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Zhang H, Guo HP, Xu RD, Duan SY, Liang HR, Cai ZC. Surgical treatment outcomes of acetabular posterior wall and posterior column fractures using 3D printing technology and individualized custom-made metal plates: a retrospective study. BMC Surg 2024; 24:157. [PMID: 38755649 PMCID: PMC11097422 DOI: 10.1186/s12893-024-02451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Fractures involving the posterior acetabulum with its rich vascular and neural supply present challenges in trauma orthopedics. This study evaluates the effectiveness of 3D printing technology with the use of custom-made metal plates in the treatment of posterior wall and column acetabular fractures. METHODS A retrospective analysis included 31 patients undergoing surgical fixation for posterior wall and column fractures of the acetabulum (16 in the 3D printing group, utilizing 3D printing for a 1:1 pelvic model and custom-made plates based on preoperative simulation; 15 in the traditional group, using conventional methods). Surgical and instrument operation times, intraoperative fluoroscopy frequency, intraoperative blood loss, fracture reduction quality, fracture healing time, preoperative and 12-month postoperative pain scores (Numeric Rating Scale, NRS), hip joint function at 6 and 12 months (Harris scores), and complications were compared. RESULTS The surgical and instrument operation times were significantly shorter in the 3D printing group (p < 0.001). The 3D printing group exhibited significantly lower intraoperative fluoroscopy frequency and blood loss (p = 0.001 and p < 0.001, respectively). No significant differences were observed between the two groups in terms of fracture reduction quality, fracture healing time, preoperative pain scores (NRS scores), and 6-month hip joint function (Harris scores) (p > 0.05). However, at 12 months, hip joint function and pain scores were significantly better in the 3D printing group (p < 0.05). Although the incidence of complications was lower in the 3D printing group (18.8% vs. 33.3%), the difference did not reach statistical significance (p = 0.433). CONCLUSION Combining 3D printing with individualized custom-made metal plates for acetabular posterior wall and column fractures reduces surgery and instrument time, minimizes intraoperative procedures and blood loss, enhancing long-term hip joint function recovery. CLINICAL TRIAL REGISTRATION 12/04/2023;Trial Registration No. ChiCTR2300070438; http://www.chictr.org.cn .
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Affiliation(s)
- He Zhang
- Department of Orthopaedic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hong-Peng Guo
- Department of General Surgery, The Center Hospital of Shenyang Sujiatun, Shenyang, Liaoning, China
| | - Rong-Da Xu
- Department of Orthopaedic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Si-Yu Duan
- Department of Orthopaedic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hai-Rui Liang
- Department of Orthopaedic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Zhen-Cun Cai
- Department of Orthopaedic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China.
- Key Laboratory of Human Ethnic Specificity and Phenomics of Critical Illness in Liaoning Province, Shenyang Medical College, Shenyang, Liaoning, China.
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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.
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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
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Xu SSD, Yeh TT, Chen JE, Li YT. Significantly reducing the presurgical preparation time for anterior pelvic fracture surgery by faster creating patient-specific curved plates. J Orthop Surg Res 2023; 18:265. [PMID: 37005637 PMCID: PMC10067232 DOI: 10.1186/s13018-023-03749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND To shorten the preoperative preparation time, reconstruction plates were designed using the computed tomography (CT)-based three-dimensional (3D) medical imaging surgical planning software OOOPDS. In addition, 3D printing was used to generate curved plates for anterior pelvic fracture surgeries. METHODS This study analyzed two groups with the same 21 patients who underwent surgery for traumatic anterior pelvic ring fractures. In Group 1, the direct reconstruction plates were preoperatively contoured according to the anatomical 3D-printed pelvic model. In Group 2, the fixation plates were contoured according to the 3D printed plate templates, which were created based on the simulated plate templates by the OOOPDS software. The processing time, including the 3D printing time for the pelvic models in Group 1, the 3D printing time for the fixation plate templates in Group 2, and the pre-contouring time for the plates in both groups, was recorded. RESULTS The mean time of pre-contouring for the curved reconstruction plates in Group 2 was significantly less than in Group 1 (-55 min; P < 0.01). The mean time of 3D printing for the 3D plate template model in Group 2 was significantly less than that for the 3D pelvic model in Group 1 (-869 min; P < 0.01). Experimental results showed that the printing time for the plate pre-contouring and the 3D plate templates could be effectively reduced by approximately 93% and 90%, respectively. CONCLUSION This method can shorten the preoperative preparation time significantly.
