3D打印模型辅助置钉技术与传统置钉技术治疗脊柱畸形有效与安全性的Meta分析

Efficacy and safety of three-dimensional model assisted screw placement technique and traditional screw placement technique in the treatment of spinal deformity:a meta-analysis

目的:目前对于3D打印模型辅助置钉技术与传统置钉技术治疗脊柱畸形是否存在差异尚有争论。为此,文章系统评价3D打印模型辅助置钉技术与传统置钉技术治疗脊柱畸形的差异。方法:计算机检索在2020年4月之前中国知网、万方、维普、The Cochrane library、Pub Med、CBM和EMBASE数据库的文献,搜集有关3D打印模型辅助置钉技术与传统置钉技术治疗脊柱畸形对比的临床研究,并且手工检索相关论文。由2位评价员独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Stata/SE 12.0软件对结局指标进行Meta分析。结果:(1)共纳入8个研究,其中1个随机对照试验的质量等级评为B级,7个队列研究NOS量表评分均大于5分;包含479例患者,其中模型组219例,传统组260例;(2)Meta分析结果显示:两种技术在术后Cobb角(MD=-4.69,95%CI:-8.05至-1.32,P<0.05)、置钉准确率(RR=1.11,95%CI:1.08-1.14,P<0.05)、平均置钉时间(MD=-1.52,95%CI:-1.75至-1.29,P<0.05)、手术时间(MD=-28.59,95%CI:-30.67至-26.52,P<0.05)、术中透视次数(MD=-3.11,95%CI:-4.70至-1.53,P<0.05)、术中出血量(MD=-177.79,95%CI:-250.08至-105.50,P<0.05)方面差异均有显著性意义,而两种技术在并发症发生率方面差异均无显著性意义(RR=0.94,95%CI:0.75-1.17,P=0.576)。结论:与传统置钉技术相比,3D打印模型辅助置钉技术畸形矫正效果好、置钉准确、快速、术中出血量少。鉴于纳入研究的质量有限,上述结论仍需大量高质量的多中心随机对照试验来提供更多的证据。

OBJECTIVE:It remains disputed whether three-dimensional(3D)model assisted screw placement technique and traditional screw placement technique in the treatment of spinal deformity.Thus,this study systematically assessed the difference between 3D model assisted screw placement technique and traditional screw placement technique in the treatment of spinal deformity.MEt HODS:A computer-based online search of CNKI,Wanfang,VIP,The Cochrane library,Pub Med,CBM,and EMBASE was performed to retrieve clinical studies of comparison between 3D model assisted screw placement technique and traditional screw placement technique in the treatment of spinal deformity published before April 2020.Moreover,related papers were manually retrieved.After two evaluators independently selected literature,extracted data and evaluated the quality of methodology included in the study,meta-analysis was carried out by using Stata/SE 12.0 software.RESULt S:(1)Eight clinical controlled trials were included,and the quality of a randomized controlled trial was grade B.NOS scores of all cohort studies were greater than 5.A total of 479 patients were included in the final analysis,and divided into model group(n=219)and traditional group(n=260).(2)The metaanalysis results showed that there were significant differences in Cobb angle(MD=-4.69,95%CI:-8.05 to-1.32,P<0.05),accuracy of pedicle screw placement(RR=1.11,95%CI:1.08-1.14,P<0.05),average screw placement time(MD=-1.52,95%CI:-1.75 to-1.29,P<0.05),operation time(MD=-28.59,95%CI:-30.67 to-26.52,P<0.05),intraoperative fluoroscopy times(MD=-3.11,95%CI:-4.70 to-1.53,P<0.05),and intraoperative blood loss(MD=-177.79,95%CI:-250.08 to-105.50,P<0.05)between the two methods.There was no significant difference in rate of complications(RR=0.94,95%CI:0.75-1.17,P=0.576]between the two methods.CONCLUSION:Compared with the traditional screw placement technology,3 D model assisted screw placement technique has the advantages of good deformity correction,accurate and rapid screw placement,and less intraoperative blood loss.Given the limited quality of included studies,a large number of high-quality multicenter randomized controlled trials are needed to provide more evidence.