Application of individualized transiliac crest nail-grafting guide plate in deep pelvic external fixator implantation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Cheng ^1,2 ,  LIANG Bin ¹ , YAO Qingqiang ^1,2 , LIU Shuai ³ , XU Yan ^1,2 ,  WANG Liming ^1,2

1. Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China;
2. Digital Medicine Institute, Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China;
3. Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Jiangsu, 221006, P.R.China;

Corresponding author：

LIANG Bin, Email: ib15366110173@163.com; WANG Liming, Email: limingwang99@yahoo.com

Keywords：

Individualized pin implant; guide plate; three-dimensional printing technology; pelvic fracture; external fixation

DOI：

10.7507/1002-1892.201903102

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Objective To explore the application of individualized transiliac crest nail-grafting guide plate prepared by computer-aided design and three-dimensional (3D) printing technology in deep pelvic external fixator implantation. Methods Five patients with pelvic fractures were collected between May 2017 and February 2018. There were 4 females and 1 male with an average age of 52 years (range, 29-68 years). Pelvic fractures were classified as type B in 3 cases and type C in 2 cases by Tile classification. The interval between injury and operation was 6-14 days (mean, 9 days). The preoperative CT images of pelvic fractures were collected. The data was reconstructed by 3D imaging reconstruction workstation. An individualized transiliac crest nail-grafting guide plate was designed on the virtual 3D model. The individualized transiliac crest nail-grafting guide plate and the solid pelvic model were produced with the 3D printing technology. The individualized transiliac crest nail-grafting guide plate was used for intraoperative deep pin position on iliac crest after the preoperative simulation. The follow-up CT scans were used to determine the differences in distance from anterior superior iliac spine, convergence angle, and caudal angle between the preoperative plan and postoperative measurement. Results During the operation, the individualized transiliac crest nail-grafting guide plate was used to guide the placement of 20 pins. X-ray film and CT examination showed that all pins were well positioned. The average depth of pins was 83.16 mm (range, 70.13-100.53 mm). Fitted 3D reconstruction images showed that the entry point and orientation of the pins were all consistent with preoperative schemes. Compared with the planned nail path, there was no significant difference in the distance from anterior superior iliac spine, convergence angle, and caudal angle in the actual nail path (P>0.05). No loosening and rupture of pin, no damage of blood vessels and nerve, and shallow or deep infection occurred during 3 months follow-up, and the incisions healed by first intention. All patients were satisfied with the treatment process. The ranges of motion of hip and knee were normal, and the visual analogue scale (VAS) score was 0-3 (mean, 0.5). Conclusion The individualized transiliac crest nail-grafting guide plate technique is the improvement of traditional technique. It can increase accuracy and effective depth of pin position, enable patients to obtain pelvic mechanical stability quickly after operation, and reduce the risk of complications related to nail path.

Citation： TANG Cheng, LIANG Bin, YAO Qingqiang, LIU Shuai, XU Yan, WANG Liming. Application of individualized transiliac crest nail-grafting guide plate in deep pelvic external fixator implantation. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(9): 1133-1140. doi: 10.7507/1002-1892.201903102 Copy

1.	Balbachevsky D, Belloti JC, Doca DG, et al. Treatment of pelvic fractures—a national survey. Injury, 2014, 45(Suppl 5): S46-S51.
2.	陈洪瑜, 贾维东, 冯佐基, 等. AO 外固定架在不稳定性骨盆骨折中的临床应用. 中华创伤骨科杂志, 2005, 7(9): 837-839.
3.	穆卫庐, 常军英, 贾东昭, 等. 3D 打印手术导板引导骶髂螺钉置入的手术技术介绍. 中华骨科杂志, 2015, 35(7): 767-773.
4.	Solomon LB, Pohl AP, Chehade MJ, et al. Surgical anatomy for pelvic external fixation. Clin Anat, 2008, 21(7): 674-682.
5.	Ponsen KJ, Joosse P, Van Dijke GA, et al. External fixation of the pelvic ring: an experimental study on the role of pin diameter, pin position, and parasymphyseal fixator pins. Acta Orthop, 2007, 78(5): 648-653.
6.	Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma, 1993, 35(5): 671-675.
7.	项舟, 段鑫, 王洪. 骨盆骨折三轴移位方式及复位原则. 中国修复重建外科杂志, 2017, 31(10): 1153-1160.
8.	Mason WT, Khan SN, James CL, et al. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury, 2005, 36(5): 599-604.
9.	张彦龙, 吴春生, 宋连新, 等. 骨盆前方皮下内固定架治疗不稳定骨盆骨折. 中华创伤杂志, 2015, 31(9): 828-832.
10.	Hiesterman TG, Hill BW, Cole PA. Surgical technique: a percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res, 2012, 470(8): 2116-2123.
11.	Noda M, Yamakawa T, Fujii T. The use of a biplanar construct in pelvic external fixation. Orthopedics, 2009, 32(6): 448.
12.	Archdeacon MT, Arebi S, Le TT, et al. Orthogonal pin construct versus parallel uniplanar pin constructs for pelvic external fixation: a biomechanical assessment of stiffness and strength. J Orthop Trauma, 2009, 23(2): 100-105.
13.	王建东, 王传舜, 王秋根, 等. 髋臼上方置钉外固定支架治疗伴腹部脏器损伤的骨盆骨折. 中华骨科杂志, 2011, 31(11): 1197-1202.
14.	Haidukewych GJ, Kumar S, Prpa B. Placement of half-pins for supra-acetabular external fixation: an anatomic study. Clin Orthop Relat Res, 2003, (411): 269-273.
15.	Liu J, Lai KA, Chou YL. Strength of the pin-bone interface of external fixation pins in the iliac crest. A biomechanical study. Clin Orthop Relat Res, 1995, (310): 237-244.
16.	胡勇, 袁振山, 谢辉, 等. 快速成型导向模板技术在枢椎椎板交叉螺钉置钉中的应用. 中华骨科杂志, 2013, 33(6): 640-648.
17.	阳宏奇, 雷青, 蔡立宏, 等. 3D打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折. 中国修复重建外科杂志, 2018, 32(2): 145-151.
18.	吴超, 邓佳燕, 谭伦, 等. 3D打印技术辅助不稳定性骨盆骨折手术疗效分析. 中国修复重建外科杂志, 2019, 33(4): 455-461.

