 3D printing workflow make it usable in nearly every hospital setting for acetabular fracture surgery.
Collapse
Affiliation(s)
- Simon Weidert
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Sebastian Andress
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Linhart
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Eduardo M Suero
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Axel Greiner
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher A Becker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
| |
Collapse
|
12
|
Mishra A, Verma T, Vaish A, Vaish R, Vaishya R, Maini L. Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma. Chin J Traumatol 2019; 22:350-355. [PMID: 31668700 PMCID: PMC6921216 DOI: 10.1016/j.cjtee.2019.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The technology of 3D printing (3DP) exists for quite some time, but it is still not utilized to its full potential in the field of orthopaedics and traumatology, such as underestimating its worth in virtual preoperative planning (VPP) and designing various models, templates, and jigs. It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications. METHODS An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation. Virtual preoperative planning and 3DP were used in the management of these fractures. Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data. RESULTS In all the 91 cases, where VPP and 3DP were used, the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively. Surgical time was reduced, with a better outcome. Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation. The average score of the questionnaire was 4.5, out of a maximum of 6, suggesting a positive role of 3DP in orthopaedics. CONCLUSION 3DP is useful in complex trauma management by accurate reduction and placement of implants, reduction of surgical time and with a better outcome. Although there is an initial learning curve to understand and execute the VPP and 3DP, these become easier with practice and experience.
Collapse
Affiliation(s)
- Abhishek Mishra
- Department of Orthopaedics and Joint Replacement Surgery, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi 110001, India,Corresponding author.
| | - Tarun Verma
- Department of Orthopaedics and Joint Replacement Surgery, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi 110001, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi 110001, India
| | - Riya Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi 110001, India
| | - Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospital, SaritaVihar, New Delhi 110076, India
| | - Lalit Maini
- Department of Orthopaedics and Joint Replacement Surgery, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi 110001, India
| |
Collapse
|
13
|
Larguier L, Hespel AM, Jamet N, Mercier E, Jouan D, Jardel N, Larrat S. Accuracy and precision of measurements performed on three-dimensional printed pelvises when compared to computed tomography measurements. J Vet Sci 2019; 20:e22. [PMID: 31161740 PMCID: PMC6538512 DOI: 10.4142/jvs.2019.20.e22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/22/2019] [Accepted: 03/07/2019] [Indexed: 12/20/2022] Open
Abstract
The preoperative contouring of plates decreases the duration of surgery and improves the quality of the reduction of pelvic fractures. Patient-tailored three-dimensionally printed pelvises might be an interesting tool for achieving that purpose. Currently, no study has evaluated the accuracy of measurements performed on three-dimensional printed models in comparison with computed tomography data for complex bones, such as the pelvis. This study examined whether the measurements obtained on pelvises printed using dual-material fused deposition modeling technology are not significantly different from those obtained on computed tomography images. The computed tomography images of the pelvic region from 10 dogs were used to produce three-dimensionally printed models with a dual-material fused deposition-modeling process. Four segments were measured on both three-dimensionally printed models and computed tomography images. The measurements were performed by three observers and repeated twice. Concordance correlation coefficients were used to assess the precision and accuracy of the measurements as well as evaluate the agreement between the methods. The accuracy of measurements between the methods was > 0.99 for all measurements. The precision was almost perfect for AE (0.996), substantial for BD and BC (0.963 and 0.958, respectively), and moderate for CD (0.912). These results indicate that, despite some minor variations, the measurements performed on printed models reproduced the computed tomography data reliably.