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Grants
- Grant TSGH-NTUST-109-04 National Taiwan University of Science and Technology
- Grant TSGH-NTUST-109-04 National Taiwan University of Science and Technology
- Grants MOST 109-2221-E-011-074, MOST 110-2221-E-011-121, and MOST 111-2221-E-011-146-MY2. The Ministry of Science and Technology (MOST), Taiwan
- Grants TSGH-D-110105, TSGH-B-110008, MND-MAB-110-016, TSGH-NTUST-109-04, TSGH-A-109004, TSGH-B-109007, TSGH-C108-001, MAB-108-034, MND-MAB-C-11109-111035, and TSGH-C107-001. The Tri-Service General Hospital, Taiwan
- Grants TSGH-D-110105, TSGH-B-110008, MND-MAB-110-016, TSGH-NTUST-109-04, TSGH-A-109004, TSGH-B-109007, TSGH-C108-001, MAB-108-034, MND-MAB-C-11109-111035, and TSGH-C107-001. The Tri-Service General Hospital, Taiwan
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Affiliation(s)
- Sendren Sheng-Dong Xu
- Graduate Institute of Automation and Control, National Taiwan University of Science and Technology, No. 43, Keelung Rd., Sec. 4, Da'an Dist., Taipei City, 106335, Taiwan
- Advanced Manufacturing Research Center, National Taiwan University of Science and Technology, No. 43, Keelung Rd., Sec. 4, Da'an Dist., Taipei City, 106335, Taiwan
| | - Tsu-Te Yeh
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chenggong Rd., Sec. 2, Neihu Dist., Taipei City, 114202, Taiwan.
- Medical 3D Printing Center, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chenggong Rd., Sec. 2, Neihu Dist., Taipei City, 114202, Taiwan.
| | - Jia-En Chen
- Graduate Institute of Automation and Control, National Taiwan University of Science and Technology, No. 43, Keelung Rd., Sec. 4, Da'an Dist., Taipei City, 106335, Taiwan
- Medical 3D Printing Center, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chenggong Rd., Sec. 2, Neihu Dist., Taipei City, 114202, Taiwan
- Department of Biomedical Engineering, National Defense Medical Center, No. 325, Chenggong Rd., Sec. 2, Neihu Dist., Taipei City, 114202, Taiwan
| | - Yuan-Ta Li
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chenggong Rd., Sec. 2, Neihu Dist., Taipei City, 114202, Taiwan
- Department of Surgery, Tri-Service General Hospital Penghu Branch, No. 90, Qianliao, Magong City, Penghu County, 880026, Taiwan
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Displacement Pattern of Anterior and Posterior Column Fragments in Both-Column Acetabular Fractures: A 3D Reconstruction-Based Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3556357. [PMID: 36312856 PMCID: PMC9613399 DOI: 10.1155/2022/3556357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/27/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022]
Abstract
Background Few studies have been conducted to examine the displacement characteristics of both-column acetabular fractures (BCAFs). The goal of this study was to investigate the displacement pattern of anterior column (AC) and posterior column (PC) fragments in BCAFs using 3D virtual software. Materials and Methods BCAFs were retrospectively reviewed, and 81 patients were enrolled. Computed tomography (CT) images were imported into Mimics software. A 3D model of each pelvis was generated. Four marked points and the rotation angle of each of the injured ACs and PCs were identified. The fracture fragments were reduced virtually using the software, and the change in coordinates of the marked points after reduction was recorded while the rotation angle was measured. The measurements of positional and directional displacement were analysed using the Mann–Whitney U test and the binomial test, respectively. Results There was a propensity for AC fragments to shift superomedially and to rotate externally (p < 0.001). Additionally, the posteroinferior fracture area of AC fragments showed the greatest displacement (p < 0.05). PC fragments moved superomedially (p < 0.001) and moved more at the proximal end than the distal end (p < 0.001). PC displacement was always accompanied by internal rotation (p < 0.001). Greater AC displacement was observed in the fracture area further away from the acetabulum (p < 0.05). Greater rotation was observed for the AC than the PC (p < 0.001). Conclusion After a BCAF occurs, there are regular patterns regarding the direction and distance of AC and PC fragment displacement. Information on these patterns may provide insight into the injury mechanism and fracture morphology and facilitate surgical decision-making for orthopaedic trauma surgeons.
