Treatment Of Complex Acetabular Fractures With 3D Printed Individual Acetabular Wing-shaped Plates

BackgroundAcetabular fracture is an intra-articular fracture.Because of its deep location,complex structure,and difficult reduction and fixation,its treatment has always been a difficult problem in trauma management.Surgical treatment has become the gold standard for the treatment of acetabular fractures.The purpose of acetabular surgery is to achieve anatomical reduction and fixation and early rehabilitation training of hip function.With the development of precision medicine and personalized medicine,3D printing technology has been widely used in clinical diagnosis and treatment.Personalized wing bone plate is a new minimally invasive surgical technique for treating acetabular fractures,but its clinical application is biomechanics.Stability is still a blank point for research.ObjectionThis study conducted a biomechanical study on the stability of acetabular fractures treated with 3D printed personalized wing plate in two aspects,experimental biomechanics and theoretical biomechanics.Data to discuss its clinical efficacy.MethodsChapter 1:Take 9 adult fresh frozen pelvic specimens,cut each specimen in half with a saw blade,and divide 18 semi-pelvic specimens into three groups according to different fixing methods:Group A is the anterior column plate+iliac sitting Steel plate fixation system,Group B is a 3D printed osteosynthesis plate fixation system,and Group C is an anterior column steel plate+arched medial plate fixation system.Place the pelvic specimen on the biomechanical testing machine to complete the measurement of the axial displacement and stiffness of the material,and analyze the biomechanical properties of the 3D printed personalized airfoil plate in the treatment of complex acetabular fractures.Chapter 2:Collect pelvic imaging data of healthy adults,and use Mimics,Geomagic Studio,SolidWorks and other software to construct pelvic acetabular fractures and internal fixation models,and verify the internal fixation of personalized airfoil bone plates by finite element technology and further explore Its stability.Chapter 3:Collect the data of 20 cases involving complex acetabular fractures treated by personalized acetabular wing plate in our department from January 2016 to June 2018,and retrospectively analyze the surgical incision length,intraoperative blood loss,The operation time and postoperative follow-up data were used to discuss the advantages and disadvantages of the 3D printed personalized wing-shaped plate for the treatment of acetabular fractures and its clinical efficacy.Results1.At 700N loading force,at the point 1 measurement area,the fracture displacements of the three groups A,B,and C are(0.62±0.08mm),(1.09 ±0.15mm),(1.27±0.10mm),Group A and Group B The difference in fracture displacement between group A and group C was statistically significant(P<0.05),and there was no significant difference between group B and group C(P>0.05);in the measurement results of point 2 area,A,B,The axial displacements of the three groups C were(1.24±0.09mm),(1.44±0.09mm),(1.62±0.06mm),and there was no significant difference between the groups(P>0.05).The displacements of the three groups A,B and C were(0.87±0.05mm),(0.93 ±0.03mm),(1.35 ± 0.06mm),and the difference in displacement between the groups A and C,B and C was statistically significant(P<0.05),and the two groups of A and B are better than the C group(P<0.05),the displacement of the A and B groups has no statistical difference(P>0.05).The axial stiffness of the three groups A,B and C are 168.4830±14.8091N/mm,122.4800± 8.8480 N/mm and 83.1300± 3.8091N/mm,respectively.The average loads in the three groups A,B,and C during fixed failure were 1516.83 ± 30.896 N,1378.83 ± 34.383 N,and 1351.00±26.046 N;group A was significantly better than groups B and C(p<0.05).2.Personalized airfoil plate fixation system,anterior column plate+iliac sitting plate fixation system,anterior column plate+medial arch plate fixation system under 700 N axial pressure load,group A,group B and group C The maximum von Mises stress of the fixed system is(7.535E+0)MPa,(6.644E+0)MPa,(6.785E+0)MPa;the maximum strain of the three fixed systems in groups A,B,and C is 9.201 E-3,8.654E-3,7.498E-3,and the unit strain is concentrated in the sacroiliac joint;the maximum displacements are 3.842E-2mm,4.177E-2mm,and 3.891E-2mm,respectively.3.In 20 patients,the surgical incision was 8 cm to 13 cm,average 9.5 cm;the intraoperative blood loss was 200 ml to 600 ml,average 309.5 ml;the operation time was 65 min to 180 min,average 110 min.According to Matta imaging reduction criteria,11 cases were anatomically reduced,8 cases were satisfied,and 1 case was not satisfied.According to the modified Merle D 'Aubigne and Postel evaluation criteria,the patients' hip follow-up function was evaluated at the last follow-up on the affected side.The results were excellent in 12 cases,good in 6 cases,and fair in 2 cases.ConclusionCompared with the traditional common steel plate fixation method,the biomechanical performance of 3D printed personalized acetabular wing-shaped bone plate for the treatment of acetabular fractures is better,and the clinical efficacy is reliable.