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　YANG Deyong,CHENG Beibei,JIANG Junyao,et al.Clinical outcomes and safety of conventional surgical methods assisted by 3D printing technology for treatment of complicated calcaneal fractures:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(08):36-45.
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3D打印技术辅助传统手术方法治疗复杂跟骨骨折有效性和安全性的Meta分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年08期
页码:
36-45
栏目:
文献研究
出版日期:
2022-08-20

文章信息/Info

Title:
Clinical outcomes and safety of conventional surgical methods assisted by 3D printing technology for treatment of complicated calcaneal fractures:a meta-analysis
作者:
杨德勇1; 程蓓蓓1; 姜钧耀2; 李志强3
(1.新疆医科大学第六附属医院,新疆 乌鲁木齐 830002; 2.河南科技大学基础医学院,河南 洛阳 471023; 3.河南省洛阳正骨医院/河南省骨科医院,河南 郑州 450016)
Author(s):
YANG Deyong1; CHENG Beibei1; JIANG Junyao2;  LI Zhiqiang3
1.The Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,Xinjiang,China2.School of Basic Medical Sciences of Henan University of Science and Technology,Luoyang 471023,Henan,China3.Luoyang Orthopedic-Traumatological Hospital,Zhengzhou 450016,Henan,China
关键词:
跟骨;  骨折;  打印; 三维;  专题Meta分析
Keywords:
calcaneus;  fractures; bone;  printing; three-dimensional;  fracture fixation; internal;  meta-analysis as topic
摘要:
目的:系统评价3D打印技术辅助传统手术方法治疗复杂跟骨骨折的有效性和安全性。方法:应用计算机检索万方数据库、中国知网、维普网、中国生物医学文献服务系统、PubMed、Web of Science、Embase和Cochrane library中关于3D打印技术辅助传统手术方法治疗复杂跟骨骨折的随机对照或非随机对照临床试验文献,检索时限为1998年1月1日至2021年10月31日。3D打印组采用3D打印技术辅助传统手术方法治疗,传统手术组采用单纯传统手术方法(钢板或螺钉内固定)治疗。由2名研究者独立检索、筛选文献,提取资料,并采用Cochrane偏倚风险评估工具对纳入研究的随机对照试验文献的质量进行评估,采用纽卡斯尔-渥太华量表(Newcastle-Ottawa scale,NOS)对纳入的非随机对照试验文献的质量进行评估。采用RevMan5.3软件进行Meta分析。结果:共检索到426篇文献,经逐层筛选,最终纳入16篇文献,共涉及835例患者,其中3D打印组415例、传统手术组420例。Meta分析结果显示,3D打印组术后跟骨宽度小于传统手术组[MD=-0.76,95%CI(-1.28,-0.24),P=0.004]、术后跟骨高度大于传统手术组[MD=0.69,95%CI(0.10,1.28),P=0.020]、术后B?hler角大于传统手术组[MD=0.51,95%CI(0.17,0.86),P=0.003]、术后美国足与踝关节协会踝与后足评分高于传统手术组[MD=3.07,95%CI(1.90,4.25),P=0.000]、手术时间短于传统手术组[SMD=-2.43,95%CI(-3.00,-1.85),P=0.000]、术中出血量小于传统手术组[SMD=-2.42,95%CI(-3.10,-1.73),P=0.000]、术中X线透视次数少于传统手术组[SMD=-1.25,95%CI(-1.54,-0.96),P=0.000]、术后并发症发生率小于传统手术组[RR=0.52,95%CI(0.35,0.77),P=0.001],2组术后Gissane角的差异无统计学意义[SMD=-0.02,95%CI(-0.25,0.21),P=0.890]。按照手术入路不同进行亚组分析的结果显示,2组术后Gissane角的差异均无统计学意义[L形切口:SMD=-0.21,95%CI(-0.51,0.08),P=0.160; 跗骨窦切口:SMD=0.25,95%CI(-0.14,0.65),P=0.210; 经皮撬拨:SMD=0.21,95%CI(-0.19,0.61),P=0.300],3D打印组手术时间均短于传统手术组[L形切口:SMD=-2.83,95%CI(-4.06,-1.59),P=0.000; 跗骨窦切口:SMD=-2.53,95%CI(-4.96,-0.11),P=0.040; 经皮撬拨:SMD=-1.92,95%CI(-3.27,-0.57),P=0.005]、术中出血量均小于传统手术组[L形切口:SMD=-2.69,95%CI(-3.97,-1.41),P=0.000; 经皮撬拨:SMD=-2.16,95%CI(-3.87,-0.46),P=0.010]。结论:现有的证据表明,3D打印技术辅助传统手术方法治疗复杂跟骨骨折的临床疗效和安全性均优于单纯的传统手术方法。
Abstract:
Objective:To systematically review the clinical outcomes and safety of conventional surgical methods assisted by 3D printing technology for treatment of complicated calcaneal fractures.Methods:All randomized controlled trial(RCT)and non-RCT articles about conventional surgical methods assisted by 3D printing technology for treatment of complicated calcaneal fractures included from January 1,1998 to October 31,2021 were retrieved from Wanfang Database,China National Knowledge Internet,Vip Database,Chinese Biomedical Literature Service System,PubMed,Web of