In a brand new research, a group of researchers from China in contrast the scientific outcomes of treating remoted acetabular (concave floor of the pelvis) fractures with conventional 3D-printed planning fashions and utilizing an strategy that mirrors the affected space following the bilaterally symmetric nature of human anatomy. Their speculation is that, whereas 3D-printed fashions can undoubtedly assist when fixing hip fractures, mirroring hip bone fashions to achieve a extra correct reconstruction of the pre-damaged bone could be more practical in its final restore. That is necessary information in China, as the quantity of “acetabular fractures and related mortality” has been on the rise there for a number of years.
“Our findings are per earlier stories 1,5,7 and advised that mirror mannequin expertise tends to enhance the scientific outcomes for sufferers with acetabular fractures,” the researchers wrote.
They defined that for essentially the most half, a human skeleton is “bilaterally symmetric; this is called a mirror relationship.”
“This mirror relationship is the theoretical foundation for utilizing the contralateral acetabular mirror mannequin as a template for the affected aspect. The mirror imaging mannequin of the contralateral acetabulum replaces the post-reduction state of the affected acetabulum, which may tremendously simplify the method of fracture meeting and discount, enhance the accuracy of discount, and supply a wonderful template for pre-bending of the pelvic reconstruction plate and willpower of the screw size.”
Over the previous couple of years, we’ve seen 3D printing develop extra helpful within the working room and for customized fracture administration. To finish a profitable acetabular fracture surgical procedure, sturdy inside fixation is critical. The femoral head and acetabulum must match, and the articular floor should have excessive integrity. 3D photographs are clearly higher than CT information, however they’re nonetheless learn on a 2D aircraft. Because of this 3D-printed fashions may also help.
“With the 3D mannequin, we are able to precisely measure the diploma of collapse of the articular floor, decide the quantity and form of the fracture fragments, carry out segmentation of every fragment mannequin, individually print and assemble the fracture fragments, simulate discount, and decide the place, size, and variety of implants,” they acknowledged.
The researchers used CT medical imaging information to print fashions of the contralateral acetabulum, then used the brand new 3D-printed mirror mannequin “as a benchmark for surgical predrilling and decided the place and pre-bending properties of the pelvic reconstruction plate and the size of the screws.”
“We performed a retrospective evaluate of prospectively gathered information from our medical middle from June 2011 to December 2017, during which consecutive sufferers who underwent conventional 3D printing expertise or 3D printing mirror mannequin expertise following an remoted acetabular fracture have been recognized by the Worldwide Classification of Illnesses (10th revision). Comply with-up was initiated on the onset of the primary day after main acetabular fracture surgical procedure,” they defined.
A complete of 62 males and 84 girls participated within the research. The sufferers handled with conventional 3D printing have been in Group T, whereas these handled with 3D printing mirror mannequin expertise have been in Group M.
“In whole, 146 advanced-age sufferers (146 hips) with an remoted acetabular fracture (Group T, n ¼ 72; Group M, n ¼ 74) have been assessed for a imply follow-up interval of 29 months (vary, 24–34 months),” the group wrote. “The first endpoint was the postoperative Harris hip rating (HHS). The secondary endpoints have been the operation time, intraoperative blood loss, fluoroscopy screening time, fracture discount high quality, and incidence of postoperative issues on the ultimate follow-up.”
All sufferers wanted sure standards to be included:
a unilateral remoted acetabular fracture
recent acetabular fracture with a 2-week period from damage to operation
no hip joint dysfunction or deformity pre-fracture
in a position to perceive directions and comply with rehab program
Materialise Mimics software program was used for information processing, and the researchers straight generated 3D photographs of the affected acetabulum for Group T, whereas with Group M, “a 3D picture of the affected acetabulum in addition to a brand new 3D picture of the contralateral acetabulum” have been each generated. The STL recordsdata have been sliced utilizing Cura software program and 3D printed on a Stratasys Objet 3D printer.
The identical group of orthopedic surgeons operated on all the sufferers.
“For Group M, we chosen the suitable reconstruction plate, pre-bent it to suit the bone floor, and adjusted it to the suitable place; we then decided the specification and mannequin of the pelvic reconstruction plate, the course and size of the fixing screw, and the connection of the acetabular joints,” they wrote.
The identical intraoperative administration was accomplished with the Group T sufferers, besides earlier than the reconstruction plate was chosen, the group eliminated the helps from between the bones within the 3D-printed mannequin, and “dissociated every fragment to intuitively and precisely perceive the fracture scenario,” earlier than resetting the fracture mannequin.
“In keeping with the preoperative plan, we accomplished the discount as quickly as doable, positioned the pre-bent pelvic reconstruction plate within the place that had been established through the rehearsal, ensured that the plate and bone floor match properly, briefly fastened the place, and inserted the suitable screw into the predesigned screw trajectory on the 3D mannequin to offer absolute stability of fracture discount,” the group defined. “C-arm photographs have been seen in a number of planes to certify anatomic discount.”
The sufferers all adopted the identical postoperative and rehabilitation directions, comparable to carrying compression stockings for at the very least 21 days, finishing steady passive movement in the future post-op, and touch-down weight-bearing with a walker between 2-30 days, and crutches between 30-90 days, post-op. Full weight-bearing was allowed after 90 days, based mostly on scientific and radiography outcomes.
“The sufferers have been reviewed clinically and radiographically at 1, three, 6, 9, and 12 months postoperatively and yearly thereafter,” the group acknowledged. “The HHS, operation time, intraoperative blood loss, fluoroscopy screening time, and incidence of postoperative issues have been considerably completely different between the teams, with Group M displaying superior scientific outcomes.”
You may see the outcomes of each the first and secondary endpoints within the tables beneath.
“In conclusion, 3D printing mirror mannequin expertise within the therapy of acetabular fractures is related to superior scientific outcomes in contrast with conventional 3D printing expertise,” the researchers wrote. “The variety of sufferers on this research was comparatively restricted, and it was not a potential research; due to this fact, evaluation of bigger samples is required for extra correct conclusions. However, this research revealed correct therapy of acetabular fractures via 3D printing mirror mannequin expertise, offering a brand new course for the surgical therapy of acetabular fractures.”
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