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Moolenaar JZ, Tümer N, Checa S. Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review. Front Bioeng Biotechnol 2022; 10:1037048. [PMID: 36312550 PMCID: PMC9613932 DOI: 10.3389/fbioe.2022.1037048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Bone fracture fixation surgery is one of the most commonly performed surgical procedures in the orthopedic field. However, fracture healing complications occur frequently, and the choice of the most optimal surgical approach often remains challenging. In the last years, computational tools have been developed with the aim to assist preoperative planning procedures of bone fracture fixation surgery. Objectives: The aims of this review are 1) to provide a comprehensive overview of the state-of-the-art in computer-assisted preoperative planning of bone fracture fixation surgery, 2) to assess the clinical feasibility of the existing virtual planning approaches, and 3) to assess their clinical efficacy in terms of clinical outcomes as compared to conventional planning methods. Methods: A literature search was performed in the MEDLINE-PubMed, Ovid-EMBASE, Ovid-EMCARE, Web of Science, and Cochrane libraries to identify articles reporting on the clinical use of computer-assisted preoperative planning of bone fracture fixation. Results: 79 articles were included to provide an overview of the state-of-the art in virtual planning. While patient-specific geometrical model construction, virtual bone fracture reduction, and virtual fixation planning are routinely applied in virtual planning, biomechanical analysis is rarely included in the planning framework. 21 of the included studies were used to assess the feasibility and efficacy of computer-assisted planning methods. The reported total mean planning duration ranged from 22 to 258 min in different studies. Computer-assisted planning resulted in reduced operation time (Standardized Mean Difference (SMD): -2.19; 95% Confidence Interval (CI): -2.87, -1.50), less blood loss (SMD: -1.99; 95% CI: -2.75, -1.24), decreased frequency of fluoroscopy (SMD: -2.18; 95% CI: -2.74, -1.61), shortened fracture healing times (SMD: -0.51; 95% CI: -0.97, -0.05) and less postoperative complications (Risk Ratio (RR): 0.64, 95% CI: 0.46, 0.90). No significant differences were found in hospitalization duration. Some studies reported improvements in reduction quality and functional outcomes but these results were not pooled for meta-analysis, since the reported outcome measures were too heterogeneous. Conclusion: Current computer-assisted planning approaches are feasible to be used in clinical practice and have been shown to improve clinical outcomes. Including biomechanical analysis into the framework has the potential to further improve clinical outcome.
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Affiliation(s)
- Jet Zoë Moolenaar
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Nazli Tümer
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
- *Correspondence: Nazli Tümer, ; Sara Checa,
| | - Sara Checa
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- *Correspondence: Nazli Tümer, ; Sara Checa,
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Lee AKX, Lin TL, Hsu CJ, Fong YC, Chen HT, Tsai CH. Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11185258. [PMID: 36142905 PMCID: PMC9506009 DOI: 10.3390/jcm11185258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 02/06/2023] Open
Abstract
Three-dimensional printing and fracture mapping technology is gaining popularity for preoperative planning of fractures. The aim of this meta-analysis is to further understand for the effects of 3D printing and fracture mapping on intraoperative parameters, postoperative complications, and functional recovery on pelvic and acetabular fractures. The PubMed, Embase, Cochrane and Web of Science databases were systematically searched for articles according to established criteria. A total of 17 studies were included in this study, of which 3 were RCTs, with a total of 889 patients, including 458 patients treated by traditional open reduction and internal fixation methods and 431 patients treated using 3D printing strategies. It was revealed that three-dimensional printing and fracture mapping reduced intraoperative surgical duration (RoM 0.74; 95% CI; 0.66–0.83; I2 = 93%), and blood loss (RoM 0.71; 95% CI; 0.63–0.81; I2 = 71%). as compared to traditional surgical approaches. In addition, there was significantly lower exposure to intraoperative imaging (RoM 0.36; 95% CI; 0.17–0.76; I2 = 99%), significantly lower postoperative complications (OR 0.42; 95% CI; 0.22–0.78; I2 = 9%) and significantly higher excellent/good reduction (OR 1.53; 95% CI; 1.08–2.17; I2 = 0%) in the three-dimensional printing and fracture mapping group. Further stratification results with only prospective studies showed similar trends. Three-dimensional printing and fracture mapping technology has potential in enhancing treatment of complex fractures by improving surgical related factors and functional outcomes and therefore could be considered as a viable tool for future clinical applications.
