The application of additive technologies in the surgical treatment of chronic pelvic injuries using original plates

INTRODUCTION. Modern technologies for 3D printing of implants for surgical treatment of patients are actively introduce into the medical field. Chronic injuries of the pelvis are an actual problem in traumatology and orthopedics, and the use of the developed original metal structure in conjunction with additive technologies will improve the results of treatment in male and female patients, as it allows creating adapted designs, taking into account the morphology of an individual patient.

The OBJECTIVE was to create the adapted design taking into account anatomical features for stable fixation pelvic bones in each individual patient using modern additive technologies and to compare the results of treatment using a serial polyposition plate and an individual plate.

METHODS AND MATERIALS. We carried out a comparative analysis of the results of treatment in the study groups. Group ¹ 1 consisted of patients with fixation of the anterior pelvis with polyposition plate, group ¹ 2 – fixation with individual reconstructive plate.

RESULTS. We used computed tomography of the female pelvis. A virtual 3D reconstruction of the female pelvis was performed and the original reconstructive plate was modeled taking into account the morphology of the anterior pelvis in a particular case. After sending the results of computed tomography and agreeing on the plate model and its position, a finished titanium original metal structure was obtained. The total period from the CT examination to the manufacture of the plate was 8 days. In the studied groups, the number of destabilizations was: in group ¹ 1 – 6.6 %, in group ¹ 2 – 0 %.

CONCLUSION. The use of additive technologies in the manufacture of metal structures allows creating the adapted design for a particular patient, taking into account his morphology. The use of metal structures using 3D printing technology will improve the results of treatment of patients with chronic pelvic injuries and reduce the number of destabilizations. The short time required for modeling and creating the adapted metal structure allows patients to receive the necessary medical care as soon as possible. 

1. Lazarev A. F., Gudushauri Ya. G., Kostiv E):et al. Clinical aspects of complications of pelvic injuries // Pacific Medical Journal. 2017;(1):17–23. (In Russ.).

2.

3. Zagorodniy N. V., Kolesnik A. I., Lazarev A. F. et al. Dorokhin Modern trends in the surgical treatment of patients with injuries of the pelvis and acetabulum (literature review) // Genius Orthopedics. 2000;26(2):266– 274.2. (In Russ.).

4.

5. Bondarenko A. B., Kruglykhin I. V., Plotnikov I. A., Voitenko A. N., Zhmurkov O. A. Features of the treatment of pelvic injuries in polytrauma // Polytrauma. 2014;(3):46–57. (In Russ.).

6.

7. Donchenko S. V., Dubrov V. E., Slinyakov L. Yu. et al. Algorithm for the surgical treatment of unstable injuries of the pelvic ring // N. N. Priorov Bulletin of Traumatology and Orthopedics. 2013;(4):9–16. (In Russ.).

8.

9. Shapkin Yu. G., Seliverstov P. A. Tactics of treatment of unstable pelvic injuries in polytrauma // Surgery News. 2015;23(4):452–459. (In Russ.). Doi: 10.18484/2305-0047.2015.4.452.

10.

11. Simon R. R., Sherman S., Koenigsknecht S. J. Emergency Orthopedics. The Extremities. McGraw-Hill Professional Pub, 2007:361–391.

12.

13. Smirnov A. A. Surgical treatment of vertically unstable pelvic injuries (type C according to the AO classification) / A. A. Smirnov // Traumatology and Orthopedics of Russia. 2012;1(63):73–76. (In Russ.).

14.

15. Tile M. Acute pelvic fractures: I. Causation and classification // J Am Acad Orthop Surg. 1996;(4):143–151.

16.

17. Kanakaris N. K. et al. Treatment and outcomes of pelvic malunions andnonunions: a systematic review // Clin Orthop Relat Res. 2009;467(8):2112– 24. Doi: 10.1007/s11999-009-0712-2.

18.

19. Balbachevsky D. et al. Treatment of pelvic fractures – a national survey // Injury. 2014(45, Suppl.5):S46–51. Doi: 10.1016/S0020- 1383(14) 70021-X.

20.

21. Bialik E. I., Fain A. M. Staged treatment of injuries in the area of the pubic symphysis using the original fixator in patients with concomitant pelvic trauma // Polytrauma. 2013;(4):30–34. (In Russ.).

22.

23. Enninghorst N. et al. Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option // J Trauma. 2010; 68(4):935–41. Doi: 10.1097/TA.0b013e3181d27b48.

24.

25. Michael D. Stover M. D., Edelstein A. I., Matta J. M. Chronic anterior pelvic instability: diagnosis and management // Journal of the American Academy of Orthopaedic Surgeons. 2017;25(7):509–517. Doi: 10.5435/ JAAOS-D-15-00338.

26.

27. Grischuk A. N. Surgical treatment of consequences of pelvic injuries // Acta Biomedica Scientifica. 2007;(1):166–167. (In Russ.).

28.

29. Martel I. I., Swedes V. V. Possibilities of external fixation according to the Ilizarov principles in closed restoration of the shape and stability of the pelvic ring in patients with chronic pelvic injuries // Genius of Orthopedics. 2013;(2):5–9.

30.

31. Shlykov I. L. Variants of surgical technique depending on the type of pelvic deformity // Perm Medical Journal. 2009;26(6):50–53. (In Russ.).

32.

