Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Level of evidence

II: prospective study.

中文翻译：

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使用针对患者的生物力学模型来计划髋臼骨折复位：一项前瞻性和比较性临床研究

目的

提出了一种简单的，针对患者的生物力学模型（PSBM），在该模型中可以模拟主要的手术工具和动作，从而使临床医生能够评估不同的策略，以实现最佳的手术计划。进行了一项前瞻性和比较性临床研究，以评估早期的临床和放射学结果。

方法

从2019年1月到2019年7月，为每个髋臼骨折（模拟组）创建PSBM。从术前高分辨率CT扫描中提取DICOM数据，以使用分割方法建立骨折的3D模型。PSBM是在定制软件中实现的，该软件允许按照减少序列对手术进行生物力学模拟。从2019年7月到2019年12月，标准组包括每例没有PSBM的髋臼骨折手术患者。记录手术时间，失血量，影像学结果和术中并发症，并在两组之间进行比较。

结果

包括22例患者，模拟组10例，标准组12例。两组在年龄，手术时间，骨折类型分布和手术方法方面具有可比性。在模拟组中，平均手术时间显着降低：113分钟±33（60–180）对184±58（90–260），p  = 0.04。在模拟组中，平均失血量明显降低，p  = 0.01。在放射学结果方面未发现统计学上的显着差异（p  = 0.16）。没有手术并发症的记录。

结论

这项研究证实，基于PSBM的髋臼手术的术前计划可缩短手术时间并减少手术中的失血量。这项研究还证实了PSBM计划在日常临床常规中的可行性。

证据水平

二：前瞻性研究。