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Affiliation(s)
- Alvin Kai-Xing Lee
- Department of Education, China Medical University Hospital, Taichung 404, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, China Medical University, Taichung 404, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
| | - Chin-Jung Hsu
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- School of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, China Medical University, Taichung 404, Taiwan
- Department of Orthopedics Surgery, China Medical University Hospital Beigang Branch, Yunlin 651, Taiwan
| | - Hsien-Te Chen
- Spine Center, China Medical University Hospital, Taichung 404, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, China Medical University, Taichung 404, Taiwan
- Correspondence:
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Individualized 3D printing-assisted repair and reconstruction of neoplastic bone defects at irregular bone sites: exploration and practice in the treatment of scapular aneurysmal bone cysts. BMC Musculoskelet Disord 2021; 22:984. [PMID: 34823490 PMCID: PMC8620964 DOI: 10.1186/s12891-021-04859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The irregular anatomical shape and complex structures of irregular bones make it more difficult to repair and reconstruct bone defects in irregular bones than in the long bones of the extremities. Three-dimensional (3D) printing technology can help to overcome the technical limitations of irregular bone repair by generating simulations that enable structural integration of the lesion area and bone structure of the donor site in all directions and at multiple angles. Thus, personalized and accurate treatment plans for restoring anatomical structure, muscle attachment points, and maximal function can be made. The present study aimed to investigate the ability of 3D printing technology to assist in the repair and reconstruction of scapular aneurysmal ABC defects. METHODS The study included seven patients with ABCs of the scapula. Based on computed tomography (CT) data for the patient, the scapula (including the defect) and pelvis were reconstructed using Mimics Medical software. The reconstructed scapula model was printed using a 3D printer. Before the operation, the model was used to design the surgical approach and simulate the operation process, to determine the length and radius of the plate and the number and direction of screws, and to determine the bone mass of the ilium and develop reasonable strategies for segmentation and distribution. The operation time, amount of bleeding, length and radius of the plate, and direction and number of screws were recorded. RESULTS The average duration of follow-up was 25.6 months, and none of the seven patients experienced recurrence during the follow-up period. The surgical approach, the length and radius of internal fixation, and the number and direction of screws were consistent with the designed operation plan. Patients gradually recovered the anatomical structure of the scapula and function of the shoulder joint. CONCLUSIONS In the treatment of bone defects caused by irregular bone tumors, 3D printing technology combined with surgery has the advantages of less trauma, short operation time, less bleeding and reducing the difficulty of operation, which can reduce the waste of bone graft, and more complete reconstruction of the anatomical structure of the defective bone.
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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.
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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.)