1. Balbachevsky D, Belloti JC, Doca DG, et al. Treatment of pelvic fractures—a national survey. Injury, 2014, 45(Suppl 5): S46-S51.
2. 陈洪瑜, 贾维东, 冯佐基, 等. AO 外固定架在不稳定性骨盆骨折中的临床应用. 中华创伤骨科杂志, 2005, 7(9): 837-839.
3. 穆卫庐, 常军英, 贾东昭, 等. 3D 打印手术导板引导骶髂螺钉置入的手术技术介绍. 中华骨科杂志, 2015, 35(7): 767-773.
4. Solomon LB, Pohl AP, Chehade MJ, et al. Surgical anatomy for pelvic external fixation. Clin Anat, 2008, 21(7): 674-682.
5. Ponsen KJ, Joosse P, Van Dijke GA, et al. External fixation of the pelvic ring: an experimental study on the role of pin diameter, pin position, and parasymphyseal fixator pins. Acta Orthop, 2007, 78(5): 648-653.
6. Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma, 1993, 35(5): 671-675.
7. 项舟, 段鑫, 王洪. 骨盆骨折三轴移位方式及复位原则. 中国修复重建外科杂志, 2017, 31(10): 1153-1160.
8. Mason WT, Khan SN, James CL, et al. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury, 2005, 36(5): 599-604.
9. 张彦龙, 吴春生, 宋连新, 等. 骨盆前方皮下内固定架治疗不稳定骨盆骨折. 中华创伤杂志, 2015, 31(9): 828-832.
10. Hiesterman TG, Hill BW, Cole PA. Surgical technique: a percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res, 2012, 470(8): 2116-2123.
11. Noda M, Yamakawa T, Fujii T. The use of a biplanar construct in pelvic external fixation. Orthopedics, 2009, 32(6): 448.
12. Archdeacon MT, Arebi S, Le TT, et al. Orthogonal pin construct versus parallel uniplanar pin constructs for pelvic external fixation: a biomechanical assessment of stiffness and strength. J Orthop Trauma, 2009, 23(2): 100-105.
13. 王建东, 王传舜, 王秋根, 等. 髋臼上方置钉外固定支架治疗伴腹部脏器损伤的骨盆骨折. 中华骨科杂志, 2011, 31(11): 1197-1202.
14. Haidukewych GJ, Kumar S, Prpa B. Placement of half-pins for supra-acetabular external fixation: an anatomic study. Clin Orthop Relat Res, 2003, (411): 269-273.
15. Liu J, Lai KA, Chou YL. Strength of the pin-bone interface of external fixation pins in the iliac crest. A biomechanical study. Clin Orthop Relat Res, 1995, (310): 237-244.
16. 胡勇, 袁振山, 谢辉, 等. 快速成型导向模板技术在枢椎椎板交叉螺钉置钉中的应用. 中华骨科杂志, 2013, 33(6): 640-648.
17. 阳宏奇, 雷青, 蔡立宏, 等. 3D打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折. 中国修复重建外科杂志, 2018, 32(2): 145-151.
18. 吴超, 邓佳燕, 谭伦, 等. 3D打印技术辅助不稳定性骨盆骨折手术疗效分析. 中国修复重建外科杂志, 2019, 33(4): 455-461.

Chinese Journal of Reparative and Reconstructive Surgery

Application of individualized transiliac crest nail-grafting guide plate in deep pelvic external fixator implantation

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