'Virtual reduction of complex fractures of the pelvis using the first patient-specific biomechanical simulation'
Place : Salle des thèses, 1er étage du Bâtiment Boucherle, Faculté de Médecine et Pharmacie, 38700 La Tronche
Thesis supervision :
- Pr Jérôme TONETTI, Professeur des Universités – Praticien Hospitalier, CHU Grenoble Alpes, Université Grenoble Alpes, Directeur
- Dr Matthieu CHABANAS, Maître de conférences, Grenoble INP, Laboratoire TIMC, Co-encadrant
- Dr Maud MARCHAL, Maître de conférences, Institut National des Sciences Appliquées de Rennes, Rapporteur
- Pr Philippe ADAM, Professeur des Universités – Praticien Hospitalier, Université de Strasbourg, Rapporteur
- Pr Pol Maria ROMMENS, Professeur des Universités – Praticien Hospitalier, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Examinateur
- Dr Yohan PAYAN, Directeur de Recherche, Laboratoire TIMC, Université Grenoble Alpes, Examinateur
- Dr Simon WEIDERT, Chirurgien, Ludwig-Maximilians-Universität München, Invité
The aim of this work was to develop and validate a new pre-operative planning in acetabular surgery based on a patient-specific biomechal model.
During the first part of this work we brought enhancement in each step of the planning process for acetabular fracture surgery. The first step was to generate 3D models of several acetabular fracture patterns using semi-automatic segmentation methods. In the same time, we showed that the segmented fragments bone could be usefull to correctly classify acetabular fracture by unexperimented residents.
The second step was to generate a patient-specific model, in a very simple way, that could be used in clinical practice by surgeons. A literature review of acetabular planning models was performed to identify that a new paradigm was required because of the limitations of the existing models.
Once the objectives of patient-specific modelling was identified, a literature review of hips models was performed to record biomechanical properties of the elements that we had to modelize. A compromise between simplicity and realistic behaviour was found to generate patient-specifics biomechanical models, in a limited time, that could be used in clinical practice. Clinical studies on 14 operated cases, then 29 operated cases and finally 39 operated cases, were performed to validate retrospectively the simulations. The results were quite promising. Only open-source softwares with their own weaknesses were used because validity and feasability of the procedure was required before bigger investissment. The proof of concept was done.
A prospective clinical study has shown the efficiency of the patient-specific biomechanical simulation and its feasibility in a daily clinical practice. This work opens a door for new approaches in surgical planning and patient-specific modelling.