Planning acetabular fracture reduction using a patient-specific biomechanical model: a prospective and comparative clinical study.
Acetabulum
/ diagnostic imaging
Adult
Biomechanical Phenomena
Computer Simulation
Female
Fracture Fixation, Internal
/ methods
Fractures, Bone
/ diagnosis
Humans
Male
Middle Aged
Operative Time
Printing, Three-Dimensional
Prospective Studies
Plastic Surgery Procedures
Software
Surgery, Computer-Assisted
/ methods
Tomography, X-Ray Computed
/ methods
Acetabular fracture
Biomechanical simulation
Computer-assisted surgery
Patient-specific biomechanical model
Segmentation
Virtual planning
Journal
International journal of computer assisted radiology and surgery
ISSN: 1861-6429
Titre abrégé: Int J Comput Assist Radiol Surg
Pays: Germany
ID NLM: 101499225
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
13
01
2021
accepted:
10
03
2021
pubmed:
26
3
2021
medline:
27
7
2021
entrez:
25
3
2021
Statut:
ppublish
Résumé
A simple, patient-specific biomechanical model (PSBM) is proposed in which the main surgical tools and actions can be simulated, which enables clinicians to evaluate different strategies for an optimal surgical planning. A prospective and comparative clinical study was performed to assess early clinical and radiological results. From January 2019 to July 2019, a PSBM was created for every operated acetabular fracture (simulation group). DICOM data were extracted from the pre-operative high-resolution CT scans to build a 3D model of the fracture using segmentation methods. A PSBM was implemented in a custom software allowing a biomechanical simulation of the surgery in terms of reduction sequences. From July 2019 to December 2019, every patient with an operated for acetabular fracture without PSBM was included in the standard group. Surgery duration, blood loss, radiological results and per-operative complications were recorded and compared between the two groups. Twenty-two patients were included, 10 in the simulation group and 12 in the standard group. The two groups were comparable regarding age, time to surgery, fracture pattern distribution and surgical approaches. The mean operative time was significantly lower in the simulation group: 113 min ± 33 (60-180) versus 184 ± 58 (90-260), p = 0.04. The mean blood loss was significantly lower in the simulation group, p = 0.01. No statistical significant differences were found regarding radiological results (p = 0.16). No per-operative complications were recorded. This study confirms that pre-operative planning in acetabular surgery based on a PSBM results in a shorter operative time and a reduction of blood loss during surgery. This study also confirms the feasibility of PSBM planning in daily clinical routine. II: prospective study.
Identifiants
pubmed: 33763792
doi: 10.1007/s11548-021-02352-x
pii: 10.1007/s11548-021-02352-x
doi:
Types de publication
Clinical Study
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1305-1317Subventions
Organisme : Fondation de l'Avenir pour la Recherche Médicale Appliquée
ID : ANR-11-LABX-0004
Informations de copyright
© 2021. CARS.
Références
Boudissa M, Courvoisier A, Chabanas M, Tonetti J (2018) Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art. Expert Rev Med Dev 15:81–89
doi: 10.1080/17434440.2017.1413347
Sebaaly A, Riouallon G, Zaraa M, Jouffroy P (2016) The added value of intraoperative CT scanner and screw navigation in displaced posterior wall acetabular fracture with articular impaction. Orthop Traumatol Surg Res 102:947–950
doi: 10.1016/j.otsr.2016.07.005
Cimerman M, Kristan A (2007) Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury 38:442–449
doi: 10.1016/j.injury.2007.01.033
Hu Y, Li H, Qiao G, Liu H, Ji A, Ye F (2011) Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data. Injury 42:1121–1124
doi: 10.1016/j.injury.2011.01.014
Fornaro J, Keel M, Harders M, Marincek B, Székely G, Frauenfelder T (2010) An interactive surgical planning tool for acetabular fractures: initial results. J Orthop Surg Res 4:5–50
Upex P, Jouffroy P, Riouallon G (2017) Application of 3D printing for treating fractures of both columns of the acetabulum: benefit of precontouring plates on the mirrored healthy pelvis. Orthop Traumatol Surg Res 103:331–334
doi: 10.1016/j.otsr.2016.11.021
Boudissa M, Ruatti S, Kerschbaumer G, Milaire M, Merloz P, Tonetti J (2016) Part 2: outcome of acetabular fractures and associated prognostic factors-a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation. Int Orthop 40:2151–2156
doi: 10.1007/s00264-015-3070-6
