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[1]楊德勇,程蓓蓓,姜鈞耀,等.3D打印技術(shù)輔助傳統(tǒng)手術(shù)方法治療復(fù)雜跟骨骨折有效性和安全性的Meta分析[J].中醫(yī)正骨,2022,34(08):36-45.
　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打印技術(shù)輔助傳統(tǒng)手術(shù)方法治療復(fù)雜跟骨骨折有效性和安全性的Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年08期
頁(yè)碼:
36-45
欄目:
文獻(xiàn)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:
楊德勇1; 程蓓蓓1; 姜鈞耀2; 李志強(qiáng)3
(1.新疆醫(yī)科大學(xué)第六附屬醫(yī)院,新疆 烏魯木齊 830002; 2.河南科技大學(xué)基礎(chǔ)醫(yī)學(xué)院,河南 洛陽(yáng) 471023; 3.河南省洛陽(yáng)正骨醫(yī)院/河南省骨科醫(yī)院,河南 鄭州 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
關(guān)鍵詞:
跟骨;  骨折;  打印; 三維;  專題Meta分析
Keywords:
calcaneus;  fractures; bone;  printing; three-dimensional;  fracture fixation; internal;  meta-analysis as topic
摘要:
目的:系統(tǒng)評(píng)價(jià)3D打印技術(shù)輔助傳統(tǒng)手術(shù)方法治療復(fù)雜跟骨骨折的有效性和安全性。方法:應(yīng)用計(jì)算機(jī)檢索萬(wàn)方數(shù)據(jù)庫(kù)、中國(guó)知網(wǎng)、維普網(wǎng)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)、PubMed、Web of Science、Embase和Cochrane library中關(guān)于3D打印技術(shù)輔助傳統(tǒng)手術(shù)方法治療復(fù)雜跟骨骨折的隨機(jī)對(duì)照或非隨機(jī)對(duì)照臨床試驗(yàn)文獻(xiàn),檢索時(shí)限為1998年1月1日至2021年10月31日。3D打印組采用3D打印技術(shù)輔助傳統(tǒng)手術(shù)方法治療,傳統(tǒng)手術(shù)組采用單純傳統(tǒng)手術(shù)方法(鋼板或螺釘內(nèi)固定)治療。由2名研究者獨(dú)立檢索、篩選文獻(xiàn),提取資料,并采用Cochrane偏倚風(fēng)險(xiǎn)評(píng)估工具對(duì)納入研究的隨機(jī)對(duì)照試驗(yàn)文獻(xiàn)的質(zhì)量進(jìn)行評(píng)估,采用紐卡斯?fàn)?渥太華量表(Newcastle-Ottawa scale,NOS)對(duì)納入的非隨機(jī)對(duì)照試驗(yàn)文獻(xiàn)的質(zhì)量進(jìn)行評(píng)估。采用RevMan5.3軟件進(jìn)行Meta分析。結(jié)果:共檢索到426篇文獻(xiàn),經(jīng)逐層篩選,最終納入16篇文獻(xiàn),共涉及835例患者,其中3D打印組415例、傳統(tǒng)手術(shù)組420例。Meta分析結(jié)果顯示,3D打印組術(shù)后跟骨寬度小于傳統(tǒng)手術(shù)組[MD=-0.76,95%CI(-1.28,-0.24),P=0.004]、術(shù)后跟骨高度大于傳統(tǒng)手術(shù)組[MD=0.69,95%CI(0.10,1.28),P=0.020]、術(shù)后B?hler角大于傳統(tǒng)手術(shù)組[MD=0.51,95%CI(0.17,0.86),P=0.003]、術(shù)后美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)踝與后足評(píng)分高于傳統(tǒng)手術(shù)組[MD=3.07,95%CI(1.90,4.25),P=0.000]、手術(shù)時(shí)間短于傳統(tǒng)手術(shù)組[SMD=-2.43,95%CI(-3.00,-1.85),P=0.000]、術(shù)中出血量小于傳統(tǒng)手術(shù)組[SMD=-2.42,95%CI(-3.10,-1.73),P=0.000]、術(shù)中X線透視次數(shù)少于傳統(tǒng)手術(shù)組[SMD=-1.25,95%CI(-1.54,-0.96),P=0.000]、術(shù)后并發(fā)癥發(fā)生率小于傳統(tǒng)手術(shù)組[RR=0.52,95%CI(0.35,0.77),P=0.001],2組術(shù)后Gissane角的差異無(wú)統(tǒng)計(jì)學(xué)意義[SMD=-0.02,95%CI(-0.25,0.21),P=0.890]。按照手術(shù)入路不同進(jìn)行亞組分析的結(jié)果顯示,2組術(shù)后Gissane角的差異均無(wú)統(tǒng)計(jì)學(xué)意義[L形切口:SMD=-0.21,95%CI(-0.51,0.08),P=0.160; 跗骨竇切口:SMD=0.25,95%CI(-0.14,0.65),P=0.210; 經(jīng)皮撬撥:SMD=0.21,95%CI(-0.19,0.61),P=0.300],3D打印組手術(shù)時(shí)間均短于傳統(tǒng)手術(shù)組[L形切口:SMD=-2.83,95%CI(-4.06,-1.59),P=0.000; 跗骨竇切口:SMD=-2.53,95%CI(-4.96,-0.11),P=0.040; 經(jīng)皮撬撥:SMD=-1.92,95%CI(-3.27,-0.57),P=0.005]、術(shù)中出血量均小于傳統(tǒng)手術(shù)組[L形切口:SMD=-2.69,95%CI(-3.97,-1.41),P=0.000; 經(jīng)皮撬撥:SMD=-2.16,95%CI(-3.87,-0.46),P=0.010]。結(jié)論:現(xiàn)有的證據(jù)表明,3D打印技術(shù)輔助傳統(tǒng)手術(shù)方法治療復(fù)雜跟骨骨折的臨床療效和安全性均優(yōu)于單純的傳統(tǒng)手術(shù)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 本文編輯:時(shí)紅磊)

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備注/Memo

備注/Memo:
通訊作者:李志強(qiáng) E-mail:[email protected]
更新日期/Last Update: 1900-01-01