33. Kolesnik A. I., Dokalin A. Yu., Solodilov I. M. et al. Retrospective analysis of the results of conservative and surgical treatment of patients with pelvic injuries // Man and his health. 2017;(2)17–23. (In Russ.). Doi: 10.21626/vestnik/2017-2/03.

34.

35. Stover M. D., Edelstein A. I., Matta J. M. Chronic Anterior Pelvic Instability: Diagnosis and Management // J Am Acad Orthop Surg. 2017;25(7):509– 517. Doi: 10.5435/JAAOS-D-15-00338. PMID: 28574938.

36.

37. Lazarev A. F., Solod E. I., Gudushauri Ya. G., Kalinin E. I., Konovalov V. V., Marychev I. N. Problems of surgical treatment of chronic injuries of the anterior pelvic ring // Practical medicine. 2021;19(3):47–54. (In Russ.). Doi: 10.32000/2072-1757-2021-3-47-54.

38.

39. Lazarev A. F., Solod E. I., Petrovsky R. A. et al. Possibilities of minimally invasive fixation of the anterior part of the pelvic ring with a threaded wire // Bulletin of Traumatology and Orthopedics named after N. N. Priorov. 2018;(3–4):6–11. (In Russ.). Doi: 10.17116/vto201803-0416.

40.

41. Semenov P. V., Grigoriev A.V., Ratiev A. P. et al. Minimally invasive osteosynthesis in the treatment of unstable pelvic ring injuries // Department of Traumatology and Orthopedics. 2016;(2):25–29. (In Russ.).

42.

43. Ivanov P. A., Zadneprovskii N. N., Nevedrov A. V., Kalenskii V. O. Intraosseous fixation of pubic bone fractures with locking nail: first clinical experience // Traumatology and Orthopedics of Russia. 2018;24(4):111– 120. (In Russ.).

44.

45. Prikhodko A. A., Vinogradov K. A., Vakhrushev S. G. Measures for the development of medical additive technologies in the Russian Federation // Medical technologies. Evaluation and choice. 2019;2(36):10–15. (In Russ.). Doi: 10.31556/2219-0678.2019.36.2.010-015.

46.

47. Ivanov V. P., Kim A. V., Khachatryan V. A. 3D printing in craniofacial surgery and neurosurgery. The experience of the Federal State Budgetary Institution “N.M.V. A. Almazova” // Neurosurgery and neurology of childhood. 2018;(3):28–39. (In Russ.). Doi: 10.29296/25877305-2021-10-02.

48.

49. Kuleshov A. A., Vetrile M. S., Shkarubo A. N. et al. Additive technologies in spinal deformity surgery // N. N. Priorov Bulletin of Traumatology and Orthopedics. 2018;3–4:19–29. (In Russ.). Doi:10.17116/vto201803- 04119.

50.

51. Kolesnik A. I., Gavryushenko N. S., Fomin L. V. et al. Repositioningfixation ring for surgical treatment of patients with acetabular fractures (preliminary results of static tests) // N. N. Priorov Bulletin of Traumatology and Orthopedics. 2021;28(2):29−38. (In Russ.). Doi: 10.17816/vto77159.

52.

53. Vetrile M. S., Kuleshov A. A., Makarov S. N. et al. Features of vertebralpelvic fixation in deformities and traumatic injuries of the spine // N. N. Priorov Bulletin of Traumatology and Orthopedics. 2021;28(1):17−27. (In Russ.). Doi: 10.17816/vto63954.

54.

55. Aimar A., Palermo A., Innocenti B. The role of 3D printing in medical applications: a state of the art // J Healthc Eng. 2019;2019:5340616. Doi: 10.1155/2019/5340616. PMID: 31019667; PMCID: PMC6451800.

56.

57. Yarikov A. V., Gorbatov R. O., Denisov A. A. et al. Application of additive 3D printing technologies in neurosurgery, vertebrology, traumatology and orthopedics // Clinical practice. 2021;12(1):90–104. (In Russ.). Doi: 10.17816/clinpract64944.

58.

59. Aleksanyan O. A., Chragyan G. A., Kagramanov S. V., Zagorodniy N. V. Treatment of an extensive acetabular defect in a patient with aseptic instability of a total hip endoprosthesis // N. N. Priorov Bulletin of Traumatology and Orthopedics. 2020;27(3):60–66. (In Russ.). Doi: 10.17816/vto202027360-66.

60.

61. Stover M. D., Edelstein A. I., Matta J. M. Chronic anterior pelvic instability: diagnosis and management // J Am Acad Orthop Surg. 2017;25(7):509– 517. Doi: 10.5435/JAAOS-D-15-00338. PMID: 28574938.

62.

63. Lazarev A. F., Solod E. I., Gudushauri Ya. G., Kalinin E. I., Konovalov V. V. Experimental study of the strength characteristics of fixation of the pubic symphysis with an original plate for the reconstruction of the anterior semiring of the pelvis // Acta Biomedica Scientifica. 2021;6(3):185– 192. (In Russ.). Doi: 10.29413/ABS.2021-6.3.19.

64.

65. Majeed S. A. Grading the outcome of pelvic fractures // J Bone Joint Surg. 1989;71:304–306.

66.

67. Kanakaris N. K. et al. Treatment and outcomes of pelvic malunions and nonunions: a systematic review // Clin Orthop Relat Res. 2009; 467(8):2112–24. Doi: 10.1007/s11999-009-0712-2.