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Title: [Application of three-dimensional printing personalized acetabular wing-plate in treatment of complex acetabular fractures via lateral-rectus approach].
Author: Mai JG, Gu C, Lin XZ, Li T, Huang WQ, Wang H, Tan XY, Lin H, Wang YM, Yang YQ, Jin DD, Fan SC.
Journal: Zhonghua Wai Ke Za Zhi; 2017 Mar 01; 55(3):172-178. PubMed ID: 28241717.
Abstract:
Objective: To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach. Methods: From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision. Results: All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month's follow-up, who didn't accept any treatment because the patient didn't feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all patients had achieved bone union. According to the modified Merle D'Aubigné and Postel scoring system, 5 cases were excellent, 2 cases were good, 1 case was fair. Conclusions: Surgical management of complex acetabular fracture via lateral-rectus approach combine with 3D printing personalized acetabular wing-plate can effectively improve reduction quality and fixation effect. It will be truly accurate, personalized and minimally invasive. 目的：探讨经腹直肌外侧切口入路显露、复位，利用三维打印技术，结合个性化设计、私人定制金属三维打印髋臼翼形接骨板治疗复杂髋臼骨折的手术技巧及早期临床疗效。 方法：回顾性分析2016年3—7月在南方医科大学第三附属医院骨科采用经腹直肌外侧入路显露、复位，使用金属三维打印髋臼翼形接骨板固定治疗的8例复杂髋臼骨折患者的临床资料。其中男性4例，女性4例；年龄31～76岁，平均57岁。髋臼骨折按Letournel-Judet分型：前方伴后半横2例，双柱骨折6例，均无涉及髋臼后壁的骨折及对侧半骨盆的骨折。术前患者髋臼的薄层CT扫描数据导入计算机，对骨折进行智能分割并模拟复位，应用三维打印技术打印出1∶1骨折模型。设计并生产金属三维打印髋臼翼形接骨板后采用经前方腹直肌外侧切口入路，直视下使用接骨板固定髋臼前柱及方形区骨折，使用空心拉力螺钉固定后柱骨折。 结果：本组8例均顺利完成手术。术后X线及CT检查显示髋臼前后柱骨折复位固定良好，个性化设计接骨板与骨面完全贴合，无围手术期并发症发生，有1例75岁老年骨质疏松患者术后1个月复查时出现耻骨支螺钉松动，患者无不适，未做特殊处理。按照Matta影像学复位评估标准，优3例，良4例，一般1例。随访3～6个月，骨折均愈合。根据改良的Merle D′Aubigné和Postel评分系统，髋关节功能优5例，良2例，可1例。 结论：经腹直肌外侧切口入路结合个性化设计、私人定制、金属三维打印髋臼翼形接骨板治疗复杂髋臼骨折，能对复杂髋臼骨折进行解剖复位，并达到坚强的固定，真正实现复杂髋臼骨折治疗的精准化、个性化、微创化。.

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