Collapse
Affiliation(s)
- Loic Larguier
- Clinique Vétérinaire Benjamin Franklin, 56400 Brech, France
| | | | - Nathalie Jamet
- Clinique Vétérinaire Benjamin Franklin, 56400 Brech, France
| | - Elise Mercier
- Clinique Vétérinaire Benjamin Franklin, 56400 Brech, France
| | - Daniel Jouan
- 3D Arc West Business Park, 78112 Fourqueux, France
| | - Nicolas Jardel
- Clinique Vétérinaire Benjamin Franklin, 56400 Brech, France
| | - Sylvain Larrat
- Clinique Vétérinaire Benjamin Franklin, 56400 Brech, France
| |
Collapse
|
14
|
Xia RZ, Zhai ZJ, Chang YY, Li HW. Clinical Applications of 3-Dimensional Printing Technology in Hip Joint. Orthop Surg 2019; 11:533-544. [PMID: 31321905 PMCID: PMC6712410 DOI: 10.1111/os.12468] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/21/2018] [Accepted: 10/03/2018] [Indexed: 12/27/2022] Open
Abstract
Three‐dimensional (3D) printing is a digital rapid prototyping technology based on a discrete and heap‐forming principle. We identified 53 articles from PubMed by searching “Hip” and “Printing, Three‐Dimensional”; 52 of the articles were published from 2015 onwards and were, therefore, initially considered and discussed. Clinical application of the 3D printing technique in the hip joint mainly includes three aspects: a 3D‐printed bony 1:1 scale model, a custom prosthesis, and patient‐specific instruments (PSI). Compared with 2‐dimensional image, the shape of bone can be obtained more directly from a 1:1 scale model, which may be beneficial for preoperative evaluation and surgical planning. Custom prostheses can be devised on the basis of radiological images, to not only eliminate the fissure between the prosthesis and the patient's bone but also potentially resulting in the 3D‐printed prosthesis functioning better. As an alternative support to intraoperative computer navigation, PSI can anchor to a specially appointed position on the patient's bone to make accurate bone cuts during surgery following a precise design preoperatively. The 3D printing technique could improve the surgeon's efficiency in the operating room, shorten operative times, and reduce exposure to radiation. Well known for its customization, 3D printing technology presents new potential for treating complex hip joint disease.
Collapse
Affiliation(s)
- Run-Zhi Xia
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zan-Jing Zhai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong-Yun Chang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui-Wu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
15
|
Kitamori H, Sumida I, Tsujimoto T, Shimamoto H, Murakami S, Ohki M. Evaluation of mouthpiece fixation devices for head and neck radiotherapy patients fabricated in PolyJet photopolymer by a 3D printer. Phys Med 2019; 58:90-98. [DOI: 10.1016/j.ejmp.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022] Open
|
16
|
Combined Application of Modified Three-Dimensional Printed Anatomic Templates and Customized Cutting Blocks in Pelvic Reconstruction After Pelvic Tumor Resection. J Arthroplasty 2019; 34:338-345.e1. [PMID: 30497901 DOI: 10.1016/j.arth.2018.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Common three-dimensional (3D)-printed anatomic templates have generally been used to reconstruct the pelvis after zone II and III borderline pelvic tumor resection. However, gradual increases in postoperative implant complications and the tumor recurrence rate have been observed. This study aimed to introduce the innovative application of a modified 3D-printed anatomic template with a customized cutting block for pelvic reconstruction and to comparatively analyze the common and modified 3D-printed anatomic templates. METHODS A total of 38 patients were included in this study and were allocated to 2 groups (19 patients/group). Group A received innovative therapy, and Group B received traditional therapy. All patients were questioned in detail about age, location, and duration of the mass and associated symptoms, and routine blood tests, such as serological tests, were administered. RESULTS We found that the modified 3D-printed anatomic template with a customized cutting block resulted in a shorter operating time, smaller bleeding loss, and simpler operation than the common 3D-printed anatomic template. Additionally, the tumor recurrence rate was lower and the accuracy of tumor resection was much greater for the modified 3D-printed anatomic template with a customized cutting block. However, compared with the traditional therapy, the innovative therapy had a significantly higher rate of implant loosening. CONCLUSION The innovative therapy can increase surgical safety and reduce recurrence after tumor resection relative to the traditional therapy. Additionally, the innovative therapy reconstructs the pelvis of zone III to improve the quality of patient life. However, the innovative therapy with implant loosening should be improved.
