3D打印辅助椎弓根钉置入与传统手术治疗腰椎滑脱的Meta分析

Comparison of three-dimensional printing-assisted pedicle screw placement and traditional surgery for lumbar spondylolisthesis:a meta-analysis

背景:随着3D打印技术的发展,其在脊柱外科已得到广泛应用。但目前3D打印辅助手术治疗腰椎滑脱是否比传统手术有优势尚存争议。目的:系统评价3D打印辅助手术和传统手术在治疗腰椎滑脱中的疗效与安全性。方法:检索中国期刊全文数据库(CNKI)、万方数据库(Wanfang)、中国生物医学文献数据库(CBM)、维普(VIP)、PubMed、CochraneLibrary、Embase、WebofScience等中外文数据库,检索为从建库至2019-11-16,收集3D打印技术应用于腰椎滑脱患者的随机对照试验。按照事先制定的入选与排除标准筛选文献,逐一评价纳入研究的质量,提取有效数据,采用Stata 11.0软件进行Meta分析。结果与结论:①最终纳入6篇随机对照试验,共394例患者,其中3D打印辅助组201例,传统手术组193例;②Meta分析结果显示,3D打印辅助组在手术时间[WMD=-38.17,95%CI(-43.93,-32.41),P=0.00]、术中出血量[WMD=-61.61,95%CI(-69.19,-54.03),P=0.00]、术中透视次数[WMD=-4.89,95%CI(-6.38,-3.41),P=0.00]、椎弓根钉置钉准确率[OR=3.89,95%CI(2.43,6.25),P=0.00]方面显著优于传统手术组;③但2组在术后目测类比评分[WMD=-0.47,95%CI(-1.21,0.27),P=0.215]、Oswestry功能障碍指数[WMD=-1.41,95%CI(-2.87,0.05),P=0.058]、日本骨科协会评分[WMD=1.02,95%CI(-0.68,2.72),P=0.240]、并发症发生率[OR=0.37,95%CI(0.12,1.11),P=0.075]方面差异无显著性意义;④综上所述,腰椎滑脱修复术中应用3D打印技术具有手术时间短、手术出血少、术中透视次数少、置钉准确率高等优点。

BACKGROUND:With the development of three-dimensional(3D)printing technology,it has been widely used in spinal surgery.However,whether 3D printing-assisted surgery for lumbar spondylolisthesis has an advantage over traditional surgery is still controversial.OBJECTIVE:To compare the clinical efficacy and safety of 3D printing-assisted versus conventional surgery for the treatment of lumbar spondylolisthesis using system evaluation.METHODS:Randomized controlled trials about 3D printing technology for lumbar spondylolisthesis in CNKI,Wanfang database,CBM,VIP,PubMed,Cochrane Library,Embase,and Web of Science were searched via computer from inception to November 16,2019.The retrieved literatures were screened according to predefined inclusion and exclusion criteria,and quality evaluation was performed.Then,the available data were extracted and analyzed with the Stata 11.0 software.RESULTS AND CONCLUSION:(1)Six randomized controlled trials including 394 cases were included.Among them,201 cases were assigned to the 3D printing-assisted group and 193 cases to the conventional group.(2)Meta-analysis results showed that the 3D printing-assisted group proved significantly superior to the conventional group regrading the operation time[WMD=-38.17,95%CI(-43.93,-32.41),P=0.00],intraoperative blood loss[WMD=-61.61,95%CI(-69.19,-54.03),P=0.00],the frequency of fluoroscopy[WMD=-4.89,95%CI(-6.38,-3.41),P=0.00]and the screw placement accuracy[OR=3.89,95%CI(2.43,6.25),P=0.00].(3)However,in terms of the postoperative visual analogue scale scores[WMD=-0.47,95%CI(-1.21,0.27),P=0.215],Oswestry disability index[WMD=-1.41,95%CI(-2.87,0.05),P=0.058],Japanese Orthopaedic Association scores[WMD=1.02,95%CI(-0.68,2.72),P=0.240]and the rate of complications[OR=0.37,95%CI(0.12,1.11),P=0.075],no statistically significant differences were found between the two groups.(4)In conclusion,the application of 3 D printing technology in the surgical treatment of lumbar spondylolisthesis has the advantage of shortening the operation time,reducing intraoperative blood loss and frequency of fluoroscopy and improving the accuracy of the screw placement.