Precision medicine, based on personalized medicine, is to provide personalized and precise treatment. The emergence of 3D printing technique as well as genome sequencing provides an effective way to realize precise and personalized treatment. The application of 3D printing technique in the field of surgery is listed as following: optimize operation plan to achieve precise and personalized surgery; design personalized navigation template; personalized prosthesis production; design of personalized tissue and organ. With the development of tissue engineering, new material technology and genome sequencing and the improvement in related polices and regulations, precision medicine will step on a higher level in the field of surgery. This review introduces the application of precision medicine in the field of surgery.
General Surgery ; Humans ; Precision Medicine ; Printing, Three-Dimensional ; Prostheses and Implants ; Tissue Engineering

OBJECTIVETo explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture.

METHODSFor a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation.

RESULTSThe operation was completed successfully with a shortened postoperative recovery time.

CONCLUSIONSThe application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Adult ; Bone Screws ; Fracture Fixation, Internal ; methods ; Hip Fractures ; rehabilitation ; Humans ; Imaging, Three-Dimensional ; Male ; Postoperative Period ; Printing, Three-Dimensional ; Rehabilitation ; instrumentation ; methods

Objective To explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture. Methods For a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation. Results The operation was completed successfully with a shortened postoperative recovery time. Conclusions The application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Objective To explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture. Methods For a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation. Results The operation was completed successfully with a shortened postoperative recovery time. Conclusions The application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Purpose::Autologous osteoperiosteal transplantation (AOPT) is one of the most feasible and effective techniques for cystic osteochondral lesions of the talus (OLT). However, few reports have been reported about the process of graft-host bone healing and bone articular surface reconstruction, which help us to further understand the actual situation of bone healing and modify surgical methods.Methods::The case series study retrospectively evaluated 33 osteochondral lesions in 30 patients undertaking AOPT for OLT with subchondral cysts from December 2016 to October 2021. According to CT observation, we used 4 variables to describe the bony articular repair, including the integration of the articular surface, the height of the bone filling, the status of bone union, and the appearance of bone resorption or cystic change. We also analyzed the demographic data and clinical function. Descriptive statistics were used for demographic and clinical variables. Normally distributed data were presented as mean ± SD, and non-normally distributed data were presented as median (Q 1, Q 3). Associations between these variables and the primary clinical outcomes were examined using t-test or one-way ANOVA test for continuous variables. Results::The patients’ mean age was (41.7 ± 14.0) years old and the mean follow-up time was (29.6 ± 17.8) months. The chondral lesion size was (14.3 ± 4.1) mm. The cyst depth was (10.9 ± 3.7) mm. Significant improvements were observed in functional outcomes (according to the numeric rating scale for pain when walking and the American orthopedic foot and ankle society score) between the preoperative and latest follow-up evaluations, from 4.2 ± 2.1 to 2.2 ± 2.0 ( p < 0.001), and from 66.8 ± 12.9 to 83.2 ± 10.4, respectively ( p < 0.001). The overall satisfaction reached 8.3 of 10 points. All patients returned to sports and their median daily steps reached 8000 steps with 27 (81.8%) patients walking over 6000 steps daily. According to CT observation, "discontinuous bony articular surface and gap > 1 mm" was found in 27 grafts (81.8%), and "below the level of the adjacent articular surface, ≤1 mm" in a third of the grafts. Abnormal height of bone filling affected numeric rating scale score ( p=0.049) and American Orthopedic Foot and Ankle Society score ( p =0.027). Of note, bone resorption or cystic changes appeared in up to 13 autografts (39.4%). Conclusions::AOPT is an effective and acceptable technique for cystic OLT. Bone reconstruction is essential for large cystic OLT. How to get better bony articular reconstruction and avoid cyst recurrence should still be paid more attention.

OBJECTIVETo assess the effects of minimal invasive surgery through an incision near the rectus abdominis muscle for treatment of pelvic fractures sustained in earthquake.

METHODSNine patients with pelvic fractures during Ludian earthquake (August 3, 2014) were treated with minimal invasive surgery through an incision near the rectus abdominis muscle followed by anterior ring fixation and reconstruction plate or posterior ring fixation with percutaneous sacroiliac lag screws. The operative time, incision length, blood loss volume, and pre- and postoperative pain levels were recorded. The surgical complications such as lateral femoral cutaneous nerve injury and hip adduction incapability were observed.

RESULTSThe minimal invasive surgery achieved satisfactory clinical effects and allowed convenient operation with better surgical exposure, shorter operative time, less blood loss and pain. The patients showed excellent fracture reduction and stable internal fixation without lateral femoral cutaneous nerve injury or hip adduction incapability.

CONCLUSIONSThe minimal invasive surgery through an incision near the rectus abdominis muscle is suitable for treatment of pelvic fractures with anteriorly interior fixation, especially in rescuing victims in the event of an earthquake where blood supply can be very limited.

Blood Loss, Surgical ; Bone Plates ; Disasters ; Earthquakes ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Pelvic Bones ; pathology ; Reconstructive Surgical Procedures ; Rectus Abdominis ; surgery

Objective To assess the effects of minimal invasive surgery through an incision near the rectus abdominis muscle for treatment of pelvic fractures sustained in earthquake. Methods Nine patients with pelvic fractures during Ludian earthquake (August 3, 2014) were treated with minimal invasive surgery through an incision near the rectus abdominis muscle followed by anterior ring fixation and reconstruction plate or posterior ring fixation with percutaneous sacroiliac lag screws. The operative time, incision length, blood loss volume, and pre- and postoperative pain levels were recorded. The surgical complications such as lateral femoral cutaneous nerve injury and hip adduction incapability were observed. Results The minimal invasive surgery achieved satisfactory clinical effects and allowed convenient operation with better surgical exposure, shorter operative time, less blood loss and pain. The patients showed excellent fracture reduction and stable internal fixation without lateral femoral cutaneous nerve injury or hip adduction incapability. Conclusions The minimal invasive surgery through an incision near the rectus abdominis muscle is suitable for treatment of pelvic fractures with anteriorly interior fixation, especially in rescuing victims in the event of an earthquake where blood supply can be very limited.