Collapse
|
17
|
Three-dimensional (3D) Printing Technology Assisted by Minimally Invasive Surgery for Pubic Rami Fractures. Curr Med Sci 2018; 38:827-833. [PMID: 30341516 DOI: 10.1007/s11596-018-1949-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/25/2018] [Indexed: 10/28/2022]
Abstract
The feasibility of three-dimensional (3D) printing technology combined with minimally invasive surgery in the treatment of pubic rami fractures was explored. From August 2015 to October 2017, a series of 30 patients who underwent surgical stabilization of their anterior pelvic ring (all utilizing the 3D printing technology) by one surgeon at a single hospital were studied. The minimally invasive incisions were made through anterior inferior cilia spine and pubic nodule. Data collected included the operative duration, the blood loss, the damage of the important tissue, the biographic union and the recovery of the function after the operation. Measurements on inlet and outlet pelvic cardiograph were made immediately post-operation and at all follow-up clinic visits. The scores of reduction and function were measured during follow-up. Results showed that the wounds of 30 patients were healed in the first stage, and there was no injury of important structures such as blood vessels and nerves. According to the Matta criteria, excellent effectiveness was obtained in 22 cases and good in 8 cases. According to the functional evaluation criteria of Majeed, excellent effectiveness was obtained in 21 cases and good in 9 cases. It was suggested that the 3D printing technology assisted by minimally invasive surgery can better evaluate the pelvic fracture before operation, which was helpful in plate modeling, and can shorten surgery duration and reduce intraoperative blood loss and complications. The positioning accuracy was improved, and better surgical result was finally achieved.
Collapse
|
18
|
Kim JW, Lee Y, Seo J, Park JH, Seo YM, Kim SS, Shon HC. Clinical experience with three-dimensional printing techniques in orthopedic trauma. J Orthop Sci 2018; 23:383-388. [PMID: 29325763 DOI: 10.1016/j.jos.2017.12.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 12/10/2017] [Accepted: 12/19/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND To report our experiences with the use of three-dimensional (3D) printing in the field of orthopedic trauma. METHODS This retrospective study enrolled 24 patients from three university teaching hospitals in whom 3D printing technique was applied: 14 patients with acetabular fractures and 10 patients with clavicular shaft fractures. We summarized our experiences with 3D printed bone models. RESULTS Three-dimensional printed acetabular models improved understanding of complex acetabular anatomy and fracture pattern to plan the optimal positioning of a reduction clamp and the trajectory of screws. Pre-bending of a reconstruction plate could reduce operative time. We also recorded fluoroscopic images of a simulated surgery for percutaneous screw fixation of the acetabular posterior column, with the optimal positioning of the guide wire determined during the simulation used as a reference during the actual operation. This surgical simulation was performed by a resident and served as a helpful training method. For fractures of the clavicle, we identified the optimal position of anatomical plates using 3D printed clavicle models. CONCLUSION In our experience, 3D printing technique provided surgeons with improved understanding of the fracture pattern and anatomy and was effectively used for preoperative planning, education of surgical trainees, and performing simulations to improve intra-operative technical outcomes.
Collapse
Affiliation(s)
- Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Yongkoo Lee
- Korea Institute of Machinery & Materials, Daegu, Republic of Korea
| | - Joonho Seo
- Korea Institute of Machinery & Materials, Daegu, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Yong Min Seo
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Sung Soo Kim
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Hyun Chul Shon
- Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheong-Ju, Republic of Korea.
