In pelvic surgery, CT images are commonly used for diagnosis and surgical planning. The images are often displayed and manipulated in a 2D environment, which is insufficient owing to the complex geometry of a pelvic structure. Moreover, a pre-bend of the reconstruction plates is necessary, but difficult to complete, because of the lack of appropriate templates. In this study, an integrated preoperative planning system is developed to provide 3D models and physical templates so that the surgeon can simulate and observe his planning and prepare better-fitted curved plates before surgery. The proposed method can be divided into the following four stages: 3D display, bone segmentation, bone reduction, and implant placement. As for the designed curved plates, they can be fabricated as templates by means of rapid prototyping technology. Several examples, including artificial bones, real CT images and real pelvic surgery, have been presented to demonstrate the feasibility of the proposed method.
Abstract. The objective of this study is to present an integrated surgical simulation program on a personal computer for the preoperative planning of pelvic fractures. It first provides a visualization module to display 2D images and 3D model simultaneously. A semi-automatic bone segmentation module is then provided to separate the bony structures, enabling the manipulation of individual fractured bone and bone fragment. A bone reduction module is provided for the localization of the fractured bones. The simulation of plate and screw fixation is also presented, which provides useful information for determining the shape and size of the implants. Also, an example with real CT images are presented to demonstrate the feasibility of the proposed method.
Pelvic disruption is among the most complex injuries in orthopedic surgery because of the complex fracture patterns in the pelvic structure. Traditional preoperative planning using two-dimensional medical images usually encounters the problem of insufficient information for accurate assessment. In our previous work, a preoperative planning system that uses three-dimensional (3D) medical images and models was developed for the pre-surgical assessment, planning, and simulation of pelvic surgery. In this study, two additional functions, namely semi-automatic bone reduction and several types of fixation simulation are proposed to enhance the integrality of the proposed system for clinical applications. Ten clinical cases are presented for feasibility verification. For some of the cases, the surgeon carries out the simulation first, and then performs the surgery using procedures very similar to those in the simulation. The primary contribution of the proposed system is that the surgeon can go through the critical part of the surgery with the proposed 3D planning and simulation to fully understand the fracture pattern and make an appropriate surgical plan beforehand.
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