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A Systematic Review and Meta-Analysis of 3D Printing Technology for the Treatment of Acetabular Fractures. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5018791. [PMID: 34458367 PMCID: PMC8387177 DOI: 10.1155/2021/5018791] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/01/2021] [Accepted: 08/06/2021] [Indexed: 01/20/2023]
Abstract
Purpose Three-dimensional (3D) printing technology has been widely used in orthopedics surgery. However, its efficacy in acetabular fractures remains unclear. The aim of this systematic review and meta-analysis was to examine the effect of using 3D printing technology in the surgery for acetabular fractures. Methods The systematic review was performed following the PRISMA guidelines. Four major electronic databases were searched (inception to February 2021). Studies were screened using a priori criteria. Data from each study were extracted by two independent reviewers and organized using a standardized table. Data were pooled and presented in forest plots. Results Thirteen studies were included in the final analysis. Four were prospective randomized trials, and nine used a retrospective comparative design. The patients aged between 32.1 (SD 14.6) years and 51.9 (SD 18.9) years. Based on the pooled analyses, overall, 3D printing-assisted surgery decreased operation time by 38.8 minutes (95% CI: -54.9, -22.8), intraoperative blood loss by 259.7 ml (95% CI: -394.6, -124.9), instrumentation time by 34.1 minutes (95% CI: -49.0, -19.1). Traditional surgery was less likely to achieve good/excellent function of hip (RR, 0.53; 95% CI: 0.34, 0.82) and more likely to have complications than 3D printing-assisted surgery (RR, 1.19; 95% CI: 1.07, 1.33). Conclusions 3D printing technology demonstrated efficacy in the treatment of acetabular fractures. It may improve surgery-related and clinical outcomes. More prospective studies using a rigorous design (e.g., randomized trial with blinding) are warranted to confirm the long-term effects of 3D printing technology in orthopedics surgeries.
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Meesters AML, Assink N, ten Duis K, Fennema EM, Kraeima J, Witjes MJH, de Vries JPPM, Stirler VMA, IJpma FFA. Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study. J Pers Med 2021; 11:jpm11080763. [PMID: 34442407 PMCID: PMC8400721 DOI: 10.3390/jpm11080763] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/26/2021] [Accepted: 07/31/2021] [Indexed: 12/14/2022] Open
Abstract
Due to the complex anatomical shape of the pelvis, screw placement can be challenging in acetabular fracture surgery. This study aims to assess the accuracy of screw placement using patient-specific surgical drilling guides applied to pre-contoured conventional implants in acetabular fracture surgery. CT scans were made of four human cadavers to create 3D models of each (unfractured) pelvis. Implants were pre-contoured on 3D printed pelvic models and optically scanned. Following virtual preoperative planning, surgical drilling guides were designed to fit on top of the implant and were 3D printed. The differences between the pre-planned and actual screw directions (degrees) and screw entry points (mm) were assessed from the pre- and postoperative CT-scans. The median difference between the planned and actual screw direction was 5.9° (IQR: 4–8°) for the in-plate screws and 7.6° (IQR: 6–10°) for the infra-acetabular and column screws. The median entry point differences were 3.6 (IQR: 2–5) mm for the in-plate screws and 2.6 (IQR: 2–3) mm for the infra-acetabular and column screws. No screws penetrated into the hip joint or caused soft tissue injuries. Three-dimensional preoperative planning in combination with surgical guides that envelope pre-contoured conventional implants result in accurate screw placement during acetabular fracture surgery.
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Affiliation(s)
- Anne M. L. Meesters
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Nick Assink
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Kaj ten Duis
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Eelco M. Fennema
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Joep Kraeima
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Max J. H. Witjes
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Vincent M. A. Stirler
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Frank F. A. IJpma
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- Correspondence: ; Tel.: +31-50-361-6161
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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.