| |
Collapse
|
19
|
Merema BJ, Kraeima J, Ten Duis K, Wendt KW, Warta R, Vos E, Schepers RH, Witjes MJH, IJpma FFA. The design, production and clinical application of 3D patient-specific implants with drilling guides for acetabular surgery. Injury 2017; 48:2540-2547. [PMID: 28899562 DOI: 10.1016/j.injury.2017.08.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/07/2017] [Accepted: 08/24/2017] [Indexed: 02/02/2023]
Abstract
An innovative procedure for the development of 3D patient-specific implants with drilling guides for acetabular fracture surgery is presented. By using CT data and 3D surgical planning software, a virtual model of the fractured pelvis was created. During this process the fracture was virtually reduced. Based on the reduced fracture model, patient-specific titanium plates including polyamide drilling guides were designed, 3D printed and milled for intra-operative use. One of the advantages of this procedure is that the personalised plates could be tailored to both the shape of the pelvis and the type of fracture. The optimal screw directions and sizes were predetermined in the 3D model. The virtual plan was translated towards the surgical procedure by using the surgical guides and patient-specific osteosynthesis. Besides the description of the newly developed multi-disciplinary workflow, a clinical case example is presented to demonstrate that this technique is feasible and promising for the operative treatment of complex acetabular fractures.
Collapse
Affiliation(s)
- B J Merema
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - J Kraeima
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - K Ten Duis
- Department of Surgery, Subdivision of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - K W Wendt
- Department of Surgery, Subdivision of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - R Warta
- Witec Fine Mechanical Technique, Mercuriusweg 4,9561 AL, Ter Apel, The Netherlands
| | - E Vos
- Witec Fine Mechanical Technique, Mercuriusweg 4,9561 AL, Ter Apel, The Netherlands
| | - R H Schepers
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M J H Witjes
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - F F A IJpma
- Department of Surgery, Subdivision of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| |
Collapse
|
20
|
Upex P, Jouffroy P, Riouallon G. Application of 3D printing for treating fractures of both columns of the acetabulum: Benefit of pre-contouring plates on the mirrored healthy pelvis. Orthop Traumatol Surg Res 2017; 103:331-334. [PMID: 28163241 DOI: 10.1016/j.otsr.2016.11.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 02/02/2023]
Abstract
Acetabular fractures can be challenging to treat, in part because the shape of the fixation plates needs to be adjusted during the surgical procedure. One possibility is to generate a model of the uninjured half of a fractured pelvis with 3D printing, and then pre-contour the fixation plates preoperatively on this model. The purpose of this technical note is to describe how we used 3D printing as an aid to treat acetabular fractures. The quality of the fracture reduction, fracture fixation and time savings were evaluated. Three-dimensional reconstructions of the preoperative CT scan of the pelvis were exported with OsiriX™ software, mirrored with Meshmixer™ software and then printed in polylactic acid (PLA). Two fracture fixation plates were pre-contoured on the printed hemipelvis and then sterilized. No additional intraoperative contouring was needed. Anatomical reduction was obtained with an estimated 30-minute time saving and € 6 consumables cost.
Collapse
Affiliation(s)
- P Upex
- Service d'orthopédie, groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - P Jouffroy
- Service d'orthopédie, groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - G Riouallon
- Service d'orthopédie, groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France.
| |
Collapse
|
21
|
[Application of 3D printing and computer-assisted surgical simulation in preoperative planning for acetabular fracture]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37. [PMID: 28377356 PMCID: PMC6780450 DOI: 10.3969/j.issn.1673-4254.2017.03.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of using 3D printing and computer-assisted surgical simulation in preoperative planning for acetabular fractures. METHODS A retrospective analysis was performed in 53 patients with pelvic fracture, who underwent surgical treatment between September, 2013 and December, 2015 with complete follow-up data. Among them, 19 patients were treated with CT three-dimensional reconstruction, computer-assisted virtual reset internal fixation, 3D model printing, and personalized surgery simulation before surgery (3D group), and 34 patients underwent routine preoperative examination (conventional group). The intraoperative blood loss, transfusion volume, times of intraoperative X-ray, operation time, Matta score and Merle D' Aubigne & Postel score were recorded in the 2 groups. Preoperative planning and postoperative outcomes in the two groups were compared. RESULTS All the operations were completed successfully. In 3D group, significantly less intraoperative blood loss, transfusion volume, fewer times of X-ray, and shortened operation time were recorded compared with those in the conventional group (P<0.05). According to the Matta scores, excellent or good fracture reduction was achieved in 94.7% (18/19) of the patients in 3D group and in 82.4% (28/34) of the patients in conventional group; the rates of excellent and good hip function at the final follow-up were 89.5% (17/19) in the 3D group and 85.3% (29/34) in the conventional group (P>0.05). In the 3D group, the actual internal fixation well matched the preoperative design. CONCLUSIONS 3D printing and computer-assisted surgical simulation for preoperative planning is feasible and accurate for management of acetabular fracture and can effectively improve the operation efficiency.
