Combined 3D Printed Template to Guide Iliosacral Screw Insertion for Sacral Fracture and Dislocation: A Retrospective Analysis

Abstract

Objective: To evaluate the accuracy and safety of a combined 3D printed guide template (combined template) to assist iliosacral (IS) screw placement for sacral fracture and dislocation.Methods: A total of 37 patients, 24 men and 13 women, age from 22 to 68 years old, diagnosed with a sacral fracture and dislocation were involved in this study for retrospective analysis from January 2016 to February 2018. There were 19 patients in the template group (42 screws) and 18 patients in the conventional group (31 screws). In the combined template group, IS screw placement was assisted by a combined 3D printed template; in the conventional group, the IS screws were placed freehand under fluoroscopy. The accuracy of the IS screw placement was evaluated by comparing the screw angle and the location of the screw entry point between the actual and the simulated screw in the combined template group. The safety of the IS screw placement was evaluated by comparing the quality of the reduction, the grading of the screws, the operation time, and radiation exposure times between groups.Results: A total of 73 pedicle screws were placed in 37 patients: 42 screws (30 S1, 12 S2) in the combined template group and 31 screws (23 S1, 8 S2) in the conventional group. In the conventional group, 1 patient developed symptoms of L5 nerve stimulation. In the combined template group, the average operative time of each screw was 25.01 AE 2.90 min, with average radiation exposure times of 12.05 AE 4.00. In the conventional group, the average operative time of each screw was 46.24 AE 9.59 min, with an average radiation exposure time of 56.10 AE 6.75. There were significant differences in operation and radiation exposure times between groups. The rate of screw perforation was lower in the combined template group (2 of 42 screws, 0 at grade III and 2 at grade II) than in the conventional group (5 of 38 screws, 2 at grade III and 3 at grade III). In the combined template group, the mean distance between the entry points of the actual and simulated screws was 1.4 AE 0.9 mm, with a mean angle of deviation of 2.1 AE 1.6 . All patients were followed up once every 3 months and were followed for 3 to 12 months.Conclusion: Using the combined template to assist with the insertion of IS screws delivered good accuracy, less fluoroscopy and shorter operation time, and avoided neurovascular injury as a result of screw malposition.

Clinical applications and prospects of 3D printing guide templates in orthopaedics

“… 2020 Wu C et al. [ 106 ] Orthop Surg 37 IS fixation for sacral fracture and dislocation Using the combined template to assist with the insertion of IS screws delivered good accuracy, less fluoroscopy, and shorter operation time, and avoided neurovascular injury as a result of screw malposition. 2020 Eltes PE et al.…”

“…[ 105 ] used a guide to assist placement in 22 patients with sacral fractures. The use of the guides significantly reduced the patient's operative time and radiation exposure [ 106 ].…”

Preoperative virtual iliosacral screw combined with individualized 3D printing navigation template for accurate treatment of posterior pelvic ring injury in a clinical study

“…In recent years, 3D printing technology has become widely used in medicine, and some researchers have placed iliosacral screw using 3D printing personalized internal guide-plates, but they must incision a 5cm wound on the posterior superior iliac spine, completely peel off, and attach to the posterior superior iliac spine 35 . The downsides of this surgical strategy include signi cant blood loss, di cult intraoperative peeling, and di culties matching the guide-plate entirely to the bone surface, which results in screw dislocation 35 .…”

Feasibility study of three-dimensional printing knee model using the ultra-low-dose CT scan for preoperative planning and simulated surgery

“…Surgical planning for TKA is difficult without the aid of a computer because of the complex regional anatomy. In recent years, use of the 3D guide template has enabled precise resection of bone and accurate implantation of the knee joint prosthesis, which reduces the time of radiation and operation, and avoids neurovascular injury caused by malpositioned screws [ 23 – 26 ]. This study shows that the ultra-low-dose 3DP model can meet the needs of clinical surgery and internal fixation model selection.…”