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| Clinical application of 3D printing technique in treating sacral fracture |
| HUAN Ke1 SU Fei2 WANG Fei3 LIU Bin3 FAN Yong2 SANG Hongxun4 |
1.Department of Orthopaedics, Shaanxi Fourth People′s Hospital, Shaanxi Province, Xi′an 710043, China;
2.Department of Orthopaedics, Honghui Hospital Affiliated to Xi′an Jiaotong University College of Medicine, Shaanxi Province, Xi'an 710054, China;
3.Department of Orthopaedics, Xijing Hospital of Military Medical University of Air Force, Shaanxi Province, Xi′an 710032, China;
4.Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangdong Province, Shenzhen 518101, China |
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Abstract Objective To disscuss the effect of 3D printing technique in treating sacral fracture. Methods From January 2010 to January 2015, in Department of Orthopaedics, Shaanxi Fourth People′s Hospital, 19 patients with sacral fracture accompanied with sacral nerve injury were selected. According to the Denis classification, 7 cases were type Ⅱ and 12 cases were type Ⅲ. All patients had varying degrees of sacral nerve damage symptoms. According to the three-dimensional reconstruction of CT scan before operation, the degree of fracture displacement and the compression of the sacral nerve were fully understood. According to the three-dimensional reconstruction of the three-dimensional structure and the experience of the operator, the software preposition screw was carried out to measure the relevant indexes (diameter, length and angle) of internal fixation, and to observe the possible effect and whether it was needed, that surgeon expanded the decompression. According to the plan, the surgical treatment was performed. After the operation, the X-ray plain film and CT scan were regularly taken. The pedicle screw and the iliac bone nail had no loosening and the fracture healing. The Gibbons score and the Mjeed curative effect standard score were carried out to evaluate the postoperative nerve function and clinical efficacy, and then the feasibility and effectiveness of the technique were evaluated. Results All patients were treated with the aid of 3D printing model, fracture reduction, bone graft fusion and internal fixation, the operation went well, and there were no incision infection, pressure sore and other complications. And all of them were followed up for more than 1 year. Postoperative X-ray or CT showed that sacral fractures were stable and well healed. The neurological function of all the patients after operation was improved in different degrees. The Gibbons score was recovered from (5.21±0.49) points before operation to (2.18±0.51) points after operation, the difference was statistically significant (P < 0.05). The effective rate of Mjeed was 84.2%. Conclusion Preoperative 3D printing technology is helpful not only on fully understanding the degree of sacral fracture damage, sacral nerve compression area, but also on supervising decompression range and placement of nail segments. These technologies can help surgeons make accurate preoperative design of surgical procedures plan, decrease operation time, improve fracture reduction and nerve decompression accuracy, which will help the recovery of sacral plexus, reduce the incidence of failure of internal fixation. In a word, these technologies have a certain guiding significance for clinical treatment.
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