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Objective To compare the biomechanical stability of 4 internal fixations in treatment of acetabular fracture of the lower anterior column through finite element analysis.Methods One normal adult male pelvis was subjected to 0.7mm thin-section CT scanning and 379 CT pictures were obtained.Finite element modeling software was used to establish internal fixation models for acetabular fracture of the lower anterior column,including lag screws (A),anterior column reconstruction plate (B),subcutaneous plate not crossing the pubic symphysis (C) and subcutaneous plate crossing the pubic symphysis (D).Finite element analysis was carried out to compare the biomechanical differences among the 4 internal fixation models which were subjected to the same loading conditions at both standing and sitting positions.Results At standing and sitting positions,the maximum displacement and the mean node displacement of fracture lines were the greatest in group A (0.558 mm and 0.462 ±0.092 mm at standing;0.634 mm and 0.473 ±0.108 mm at sitting),the smallest in group D (0.512 mm and 0.425 ±0.083 mm at standing;0.031 mm and 0.025 ± 0.004 mm at sitting),and in between in group B (0.513 mm and 0.432 ±0.085 mm at standing;0.630 mm and 0.466 ± 0.109 mm at sitting) and in group C (0.514 mm and 0.433 ± 0.085 mm at standing;0.627 mm and 0.464 ± 0.107 mm at sitting).At both standing and sitting positions,the maximum stress at the fracture line was the greatest in group D (10.519 MPa and 24.879 MPa),the smallest in group A (3.254 MPa and 8.954 MPa),and in between in group B (4.873 MPa and 9.431 MPa) and in group C (4.384 MPa and 10.128 MPa).Conclusions In treatment of acetabular fracture of the lower anterior column,subcutaneous plate crossing the pubic symphysis may result in the greatest biomechanical stability,lag screws the smallest biomechanical stability,and anterior column reconstruction plate and subcutaneous plate not crossing the pubic symphysis the moderate biomechanical stability.
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Objective To evaluate the value of computer aided rapid prototyping technology in diagnosis and treatment of complicated pelvic fractures. Methods Twenty-two patients of complicated pelvic fractures were examined by thin-slice CT to gain two-dimensional data of the pelvis. Three-dimensional reconstructions of anatomical models were accomplished by computer aided technology. By rapid prototyping technology , the pelvic models were rendered , by which diagnosis and typing of pelvic fractures were finalized for operation project , mimic operation and guiding the operation. Results Three-dimensional reconstruction images and rapid prototyping pelvic models were extremely similar to what doctors saw in the operations. Preoperative mimic operation shortened the time of operation and reduced the volume of bleeding in the operation. All 22 cases were available for review in follow-up period of 6 ~ 24 months. Patients could sit up in 2 ~ 4 weeks after surgery , and walk with a crutch 6 weeks later. Pelvic fractures reductions were good in 22 cases. According to the Majeed's functional criteria , 16 patients were judged excellent and 3 patients were good. The excellent and good rate was 86.4%. Conclusions Computer aided rapid prototyping technology can overall, direct-viewing, and exactly display the three-dimensional shape of pelvis and spatial relation of anatomic structures. It is important for definite clinic diagnosis , typing and treatment.
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Objective To investigate the clinical significance of the 3D-CTA (three-dimensional computed tomography angiography)assisted design of finger reconstruction the second toe.Methods Between June 2010 and January 2013,five patients with finger defect received 3D-CTA assisted finger reconstruction surgeries using the second toe.Preoperative ipsilateral foot and hand 3D-CTAs were conducted and the 3D digital models were analyzed.The accurate positions and adjacent relations of vessels in both donor and recipient site were precisely marked and then the calibers of the vessels were measured.Four cases received thumb reconstructions and 1 case received little finger reconstruction.All of these surgeries were second-stage.According to Gu Yudong's classification of finger defect:second degree 2 cases,third degree 2 cases,five degree 1 case(little finger).Results With the help of 3D-CTA,five patients in this group had no vascular crisis,and all fingers survived successfully.With 4-12 months' follow-up,the algesthesia and thalposis of the reconstructed fingers gained good recoveries.The two-point discrimination was 5-10 mm.Tthe range of flexion of interphalangeal joint was 10 °-30 °.The range of flexion of the metacarpophalangeal joints was 35 °-80 °.And all patients restored walking and bearing functions with 3 months after surgeries.Conclusion The 3D-CTA reconstruction based digital model of ipsilateral foot and hand can objectively reflect the real situation of the vessels in both donor sites and recipient sites (exist of variations,routes and the calibers of the vessels),thus improve the success rate of surgery.