Accuracy of infra-acetabular screw implantation assisted by a 3D-printed personalized screw guide in vitro
10.3760/cma.j.cn115530-20230625-00305
- VernacularTitle:3D打印个性化导板体外辅助髋臼下缘螺钉置钉的准确性分析
- Author:
Jialang HU
1
;
Xin GUO
;
Hai DENG
;
Jing JIAO
;
Ming CHEN
Author Information
1. 武汉市第四医院骨科，武汉 430033
- Keywords:
Acetabulum;
Fractures, bone;
Infra-acetabular screw;
3D printing technology;
Guide
- From:
Chinese Journal of Orthopaedic Trauma
2023;25(9):805-811
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the accuracy of infra-acetabular screw implantation assisted by a 3D-printed personalized screw guide in vitro. Methods:The imaging data were collected of the 10 patients with acetabular fracture involving the anterior column who had been treated at Department of Orthopaedics, The Fourth Hospital of Wuhan from June 2015 to October 2021. There were 8 males and 2 females, with an average age of (42.6±2.1) years. According to the Letournel-Judet classification, there were 2 anterior column fractures, 4 anterior column + posterior semi-transverse fractures, 3 double column fractures, and 1 T-shaped fracture. The thin-slice CT scan data of the patients’ pelves were imported into the E3D software to generate digital 3D fracture models in which fracture reduction and post-reduction were simulated and personalized screw guides for infra-acetabular screw implantation were generated. After the above models were printed by a 3D printer, the fracture models were reduced in vitro and the infra-acetabular screws were implanted assisted by the personalized guide on the affected and healthy acetabulum models. After operation, the printed models were scanned by CT again, and the CT data were imported into the E3D software again to generate the postoperative digital 3D models. The position relationships were observed between the screws and the cortex around the corridor on the postoperative CT scan images. The consistency of the position parameters was compared between pre- and post-operation for each screw in the digital models. Results:Ten personalized screw guides were generalized respectively for the affected and healthy sides of the 10 patients in this group. Anatomical reduction was achieved in vitro in all the 3D printed fracture models. A total of 20 infra-acetabular screws were implanted with the assistance by the screw guide. According to the Andrew's CT grading for pedicle screw positions, 19 infra-acetabular screws were rated as grade Ⅰ and 1 was rated as grade Ⅱ. The linear distance from the midpoint of the pubic symphysis to the point of insertion, and the angles between the axis of the screw and the horizontal, sagittal and coronal planes on the health side before operation were respectively (60.65±5.55) mm, 23.96°±5.59°),2.88 °±1.25°, and 65.06°±5.48°, showing insignificant differences from the postoperative values [(60.91±5.73) mm, 24.00°±6.15°, 3.20°±1.13°, and 65.74°±5.57°] ( P>0.05); the above screw position parameters on the affected side before operation were respectively (60.76±4.41) mm, 24.77°±2.97°, 3.06° (2.66°, 3.68°), and 63.70° (62.70°, 65.60°), showing insignificant differences from the postoperative values [(60.71±4.56) mm, 24.67°±2.73°, 3.04° (2.64°, 3.51°), and 64.40°(63.20°, 65.90°)] ( P>0.05). Conclusion:In the models in vitro, implantation of infra-acetabular screws assisted by a 3D printed personalized screw guide can be highly accurate, owing to insignificant differences in all the position parameters between the simulated operations and the operations in vitro.