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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
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Choi SW, Park KS, Yoon TR. Patient-specific Three-dimensional Bone Model for the Diagnosis and Treatment of Orthopedic Diseases of the Hip: Opinions of Orthopedic Surgeons on New Medical Technology. Hip Pelvis 2021; 33:96-101. [PMID: 34141696 PMCID: PMC8190497 DOI: 10.5371/hp.2021.33.2.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the perceptions and opinions of orthopedic surgeons on new medical technology for patient-specific three-dimensional (3D) bone models in the diagnosis and treatment of orthopedic diseases related to the hip joint. Materials and Methods A total of 75 doctors who were trained in orthopedic surgery or were current residents in the Republic of Korea were surveyed via questionnaires. Eight questions were included regarding the utility and current issues in the diagnosis and treatment of orthopedic disease using a customized 3D bone model made from s patient's computed tomography (CT) image. In addition to the questionnaire, the simple plain radiography and 3D CT image of the patient and 3D printed models of two actual patients were presented for comparison. Results An average of 92.7% of the orthopedic surgeons answered “very much” or “yes” to questions regarding the effectiveness of diagnosis, treatment, education, and simulation of surgery using the patient-specific 3D bone model. To the question, “Do you think you must have medical insurance to provide better medical services by using a new patient-specific 3D bone model medical technology for simulated surgery?” 93.3% of orthopedic surgeons answered either “very much” or “yes”. Conclusion Patient-specific 3D bone models of new medical technology can provide breakthrough support in the diagnosis, treatment, and education of orthopedic diseases in the field of hip joints. Therefore, it seems that efforts should be made to change governmental policy for coverage of patient-specific 3D bone modeling.
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Affiliation(s)
- Seung-Won Choi
- 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
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Efficacy Evaluation of 3D Navigational Template for Salter Osteotomy of DDH in Children. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8832617. [PMID: 34124261 PMCID: PMC8166498 DOI: 10.1155/2021/8832617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
Background The aim of this study is to retrospectively evaluate the efficacy of 3D navigational template for Salter osteotomy of DDH in children. Methods Thirty-two consecutive patients with DDH who underwent Salter osteotomy were evaluated between July 2014 and August 2017, and they were divided into the conventional group (n = 16) and navigation template group (n = 16) according to different surgical methods. The corrective acetabular degrees, radiation exposure, and operation time were compared between the two groups. Results No nerve palsy or redislocation was reported in the navigation template group. Compared with the conventional group, the navigation template group had the advantages of more accurate acetabular degrees, less radiation exposure, and shorter operation time (P < 0.05). Meanwhile, the navigation template group achieved a better surgical outcome than the conventional group (McKay, P = 0.0293; Severin, P = 0.0949). Conclusions The 3D navigational template for Salter osteotomy of DDH is simple and effective, which could be an alternative approach to improve the Salter osteotomy accuracy and optimize the efficacy.
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14
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Three-dimensional printing combined with open reduction and internal fixation versus open reduction and internal fixation in the treatment of acetabular fractures: A systematic review and meta-analysis. Chin J Traumatol 2021; 24:159-168. [PMID: 33678536 PMCID: PMC8173577 DOI: 10.1016/j.cjtee.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This meta-analysis compared the clinical outcome of three-dimensional (3D) printing combined with open reduction and internal fixation (ORIF) to traditional ORIF in the treatment of acetabular fractures. METHODS We searched the Cochrane Library, PubMed, Embase, VIP database, CNKI, and Wanfang database with keywords "acetabular fracture", "3D printing", "three-dimensional printing", "open reduction and internal fixation", "Acetabulum", "Acetabula" from January 2000 to March 2020. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration' s tools and/or Newcastle-Ottawa scale. When the two analysts had different opinions, they would ask the third analyst for opinion. Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF (3D printing group) versus traditional ORIF (conventional group) in the treatment of acetabular fractures were selected. The data of operation time, intraoperative blood loss, intraoperative fluoroscopy times, incidence of complications, excellent and good rate of Matta score for reduction, and excellent and good rate of hip function score were extracted. Stata14.0 statistical software was used for data analysis. RESULTS Altogether 9 articles were selected, including 5 randomized controlled trials and 4 retrospective studies. A total of 467 patients were analyzed, 250 in the conventional group, and 217 in the 3D printing group. The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant (standardized mean difference (SMD) = -1.19, 95% CI: -1.55 to -0.82, p < 0.05). The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group (SMD = -1.08, 95% CI: -1.65 to -0.51, p < 0.05). The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant (SMD = -1.64, 95% CI: -2.35 to -0.93, p < 0.05). The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group (OR = 0.43, 95% CI: 0.24-0.79, p < 0.05). There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups (OR = 0.60, 95% CI: 0.34-1.06, p > 0.05). There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups (OR = 0.84, 95% CI: 0.46-1.56, p > 0.05), but the follow-up time varies from 6 months to 40 months. CONCLUSION Compared with traditional ORIF, 3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively, but also effectively reduces operation time, intraoperative blood loss, intraoperative fluoroscopy times, and postoperative complications. However, there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.
