Accuracy Assessment of Pedicle and Lateral Mass Screw Insertion Assisted by Customized 3D-Printed Drill Guides: A Human Cadaver Study, by Pijpker et al.Operative Neurosurgery (2018).
Accurate cervical screw insertion is of paramount importance considering the risk of damage to adjacent vital structures. Recent research in 3-dimensional (3D) technology describes the advantage of patient-specific drill guides for accurate screw positioning, but consensus about the optimal guide design and the accuracy is lacking.
To find the optimal design and to evaluate the accuracy of individualized 3D-printed drill guides for lateral mass and pedicle screw placement in the cervical and upper thoracic spine.
Five Thiel-embalmed human cadavers were used for individualized drill-guide planning of 86 screw trajectories in the cervical and upper thoracic spine. Using 3D bone models reconstructed from acquired computed tomography scans, the drill guides were produced for both pedicle and lateral mass screw trajectories. During the study, the initial minimalistic design was refined, resulting in the advanced guide design. Screw trajectories were drilled and the realized trajectories were compared to the planned trajectories using 3D deviation analysis.
The overall entry point and 3D angular accuracy were 0.76 ± 0.52 mm and 3.22 ± 2.34°, respectively. Average measurements for the minimalistic guides were 1.20 mm for entry points, 5.61° for the 3D angulation, 2.38° for the 2D axial angulation, and 4.80° for the 2D sagittal angulation. For the advanced guides, the respective measurements were 0.66 mm, 2.72°, 1.26°, and 2.12°, respectively.
The study ultimately resulted in an advanced guide design including caudally positioned hooks, crosslink support structure, and metal inlays. The novel advanced drill guide design yields excellent drilling accuracy.
Open access 3D printing-based minimally invasive cannulated screw treatment of unstable pelvic fracture, Cai, L., Zhang, Y., Chen, C. et al. J Orthop Surg Res (2018) 13: 71.
Open reduction and internal fixation of pelvic fractures could restore the stability of the pelvic ring, but there were several problems. Minimally invasive closed reduction cannulated screw treatment of pelvic fractures has lots advantages. However, how to insert the cannulated screw safely and effectively to achieve a reliable fixation were still hard for orthopedist. Our aim was to explore the significance of 3D printing technology as a new method for minimally invasive cannulated screw treatment of unstable pelvic fracture.
One hundred thirty-seven patients with unstable pelvic fractures from 2014 to 2016 were retrospectively analyzed. Based on the usage of 3D printing technology for preoperative simulation surgery, they were assigned to 3D printing group (n = 65) and control group (n = 72), respectively. These two groups were assessed in terms of operative time, intraoperative fluoroscopy, postoperative reduction effect, fracture healing time, and follow-up function. The effect of 3D printing technology was evaluated through minimally invasive cannulated screw treatment.
There was no significant difference in these two groups with respect to general conditions, such as age, gender, fracture type, time from injury to operation, injury cause, and combined injury. Length of surgery and average number of fluoroscopies were statistically different for 3D printing group and the control group (p < 0.01), i.e., 58.6 vs. 72.3 min and 29.3 vs. 37 min, respectively. Using the Matta radiological scoring systems, the reduction was scored excellent in 21/65 cases (32.3%) and good in 30/65 cases (46.2%) for the 3D printing group, versus 22/72 cases (30.6%) scored as excellent and 36/72 cases (50%) as good for the control group. On the other hand, using the Majeed functional scoring criteria, there were 27/65 (41.5%) excellent and 26/65 (40%) good cases for the 3D printing group in comparison to 30/72 (41.7%) and 28/72 (38.9%) cases for the control group, respectively. This suggests no significant difference between these two groups about the function outcomes.
Full reduction and proper fixation of the pelvic ring and reconstruction of anatomical morphology are of great significance to patients’ early functional exercise and for the reduction of long-term complications. This retrospective study has demonstrated the 3D printing technology as a potential approach for improving the diagnosis and treatment of pelvic fractures.
A Frame of 3D Printing Data Generation Method Extracted from CT Data, Zhao, S., Zhang, W., Sheng, W. et al. Sens Imaging (2018) 19: 12. https://doi.org/10.1007/s11220-018-0197-8
3D Printing based on the CT data of measured object can print out the outer surface structure and internal surface structure of the object and can be used for reverse engineering. This paper presents a frame for generating 3D printing data directly from CT data. The frame includes three steps: firstly, surface mesh data with internal structure is extracted from CT data. Secondly, a mesh model recognized by 3D printer is obtained through generating topological information, removing isolated facets and non-manifold facets, filling holes and smoothing surface. Thirdly, for the target surface mesh model with internal structure or exceeding the maximum size of objects that 3D printer can print, the frame splits the mesh model into several parts and print them separately. The proposed frame was evaluated with a simulated CT data and two real CT data. These experiments showed that the proposed frame is effective to generate 3D printing data directly from CT data and preserve the shape analogy with the original object model with high precision.