Collapse
|
22
|
Wang GY, Huang WJ, Song Q, Qin YT, Liang JF. Computer-assisted virtual preoperative planning in orthopedic surgery for acetabular fractures based on actual computed tomography data. Comput Assist Surg (Abingdon) 2016; 21:160-165. [PMID: 27973962 DOI: 10.1080/24699322.2016.1240235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Guang-Ye Wang
- Department of Orthopaedics, Shenzhen Baoan Hospital Southern Medical University, Shenzhen, China
| | - Wen-Jun Huang
- Department of Orthopaedics, Shenzhen Baoan Hospital Southern Medical University, Shenzhen, China
| | - Qi Song
- Department of Orthopaedics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yun-Tian Qin
- College of Astronautics, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jin-Feng Liang
- Department of Orthopaedics, Shenzhen Baoan Hospital Southern Medical University, Shenzhen, China
| |
Collapse
|
23
|
Rugg AL, Nelson LY, Timoshchuk MAI, Seibel EJ. Design and Fabrication of a Disposable Dental Handpiece for Clinical Use of a New Laser-Based Therapy-Monitoring System. J Med Device 2015. [DOI: 10.1115/1.4031800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Dental caries, the breakdown of tooth enamel by bacteria infection that causes cavities in the enamel, is the most common chronic disease in individuals 6–19 years of age in the U.S. Optical detection of caries has been shown to be sensitive to the presence of bacteria and the resulting demineralization of enamel. The scanning fiber endoscope (SFE) is a miniature camera system that can detect early stages of caries by performing high-quality imaging and laser fluorescence spectroscopy with 405 nm excitation. Because optical imaging of caries does not involve radiation risk, repeated imaging of the teeth is acceptable during treatment of the bacterial infection to monitor healing. A disposable handpiece was designed and fabricated to position the flexible fiber optic SFE probe for quantitative measurements. Plastic 3D-printed handpiece prototypes were tested with the SFE and a fluorescence calibration standard to verify mechanical fit and absence of signal contamination. Design feedback was provided by pediatric dentists and staff engineers to guide iterations. The final design configuration was based on the need to image interproximal regions (contact surfaces between adjacent teeth), ergonomics, and probe safety. The final handpiece design: (1) is safe for both the patient and the probe, (2) allows easy SFE insertion and removal, (3) does not interfere with spectral measurements, (4) standardizes the SFE's positioning during imaging by maintaining a consistent distance from the target surface, and (5) is significantly less expensive to produce and use than purchasing sanitary endoscope sheaths. The device will be used to help determine if new medicinal therapies can arrest caries and repair early interproximal demineralization under the clinical monitoring program. Ultimately, we anticipate that this handpiece will help us move closer toward widespread implementation of a dental diagnostic laser system that is safer and more sensitive than conventional methods for early caries detection.
Collapse
Affiliation(s)
- Amanda L. Rugg
- Department of Bioengineering, University of Washington, Seattle, WA 98195 e-mail:
| | - Leonard Y. Nelson
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | | | - Eric J. Seibel
- Department of Bioengineering, University of Washington, Seattle, WA 98195
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
- Human Photonics Lab, University of Washington, Seattle, WA 98195
| |
Collapse
|