PDF(Pubmed)
Abstract：
Background: Treatment of pelvic injuries poses serious problems for surgeons due to the difficulties of the associated injuries. The objective of this research is to create a clinical workflow that integrates three-dimensional technologies in preoperative planning and performing surgery for the reduction and stabilization of associated acetabular fractures. Methods: The research methodology consisted of integrating the stages of virtual preoperative planning, physical preoperative planning, and performing the surgical intervention in a newly developed clinical workflow. The proposed model was validated in practice in a pilot surgical intervention. Results: On a complex pelvic injury case of a patient with an associated both-column acetabular fracture (AO/OTA-62C1g), we presented the results obtained in the six stages of the clinical workflow: acquisition of three-dimensional (3D) images, creation of the virtual model of the pelvis, creation of the physical model of the pelvis, preoperative physical simulation, orthopedic surgery, and imaging validation of the intervention. The life-size 3D model was fabricated based on computed tomography imagistics. To create the virtual model, the images were imported into Invesalius (version 3.1.1, CTI, Brazil), after which they were processed with MeshLab (version 2023.12, ISTI-CNR, Italy) and FreeCAD (version 0.21.2, LGPL, FSF, Boston, MA, USA). The physical model was printed in 21 h and 37 min using Ultimaker Cura software (version 5.7.2), on an Ultimaker 2+ printing machine through a Fused Deposition Modeling process. Using the physical model, osteosynthesis plate dimensions and fixation screw trajectories were tested to reduce the risk of neurovascular injury, after which they were adjusted and resterilized, which enhanced preoperative decision-making. Conclusions: The life-size physical model improved anatomical appreciation and preoperative planning, enabling accurate surgical simulation. The tools created demonstrated remarkable accuracy and cost-effectiveness that support the advancement and efficiency of clinical practice.
摘要：
背景：由于相关损伤的困难，骨盆损伤的治疗给外科医生带来了严重的问题。这项研究的目的是创建一个临床工作流程，在术前计划和执行手术中整合三维技术，以减少和稳定相关的髋臼骨折。方法：研究方法包括整合虚拟术前计划的各个阶段，物理术前计划，并在新开发的临床工作流程中进行手术干预。所提出的模型在试点手术干预中得到了实践验证。结果：在一个复杂的骨盆损伤病例中，患者伴有双柱髋臼骨折（AO/OTA-62C1g），我们介绍了在临床工作流程的六个阶段获得的结果：三维（3D）图像的采集，创建骨盆的虚拟模型，创建骨盆的物理模型，术前物理模拟，骨科手术,和干预的影像学验证。真人大小的3D模型是基于计算机断层扫描图像制作的。要创建虚拟模型，图像被导入到Invesalius(版本3.1.1，CTI，巴西),之后，用MeshLab(2023.12版，ISTI-CNR，意大利)和FreeCAD(0.21.2版，LGPL，FSF,波士顿,MA,美国）。使用UltimakerCura软件（版本5.7.2）在21小时和37分钟内打印物理模型，通过熔融沉积建模过程在Ultimaker2+印刷机上。使用物理模型，测试了接骨板尺寸和固定螺钉轨迹，以降低神经血管损伤的风险，之后，他们被调整和重新注册，这增强了术前决策。结论：真人大小的物理模型改善了解剖欣赏和术前计划，实现精确的手术模拟。创建的工具证明了显着的准确性和成本效益，支持临床实践的进步和效率。