Science,Embase and Cochrane library through computer.The patients in 3D printing group were treated with conventional surgical methods assisted by 3D printing technology,while the ones in conventional surgery group merely with conventional surgical methods(internal fixation with steel plates or screws).The articles were retrieved and screened and the information was extracted independently by two researchers according to unified literature information extraction table and evaluation indicators,and if any disagreement was found between them,discussion was conducted or asked for another researcher for making a final decision.The methodological quality of researches in the RCT and non-RCT articles was evaluated by using Cochrane bias risk assessment tools and Newcastle-Ottawa scale(NOS)respectively,and then a Meta-analysis was conducted by using RevMan5.3 software.Results:Four hundred and twenty-six articles were searched out.After screening,16 articles(835 patients)were included in the final analysis,415 patients in 3D printing group and 420 ones in conventional surgery group.The results of Meta-analysis revealed that the postoperative calcaneal width was smaller,the postoperative calcaneal height and postoperative B?hler angle were larger,the postoperative American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores were higher,the operative time was shorter,the intraoperative blood loss was less,the intraoperative X-ray exposure was fewer and the postoperative complication incidence rate was lower in 3D printing group compared to conventional surgery group(MD=-0.76,95%CI(-1.28,-0.24),P=0.004; MD=0.69,95%CI(0.10,1.28),P=0.020; MD=0.51,95%CI(0.17,0.86),P=0.003; MD=3.07,95%CI(1.90,4.25),P=0.000; SMD=-2.43,95%CI(-3.00,-1.85),P=0.000; SMD=-2.42,95%CI(-3.10,-1.73),P=0.000; SMD=-1.25,95%CI(-1.54,-0.96),P=0.000; RR=0.52,95%CI(0.35,0.77),P=0.001),while there was no statistical difference in postoperative Gissane angle between the 2 groups(SMD=-0.02,95%CI(-0.25,0.21),P=0.890).The subgroup analysis was conducted according to the surgical approaches,and the results showed that there was no statistical difference in postoperative Gissane angle between the 2 groups(L-shaped approach:SMD=-0.21,95%CI(-0.51,0.08),P=0.160; sinus tarsi approach:SMD=0.25,95%CI(-0.14,0.65),P=0.210; percutaneous leverage:SMD=0.21,95%CI(-0.19,0.61),P=0.300),whereas the operative time was shorter(L-shaped approach:SMD=-2.83,95%CI(-4.06,-1.59),P=0.000; sinus tarsi approach:SMD=-2.53,95%CI(-4.96,-0.11),P=0.040; percutaneous leverage:SMD=-1.92,95%CI(-3.27,-0.57),P=0.005),and the intraoperative blood loss was less in 3D printing group compared to conventional surgery group(L-shaped approach:SMD=-2.69,95%CI(-3.97,-1.41),P=0.000; percutaneous leverage:SMD=-2.16,95%CI(-3.87,-0.46),P=0.010).Conclusion:Available evidences suggest that the clinical outcomes and safety of conventional surgical methods assisted by 3D printing technology is better than that of conventional surgical methods alone in treatment of complicated calcaneal fractures.

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(收稿日期:2022-01-07 本文编辑:时红磊)

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备注/Memo

备注/Memo:
通讯作者:李志强 E-mail:lizhiqiang2003@163.com
更新日期/Last Update: 1900-01-01