ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the feasibility and effectiveness of using 3D printing and computer-assisted surgical simulation in preoperative planning for acetabular fractures.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical effect of 3D printing-assisted minimal invasive surgery on pelvic fracture by plate internal fixation through a small incision lateral to the rectus abdominis.</p><p><b>METHODS</b>This retrospective study was conducted among 50 patients with pelvic fracture undergoing anteromedial plate internal fixation between September, 2013 and June, 2015. Thin-layer computed tomography scan data of the patients were input into Mimics software in DICOM format for 3D editing and virtual surgery before the operation. The pelvic model was created by 3D printing. Simulated operation was performed to design the optimum location of the plate screw, prelflex of the plate, screw length measurement and screwing approach. Diaplasis and internal fixation were performed through the extraperitoneal space with a small incision lateral to the rectus abdominis. Matta standard was employed for diaplasis evaluation, and Majeed assessment was used for function evaluation 6 months after the operation.</p><p><b>RESULTS</b>According to Matta standard, excellent and good diaplases were achieved in 96% of the cases, as compared with 94% according to Majeed assessment. Radiographic examination showed a good consistency between the internal fixation and simulated operation. No screw entry into the hip joint cavity occurred in these cases. The mean operation time was 127 min in these cases with a mean intraoperative blood loss of 728 mL and a mean incision length of 8.4 cm. Based on the postoperative VAS score, 12 patients reported severe pain, 28 reported moderate pain and 10 reported mild pain. All the patients were advised for early functional exercise after the operation and clinical healing was achieved in a mean of 8 weeks.</p><p><b>CONCLUSIONS</b>3D printing with simulated operation can improve the accuracy and safety of the operation. Preoperative simulation of plate preflex and screw length measurement can shorten the operation time. A small incision lateral to the rectus abdominis allows minimally invasive operation for pelvic fractures.</p>