Pararectus approach combined with three-dimensional printing for anterior plate fixation of sacral fractures |
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| Affiliation: | 1. The Third Affiliated Hospital of Southern Medical University（Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong, 510630, China;2. Shunde Hospital, Southern Medical University (The First People''s Hospital of Shunde), Shunde, Guangdong, 528308, China;3. Musculoskeletal Disease Center, Jerry L. Pettis Memorial VA Medical Center, Research Service, 11201 Benton St, Loma Linda, CA 92357, USA;4. National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China;5. Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China;6. Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, Guangdong, 510515, China;1. Royal Melbourne Hospital – Orthopedic Department, Grattan Street, Melbourne 3050, Australia;2. Dip. Sport Med; Clinical Professor in Orthopaedics, Department of Surgery, Cumming School of Medicine; Adjunct Professor Faculty of Kinesiology; Medical Director Sport Medicine Centre, University of Calgary, Alberta, Canada;3. Clinical Professor in Orthopedics, Department of Surgery, Cumming School of Medicine, University of Calgary, 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Hospital, Calgary, Alberta, Canada;1. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States;2. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;3. Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States;4. Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, United State;1. Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom;2. Higher Orthopaedic Trainee, Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom;3. Clinical Fellow, Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom;1. Institution: AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, Tobelbad 8144, Austria;2. Institution: Department of Orthopaedics and Trauma Surgery, Medical University of Graz, Graz, Austria;3. Institution: AUVA Trauma Hospital Graz, Graz, Austria;1. Department of Orthopaedic Surgery University of California San Diego, USA;2. Department of Orthopaedic Surgery University of California Davis, USA |
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| Abstract: | BackgroundSurgical treatment of sacral fractures is difficult, both for reduction and stabilization. Traditional surgical reduction and internal fixation require a long duration of operation leading to extra blood loss, extensive tissue damage, and increased risk of post-operation complications. The purpose of this study was to evaluate the feasibility of a minimally invasive technique that could be more effective, more tissue sparing, and lead to less bleeding. We hypothesized that a Pararectus approach for anterior fixation of unstable sacral fractures would be reliable and more advantageous and significantly improve the outcome of sacral fracture repair.MethodsTwelve patients with unstable sacral fractures were recruited and examined by CT scanning. A 3D model of each sacral fracture was reconstructed. The computer-assisted 3D image of the reduced pelvis was 3D printed for surgery simulation and plate pre-bending. All cases were treated operatively with the anterior anatomical reduction and internal fixation via a minimally invasive Pararectus approach. VAS, Matta, and Majeed scores were used to evaluate outcomes of the operation.ResultsPre-operations were consistent with the actual surgeries in all cases. The pre-bent plates had an anatomical shape specifically fit to the individual pelvis without further adjustment at the time of surgery, and fracture reductions were significantly improved with little invasive tissue damage. The average operation time was 110 min. The intraoperative blood loss and incision length averaged 695 ml and 6.7 cm, respectively. A high percentage of all cases achieved a diaplasis with an excellent or good score according to the Matta and Majeed standards (83.33% and 91.67%, respectively).All patients achieved clinical healing with an average healing time of 8 weeks.Conclusion3D printing-assisted anterior fixation of unstable sacral fractures via a minimally invasive Pararectus approach is feasible. This new surgical strategy minimizes trauma damage and bleeding and produces satisfactory reduction and therapeutic efficacy. |
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