Surgical treatment for both-column acetabular fractures using pre-operative virtual simulation and three-dimensional printing techniques

Abstract

Background: Surgical treatment of both-column acetabular fractures is challenging because of the complex acetabular fracture patterns and the curved surface of the acetabulum. Seldom study has compared the application of three-dimensional (3D) printing technology and traditional methods of contouring plates intra-operatively for the surgical treatment of both-column acetabular fractures. We presented the use of both 3D printing technology and a virtual simulation in pre-operative planning for both-column acetabular fractures. We hypothesized that 3D printing technology will assist orthopedic surgeons in shortening the surgical time and improving the clinical outcomes. Methods: Forty patients with both-column acetabular fractures were recruited in the randomized prospective case–control study from September 2013 to September 2017 for this prospective study (No. ChiCTR1900028230). We allocated the patients to two groups using block randomization (3D printing group, n = 20; conventional method group, n = 20). For the 3D printing group, 1:1 scaled pelvic models were created using 3D printing, and the plates were pre-contoured according to the pelvic models. The plates for the conventional method group were contoured during the operation without 3D printed pelvic models. The operation time, instrumentation time, time of intra-operative fluoroscopy, blood loss, number of times the approach was performed, blood transfusion, post-operative fracture reduction quality, hip joint function, and complications were recorded and compared between the two groups. Results: The operation and instrumentation times in the 3D printing group were significantly shorter (130.8 ± 29.2 min, t = −7.5, P < 0.001 and 32.1 ± 9.5 min, t = −6.5, P < 0.001, respectively) than those in the conventional method group. The amount of blood loss and blood transfusion in the 3D printing group were significantly lower (500 [400, 800] mL, Mann-Whitney U = 74.5, P < 0.001 and 0 [0,400] mL, Mann-Whitney U = 59.5, P < 0.001, respectively) than those in the conventional method group. The number of the approach performed in the 3D printing group was significantly smaller than that in the conventional method group (pararectus + Kocher-Langenbeck [K-L] approach rate: 35% vs. 85%; χ 2 = 10.4, P < 0.05). The time of intra-operative fluoroscopy in the 3D printing group was significantly shorter than that in the conventional method group (4.2 ± 1.8 vs. 7.7 ± 2.6 s; t = −5.0, P < 0.001). The post-operative fracture reduction quality in the 3D printing group was significantly better than that in the conventional method group (good reduction rate: 80% vs. 30%; χ 2 = 10.1, P < 0.05). The hip joint function (based on the Harris score 1 year after the operation) in the 3D printing group was significantly better than that in the conventional method group (excellent/good rate: 75% vs. 30%; χ 2 = 8.1, P < 0.05). The complication was similar in both groups (5.0% vs. 25%; χ 2 = 3.1, P = 0.182). Conclusions: The use of a pre-operative virtual simulation and 3D printing technology is a more effective method for treating both-column acetabular fractures. This method can shorten the operation and instrumentation times, reduce blood loss, blood transfusion and the time of intra-operative fluoroscopy, and improve the post-operative fracture reduction quality. Clinical trail registration: No.ChiCTR1900028230; http://www.chictr.org.cn

How to Restore Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology? A Pilot Study

“…Previous studies have reported 3-D printing simulated operations improved the accuracy and safety of orthopedic surgeries [22]. Huang et al [23] demonstrated that 3-D printing technology increased the predictability, accuracy and reliability of both-column acetabular fractures reduction.Wang reported that, compared with CT images or humerus-subtracted volume renderings,the 3-D-printed model was able to represent the glenoid bony morphology accurately and clearly which facilitated shoulder surgeons to perform preoperative planning [24]. A double-blinded randomized clinical trial indicated that osteotomy simulation on the 3-D-printed pelvis models for DDH patients increased the success rate of the operation and shortened surgery time ,as well as promoted postoperative recovery [25].Xu et al [26] recommended the use of the 3-D printed model before THA in DDH patients due to better preoperative planning and intraoperative orientation,as well as surgical outcomes.Our study demonstrated the high agreement between the size of the acetabular cup and bone defect of simulated operations on 3-D printing models and the actual size used in the operations.…”

How to Restore Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology? A Pilot Study

“…Previous studies have reported 3-D printing simulated operations improved the accuracy and safety of orthopedic surgeries [22]. Huang et al [23] demonstrated that 3-D printing technology increased the predictability, accuracy and reliability of both-column acetabular fractures reduction.Wang reported that, compared with CT images or humerus-subtracted volume renderings,the 3-D-printed model was able to represent the glenoid bony morphology accurately and clearly which faciliated shoulder surgeons to perform preoperative planning [24]. A double-blinded randomized clinical trial indicated that osteotomy simulation on the 3-D-printed pelvis model for DDH patients increased the success rate of the operation and shortened surgery time ,as well as promoted postoperative recovery [25].Xu et al [26] recommended the use of the 3-D printed model before THA in DDH patients due to better preoperative planning and intraoperative orientation,as well as surgical outcomes.Our study demonstrated the high agreement between the size of the acetabular cup and bone defect of simulated operations on 3-D printing models and the actual size used in the operations.…”

“…With the rapid development of 3-D printing technology, the individual life-size models allow surgeons to simulate operations and perform precise treatment,as well as improve outcomes [4][5][6].In this study,we developed a new method to restore the hip rotation center by simulating operations on 3-D printing model.…”

Traditional versus mirror three-dimensional printing technology for isolated acetabular fractures: a retrospective study with a median follow-up of 25 months

“…1,5,6 Despite these advantages of TPT, it is not always easy to achieve anatomical reduction of the articular surface of complex AFs because of the limitations in accuracy of the current printing technology and printed materials, lack of a detailed understanding of true anatomical relationships, presence of 3D anisotropy, and the complex anatomical structure of the pelvis. 2,7 These factors markedly increase the risk of an inappropriate pre-bent shape of the reconstructed plate, resulting in an inaccurate length of the screws fixed on the model and ultimate failure to achieve the desired effect. [8][9][10] In this review, we introduce the use of mirror 3D printing model technology (MTT), which involves printing a 3D model of the unaffected acetabulum to reflect the true anatomical relationship, to assess the clinical outcomes of TPT versus MTT for the management of isolated AFs (IAFs).…”

“…1,5,6 Despite these advantages of TPT, it is not always easy to achieve anatomical reduction of the articular surface of complex AFs because of the limitations in accuracy of the current printing technology and printed materials, lack of a detailed understanding of true anatomical relationships, presence of 3D anisotropy, and the complex anatomical structure of the pelvis. 2,7…”