Meena UK, Tripathy SK, Sen RK, Aggarwal S, Behera P (2013) Predictors of postoperative outcome for acetabular fractures. Orthop Traumatol Surg Res 99:929–935
doi: 10.1016/j.otsr.2013.09.004
Boudissa M, Oliveri H, Chabanas M, Tonetti J (2018) Computer-assisted surgery in acetabular fractures: virtual reduction of acetabular fracture using the first patient-specific biomechanical model simulator. Orthop Traumatol Surg Res 104:359–362
doi: 10.1016/j.otsr.2018.01.007
Oliveri H, Boudissa M, Tonetti J, Chabanas M (2017) Planning acetabular fracture reduction using patient-specific multibody simulation of the hip. Med Imaging 2017 ImageGuided Proced Robot Interv Model 10135:101352P. https://doi.org/10.1117/12.2250380
Boudissa M, Chabanas M, Oliveri H, Bahl G, Tonetti J (2019) Pre-operative planning in acetabular and pelvic ring surgery: the first biomechanical model. SURGETICA, Rennes
Boudissa M (2019) Virtual reduction of complex fractures of the pelvis using the first patient-specific biomechanical simulation. Dissertation, Université Grenoble Alpes
Lloyd J, Stavness I, Fels S (2012) Artisynth: a fast interactive biomechanical modeling toolkit combining multibody and finite element simulation. In: Payan Y, Gefen A (eds) Soft tissue biomechanical modeling for computer assisted surgery, Studies in Mechanobiology, Tissue Engineering and Biomaterials, Springer, New York, pp 355–394
Fouard C, Deram A, Keraval Y, Promayon E (2012) CamiTK: a modular framework integrating visualization, image processing and biomechanical modeling. In: Payan Y (ed) Soft tissue biomechanical modeling for computer assisted surgery, Springer, Heidelberg, pp 323–354
Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128
doi: 10.1016/j.neuroimage.2006.01.015
Phillips AT, Pankaj P, Howie CR, Usmani AS, Simpson AH (2007) Finite element modelling of the pelvis: inclusion of muscular and ligamentous boundary conditions. Med Eng Phys 29:739–748
doi: 10.1016/j.medengphy.2006.08.010
Phillips AT (2009) The femur as a musculo-skeletal construct: a free boundary condition modelling approach. Med Eng Phys 31:673–680
doi: 10.1016/j.medengphy.2008.12.008
Clarke SG, Phillips AT, Bull AM (2013) Evaluating a suitable level of model complexity for finite element analysis of the intact acetabulum. Comput Methods Biomech Biomed Eng 16:717–724
doi: 10.1080/10255842.2011.633906
Fan Y, Lei J, Zhu F, Li Z, Chen W, Liu X (2015) Biomechanical analysis of the fixation system for T-shaped acetabular fracture. Comput Math Methods Med 2015:370631
doi: 10.1155/2015/370631
Dakin GJ, Arbelaez RA, Molz FJ 4th, Alonso JE, Mann KA, Eberhardt AW (2001) Elastic and viscoelastic properties of the human pubic symphysis joint: effects of lateral impact joint loading. J Biomech Eng 123:218–226
doi: 10.1115/1.1372321
Cooper HJ, Walters BL (2015) Rodriguez JA (2015) Anatomy of the hip capsule and pericapsular structures: a cadaveric study. Clin Anat 28:665–671
doi: 10.1002/ca.22539
Elkins JM, Stroud NJ, Rudert MJ, Tochigi Y, Pedersen DR, Ellis BJ, Callaghan JJ, Weiss JA, Brown TD (2011) The capsule’s contribution to total hip construct stability-a finite element analysis. J Orthop Res 29:1642–1648
doi: 10.1002/jor.21435
Matta JM, Merritt PO (1988) Displaced acetabular fractures. Clin Orthop Relat Res 230:83–97
Sagi HC, Afsari A, Dziadosz D (2010) The anterior intra-pelvic (modified rives-stoppa) approach for fixation of acetabular fractures. J Orthop Trauma 24:263–270
doi: 10.1097/BOT.0b013e3181dd0b84
Elmadag M, Güzel Y, Acar MA, Uzer G, Arazi M (2014) The Stoppa approach versus ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res 100:675–680
doi: 10.1016/j.otsr.2014.05.020
Wang H, Wang F, Newman S, Lin Y, Chen X, Xu L, Wang Q (2016) Application of an innovative computerized virtual planning system in acetabular fracture surgery: a feasibility study. Injury 47:1698–1701
doi: 10.1016/j.injury.2016.05.006
Xu M, Zhang LH, Zhang YZ, Zhang LC, He CQ, Wang Y, Tang PF (2014) Custom-made locked plating for acetabular fracture: a pilot study in 24 consecutive cases. Orthopedics 7:660–667
Zeng C, Xing W, Wu Z, Huang H, Huang W (2016) A combination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction. Injury 47:2223–2227
doi: 10.1016/j.injury.2016.03.015
Weidert S, Andress S, Suero E, Becker C, Hartel M, Behle M, Willy C (2019) 3D printing in orthopedic and trauma surgery education and training: possibilities and fields of application. Unfallchirurg 122:444–451
doi: 10.1007/s00113-019-0650-8
Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop 151:81–106