Application of 3D reconstruction navigation template in Bernese periacetabular osteotomy

Abstract

Objective To explore the feasibility of using a navigation template designed based on CT 3D reconstruction in Bernese periacetabular osteotomy (PAO). Methods The 3D print navigation template technology was introduced in the Bernese periacetabular osteotomy for 26 patients (26 hips) with acetabular dysplasia from July 2013 to March 2015. They were 10 males and 16 females, 12 to 32 years of age (average, 18.6 years). There were 14 right hips and 12 left ones. Preoperative patients were prepared by pelvic plain film, CT scan, CT data reconstruction and simulated acetabular osteotomy and rotation in Mimics10.1 software. According to preoperative planning, reverse engineering technology was applied to extract the pelvic anatomic morphology and the osteotomy surface of operative field. Navigation templates were designed and manufactured by 3D printing technology. In operation, the navigation template was attached onto the exposed pelvis and osteotomy surface with complete accurate rotation displacement of osteotomy and acetabular bone block. Lateral center-edge (LCE) angle, acetabular index (AC), extrusion index (EI) and femoral coverage were analyzed. Results The operation time for this group ranged from 2.7 to 4.6 hours, averaging 3.2 hours. Intraoperative bleeding ranged from 950 mL to 3,300 mL, averaging 1,630 mL. No injury to the femoral nerve or sciatic nerve was observed in this group. No serious complications like bone fragments into the hip joint occurred. Postoperative infection was not found in all the cases. Posterior column breakage occurred in only one case. There were significant differences between the preoperative and postoperative measurements regarding LCE, AC, EI and femoral coverage (P 0.05). Conclusion Since application of the navigation template designed based on CT 3D reconstruction in PAO can improve the surgical accuracy and safety, it is an effective method to solve the difficulties of PAO. Key words: Hip dysplasia; Osteotomy; Computer-aided design; 3D reconstruction; Navigation template