Objective To assess the effects of minimal invasive surgery through an incision near the rectus abdominis muscle for treatment of pelvic fractures sustained in earthquake. Methods Nine patients with pelvic fractures during Ludian earthquake (August 3, 2014) were treated with minimal invasive surgery through an incision near the rectus abdominis muscle followed by anterior ring fixation and reconstruction plate or posterior ring fixation with percutaneous sacroiliac lag screws. The operative time, incision length, blood loss volume, and pre- and postoperative pain levels were recorded. The surgical complications such as lateral femoral cutaneous nerve injury and hip adduction incapability were observed. Results The minimal invasive surgery achieved satisfactory clinical effects and allowed convenient operation with better surgical exposure, shorter operative time, less blood loss and pain. The patients showed excellent fracture reduction and stable internal fixation without lateral femoral cutaneous nerve injury or hip adduction incapability. Conclusions The minimal invasive surgery through an incision near the rectus abdominis muscle is suitable for treatment of pelvic fractures with anteriorly interior fixation, especially in rescuing victims in the event of an earthquake where blood supply can be very limited.

Objective:To explore the safety, efficacy and preliminary clinical application of the single plantar approach or in combination with the dorsalis pedis approach in the treatment of Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions.Methods:(1) Six fresh cadaveric specimens of adult foot were collected and dissected through the plantar approach in order to determine the skin incision of the plantar approach and the safe area for plate-screw internal fixation, including start-stop points and courses of plantar nerves, blood vessels, tendons and ligaments, followed by plate-screw fixation on the specimens. (2) After feasibility of the plantar approach was confirmed by our anatomical study, it was used to treat the 3 patients who were admitted to Department of Orthopedics, The Third Hospital Affiliated to Southern Medical University between September 2020 and November 2021 for Lisfranc injury with severe necrosis due to dorsalis pedis skin contusion or metatarsal base avulsion fracture. They were 2 males and one female, with an average age of 51 years (from 34 to 68 years). The preliminary clinical efficacy was evaluated in terms of visual analogue scale (VAS), midfoot score of American Orthopaedic Foot and Ankle Surgeons (AOFAS), Maryland score, Kofoed score, fracture healing at the last follow-up and postoperative complications.Results:(1) Regarding the anatomical exposure range, the metatarsal side of the first metatarsal wedge joint was exposed medially and the metatarsal side of the third metatarsal wedge joint was exposed laterally; the peroneus longus tendon, Lisfranc plantar ligament and interosseous ligament were explored. X-ray films after the simulated operation showed satisfactory plate positions. (2) As for the preliminary clinical application, all patients were followed up for 6 to 14 months (mean, 11 months). At the last follow-up, the VAS score ranged from 0 to 1 (mean, 0.5), AOFAS score from 85 to 92 (mean, 89), Maryland score from 93 to 96 (mean, 95), and Kofoed score from 92 to 95 (mean, 94). There were no early complications such as fascial compartment syndrome, skin necrosis or infection. All fractures got united, with no complications like traumatic arthritis, muscle atrophy or screw loosening.Conclusion:Testified by the anatomical study, the plantar approach can be used to treat Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions, leading to safe, effective and satisfactory clinical outcomes.

Objective:To investigate the safety and feasibility of modified pararectus abdominis approach in the anterior plate fixation of sacral fractures.Methods:In 5 fresh adult cadavers (3 males and 2 females), gross anatomy was performed on one pelvic side using a modified pararectus abdominis approach to clarify the anatomical structures around the approach. On the other side of the pelvis, the anterior structures of the sacrum were exposed in simulated anterior plate fixation of sacral fracture via the modified pararectus abdominis approach. The exposed anatomic range of the approach, and the locations and courses of lumbosacral trunk nerve and iliac vessels were observed and recorded.Results:(1) The modified pararectus abdominis approach exposed the whole S1 vertebral body from the sacroiliac joint to the medial side, the L5 vertebral body cephalally, the S1 foramina in the true pelvis, and the same structures laterally as a traditional pararectus abdominis approach did. (2) Via the modified pararectus abdominis approach, exploration and decompression of the lumbosacral plexus (from L4 to S1) (including S1 foraminoplasty) were performed under direct vision to decompress the nerve entrapment from anterior compressed fracture fragments and hyperplastic callus. (3) There was a safe surgical area in anterior L5 and S1 where a plate could be safely fixed to the S1 vertebral body. (4) Since the maximum vertical distance from the lumbosacral trunk nerve lifted above the periost to the sacral ala was 1.4 cm (range, from 1.2 to 1.5 cm), a plate could be safely placed from the subperiosteum to the S1 vertebral body to fix the fracture.Conclusions:The modified pararectus abdominis approach is safe and feasible for exploration and decompression of lumbosacral nerves in the anterior sacral region (from L4 to S1) because it has significant advantages in vision and operation. It also broadens the range of anterior sacral plate fixation because a sacral fracture displacement can be reduced under direct vision and a plate can be fixated to the S1 vertebral body along the alae sacralis and across the sacroiliac joint to the iliac bone.