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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.
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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
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IJpma FFA, Meesters AML, Merema BBJ, ten Duis K, de Vries JPPM, Banierink H, Wendt KW, Kraeima J, Witjes MJH. Feasibility of Imaging-Based 3-Dimensional Models to Design Patient-Specific Osteosynthesis Plates and Drilling Guides. JAMA Netw Open 2021; 4:e2037519. [PMID: 33599774 PMCID: PMC7893502 DOI: 10.1001/jamanetworkopen.2020.37519] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE In acetabular fracture surgery, achieving an optimal reconstruction of the articular surface decreases the risk of osteoarthritis and the subsequent need for total hip arthroplasty. However, no one-size-fits-all osteosynthesis plate is available owing to differences in fracture patterns and variations in pelvic anatomy. Currently, osteosynthesis plates need to be manually contoured intraoperatively, often resulting in inadequate reduction and fixation of the fractured segments. OBJECTIVE To determine the feasibility and accuracy of a novel concept of fast-track 3-dimensional (3-D) virtual surgical planning and patient-specific osteosynthesis for complex acetabular fracture surgery. DESIGN, SETTING, AND PARTICIPANTS This case series study examines the use of patient-specific osteosynthesis plates for patients needing operative treatment for displaced associated-type acetabular fractures at a tertiary university-affiliated referral center and level 1 trauma center between January 1, 2017, and December 31, 2018. Models were created in 3-D based on computed tomography (CT) data, fractures were virtually reduced, and implant positions were discussed in a multidisciplinary team of clinicians and engineers. Patient-specific osteosynthesis plates with drilling guides were designed, produced, sterilized and clinically applied within 4 days. Data were analyzed at the 1-year follow-up. EXPOSURES Development and clinical implementation of personalized fracture surgery. MAIN OUTCOMES AND MEASURES The primary outcome was the quality of the reduction as determined by the postoperative CT scan. The secondary outcomes were accuracy of the screw placement and clinical outcome using patient-reported outcome measures. RESULTS Ten patients with a median (range) age of 63 (46-79) years with an acetabular fracture were included. The median (interquartile range [IQR]) preoperative gap was 20 (15-22) mm, and the median (IQR) step-off was 5 (3-11) mm. Postoperatively, the median (IQR) gap was reduced to 3 (2-5) mm (P = .005), and the median (IQR) step-off was reduced to 0 (0-2) mm (P = .01), indicating good fracture reduction, indicating good fracture reduction. The mean difference between the preoperative and postoperative gap was 14.6 (95% CI, 10-19) mm, and the mean difference in step-off was 5.7 (95% CI, 2-9) mm. The median (IQR) difference in screw direction between the planning and actual surgery was only 7.1° (7°-8°). All patients retained their native hip and reported good physical functioning at follow-up. CONCLUSIONS AND RELEVANCE These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides was feasible and yielded good clinical outcomes. Fast-track personalized surgical treatment could open a new era for the treatment of complex injuries.
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Affiliation(s)
- Frank F. A. IJpma
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne M. L. Meesters
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bram B. J. Merema
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kaj ten Duis
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hester Banierink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Klaus W. Wendt
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J. H. Witjes
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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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.
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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;
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Shi Q, Sun D. Efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH. J Orthop Surg Res 2020; 15:317. [PMID: 32787911 PMCID: PMC7424650 DOI: 10.1186/s13018-020-01843-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
Background This present study is aimed to retrospectively evaluate the efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH. Methods Twenty-nine consecutive patients with DDH who underwent proximal femoral corrective osteotomy were evaluated between August 2013 and June 2017. Based on the different surgical methods, they were divided into the conventional group (n = 14) and navigation template group (n = 15). The osteotomy degrees, radiation exposure, and operation time were compared between the two groups. Results No major complications relating to osteotomy surgery such as redislocation or avascular necrosis occurred in the navigation template group, which had more accurate osteotomy degrees, less radiation exposure, and shorter operation time when compared with the conventional group (P < 0.05). Moreover, there was significant difference according to the McKay criteria between the two groups (P = 0.0362). Conclusions The novel personalized navigation template in proximal femoral corrective osteotomy is effective and safe, which could improve the femoral osteotomy accuracy, reduce radiation exposure, and shorten operation time.
