The Application Of 3D Printing Technology To Treat The Old Tibial Plateau Fracture

Objective:To analyze the preoperative workup for 3D printing technology to form the miniature for the treatment of the old tibial plateau fracture.Methods:Nine cases of tibial plateau fracture were taken from the year 2009 September to 2016 September who was admitted to our institution.Among the nine patients five were male and four were female with age range of(34-58 years old).The mechanism of injury was one high fall injury,two were postoperative osteomyelitis and six were tumble injury.The cases were classified according to the Schatzker classification;2 type II,2 type III,3 type IV and 2 type V.The treatment method chosen was open reduction and internal fixation(ORIF)with osteotomy,the total time to recovery apparently takes 5.7 months(2-9 months).The 3D CT film of knee was taken to get further ideas and information was kept in DICOM format.Using the computer-based software orthoview was used to make the 3D reconstructions model.With the use of STL computer based program to run the Thermoplastic liquid photosensitive resinlayer by layer forming under laser irradiation.With exact proportion of 1:1 to mimics the model.In the preoperative design can simulate osteotomy,the optimal design of the osteotomy site,restore tibial plateau height,select suitable for simulation of bone plate and screw fixation,and to solve difficult problems encountered in the simulation process.The maximum recovery of the tibial plateau lower limb force line and local anatomy.According to the preoperative plan,the osteotomy was performed and a series of operations were carried out to control the mold.After the osteotomy,a large gap was implanted with autologous bone or artificial bone.Results:3D print tibial platform model and the actual situation of the patient has the form of good consistency,osteotomy on temporary Kirschner wire fixation,select the appropriate plate for shaping and simulation tobe fixed,ensure the restoration of tibial anatomy and limb alignment,surgery according to the preoperative plan to find the corresponding anatomic location of osteotomy,recovery tibial anatomy and limb alignment,preoperative selection plate attached to the selected project fixed position,under C arm fluoroscopy limb alingment correction was cross checked,and also bone block fixation stability.All patients were followed up accordingly,6 weeks to 12 months.3 days after the operation,the attending doctor began to motivate the patients for bedside exercise for the function,under the guidance of the senior surgeon.Post-operation follow-ups for 6 weeks,3 months and 12 months were observed by clinical and radiological examinations.According to the Merchant grading system the ROM for knee full extension is0-30? and 90?-120? for full flexion,where seven cases achieved excellent grade and two cases were poor outcome.Except these two cases with limitation of motion with pain on movement,the other cases had achieved full anatomical reduction after the fracture and also the excellent grade.This is described by Merchant for ROM for full extension 0-30? and 90?-120? for full extension.3D printing products is the architecture of the Department of orthopedics patients with personalized anatomical model consistent with the structural characteristics;with the help of this operation for difficult cases of orthopedic make better preoperative planning that laid a solid foundation,which forms the bridge between design and actual operation of virtual surgery.The limb proportions of mold can let a surgeon to better understand the deformity characteristics,to facilitate analysis of the reasons for surgical design deformity;more people involved,more comprehensive optimization;preoperative exercise can make patients smooth operation during the operation,but also the difficult problems that may arise duringthe pre operation to get secure solution.This makes the operation more skilled,more accurate,the operation time is reduced and the surgeon and the patient’s radiation exposure is reduced,and ultimately make the clinical effect has been significantly improved and improved.Conclusion:With the help of 3D printing technique the customized model with the ratio of1:1 duplication,the design pre-operation preparation help the surgeons to intuitive visual and accuracy which help the surgeons to understand the situation;simulation of operation process that brings skilled operation and encounters the problem during operation.Thus the operation can be conduct smoothly which shorten the time of operation,improve surgical reduction and fixation effect in mean while it can be helpful pre-operative to the patient to understand the process of the operation which reduces the communication gap between patients and attending doctor.3D printing technique is a new breakthrough in the field of medicine with rapid progress of technique will give better result and effectiveness in clinical practice.The goal towards the personalized medical treatment beneficial for surgeons and patients will be achieved by this technique.