Abstract
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.
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Funding
The study received support from ANR France and the Fondation pour l’Avenir (labex CAMI), reference ANR-11-LABX-0004.
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MB, MC, JT contributed to conceptualization. HO, GB, BN were involved in data curation. MB, MC contributed to methodology. JT was involved in supervision. MB contributed to writing—original draft. MH was involved in writing—review and editing.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Boudissa, M., Noblet, B., Bahl, G. et al. Planning acetabular fracture reduction using a patient-specific biomechanical model: a prospective and comparative clinical study. Int J CARS 16, 1305–1317 (2021). https://doi.org/10.1007/s11548-021-02352-x
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DOI: https://doi.org/10.1007/s11548-021-02352-x