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Affiliation(s)
- Qiang Shi
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, People's Republic of China
| | - Deyi Sun
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.
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Wake N, Alexander AE, Christensen AM, Liacouras PC, Schickel M, Pietila T, Matsumoto J. Creating patient-specific anatomical models for 3D printing and AR/VR: a supplement for the 2018 Radiological Society of North America (RSNA) hands-on course. 3D Print Med 2019; 5:17. [PMID: 31889235 PMCID: PMC6937827 DOI: 10.1186/s41205-019-0054-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/13/2019] [Indexed: 01/09/2023] Open
Abstract
Advanced visualization of medical image data in the form of three-dimensional (3D) printing continues to expand in clinical settings and many hospitals have started to adapt 3D technologies to aid in patient care. It is imperative that radiologists and other medical professionals understand the multi-step process of converting medical imaging data to digital files. To educate health care professionals about the steps required to prepare DICOM data for 3D printing anatomical models, hands-on courses have been delivered at the Radiological Society of North America (RSNA) annual meeting since 2014. In this paper, a supplement to the RSNA 2018 hands-on 3D printing course, we review methods to create cranio-maxillofacial (CMF), orthopedic, and renal cancer models which can be 3D printed or visualized in augmented reality (AR) or virtual reality (VR).
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Affiliation(s)
- Nicole Wake
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467 USA
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU School of Medicine, New York, NY USA
| | | | | | - Peter C. Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, MD USA
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A New Diagnostic Approach for Periprosthetic Acetabular Fractures Based on 3D Modeling: A Study Protocol. Diagnostics (Basel) 2019; 10:diagnostics10010015. [PMID: 31905717 PMCID: PMC7168180 DOI: 10.3390/diagnostics10010015] [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: 11/28/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 12/18/2022] Open
Abstract
Periprosthetic acetabular fractures after total hip arthroplasty (THA) are mostly related to low energy trauma reduced bone quality. CT-scan is widely used to evaluate acetabular fractures, however, metal artifacts produced prosthetic implants limit the visualization of the articular surface and bone loss assessment. 3D modeling software allows us to creating tridimensional images of the bony surface, removing the metallic implants trough image segmentation. We highlight the use of 3D modeling and rapid prototyping (3D printing) for the diagnostic process of periprosthetic acetabular fracture around THA. 3D modeling software was used to improve the assessment of fracture morphology and bone quality. Moreover, the 3D images were printed in a real-life size model and used for preoperative implant templating, sizing and surgical simulation.
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21
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Zhang YW, Xiao X, Gao WC, Xiao Y, Zhang SL, Ni WY, Deng L. Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. J Orthop Surg Res 2019; 14:353. [PMID: 31706346 PMCID: PMC6842546 DOI: 10.1186/s13018-019-1403-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. MATERIAL AND METHODS Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. RESULTS Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents' excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). CONCLUSIONS The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.
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Affiliation(s)
- Yuan-Wei Zhang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No.152 Aiguo Road, Nanchang, 330006, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xin Xiao
- Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Wen-Cheng Gao
- Department of Orthopedics, Dongguan Houjie Town People's Hospital, Dongguan, 523900, Guangdong, China
| | - Yan Xiao
- Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Su-Li Zhang
- Department of Operating room, Wujin Hospital Affiliated to Jiangsu University, Changzhou, 213161, Jiangsu, China
| | - Wen-Yan Ni
- Department of Operating room, Wujin Hospital Affiliated to Jiangsu University, Changzhou, 213161, Jiangsu, China
| | - Liang Deng
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No.152 Aiguo Road, Nanchang, 330006, Jiangxi, China.
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