Evaluation of the accuracy of 3D-printed patient-specific osteotomy templates in pelvic tumor resection and reconstruction.

Abstract

Purpose: The treatment of pelvic tumors has been widely recognized as challenging. Patient-specific osteotomy templates were designed and generated for precise surgery, based on tumor fusion images and 3D printing technology. This study aimed to investigate the accuracy of patient-specific osteotomy templates for the resection of pelvic tumors.

Methods: From April 2014 to August 2023, 27 patients with pelvic tumors at our hospital were enrolled in this study. All patients underwent CT and enhanced MRI before surgery to develop a 3D preoperative imaging plan model for pelvic tumors based on tumor fusion images. For patients in the intraoperative use of osteotomy templates group, we designed and generated patient-specific osteotomy templates for intraoperative assisted tumor resection. For patients in the no use of osteotomy templates group, surgeons performed tumor resection according to conventional techniques. All patients were followed up to obtain postoperative CT images of the pelvis. Preoperative planning osteotomy surface and intraoperative actual osteotomy surface were obtained by means of the image registration technique. Then, the distance deviation and angle deviation between the two surfaces were compared to assess the accuracy of surgery.

Results: Surgery was successfully completed in 27 patients, and all specimens were obtained for tumor-free resection margins. The median of intraoperative bleeding was 2350(1425 ∼ 3000) ml in the intraoperative use of osteotomy templates group and 4500(3150 ∼ 5200)ml in the no use of osteotomy templates group. p-value was 0.016. The median angular deviation of the actual osteotomy surfaces from the planned osteotomy surfaces was 5.02 (2.84 ∼ 7.37)° in the intraoperative use of osteotomy templates group, and 7.17 (4.49 ∼ 11.96)° in the no use of osteotomy templates group. p-value was 0.044. The absolute mean distance deviation between the two surfaces was 4.90 ± 3.01 mm in the intraoperative use of osteotomy templates group, and 7.21 ± 3.89 mm in the no use of osteotomy templates group. p-value was 0.038.

Conclusions: 3D-printed patient-specific osteotomy templates can be accurately customized based on preoperative tumor fusion image, which can help improve the precision of pelvic tumor surgery.