3D打印应用于肱骨近端骨折手术疗效的meta分析

Meta analysis on effect of 3D printing applied in proximal humeral fracture surgery

目的分析3D打印技术对肱骨近端骨折手术疗效的影响。方法在Web of Science、PubMed、Cochrane Library、中国生物医学文献数据库、中国知网、维普、万方数据库等检索应用3D打印技术辅助肱骨近端骨折手术的随机对照试验(RCTs),检索时间从建库至2022年3月。依据纳入和排除标准筛选文献,使用改良Jadad量表评估入选文献质量,提取最终纳入文献的各项数据,应用RevMan5.3软件进行meta分析。结果共纳入8篇文献,其中中文文献5篇,英文文献3篇。手术时间、术中出血量均纳入8项RCTs进行meta分析,结果显示:与常规手术组比较,3D打印组手术时间明显缩短[MD=-29.06,95%CI(-41.98~-16.14),P<0.01],术中出血量明显减少[MD=-49.13,95%CI(-74.18~-24.08),P<0.01]。术中C臂透视次数、术后骨折愈合时间、术后引流量、术后Neer功能评分分别纳入3、6、2、2项RCTs进行meta分析,结果显示:3D打印组术中C臂透视次数[MD=-3.04,95%CI(-3.37~-2.72),P<0.01]、术后引流量[MD=-8.30,95%CI(-10.91~-5.68),P<0.01]均较常规手术组明显减少,术后Neer功能评分明显高于常规手术组[MD=2.98,95%CI(1.82~4.14),P<0.01],两组术后骨折愈合时间无明显差异(P>0.05)。结论3D打印技术辅助下的肱骨近端骨折手术在缩短手术时间,减少术中出血量、术中C臂透视次数及术后引流量等方面获益,并可加快患者术后运动功能的恢复。

Objective To analyze the influence of 3D printing technology on the surgical effect of proximal humeral fracture.Methods The randomized controlled trials(RCTs)on the 3D printing technology assisted proximal humeral fracture operation were retrieved from the databases of Web of Science,PubMed,Cochrane Library,CBMdisc,CNKI,VIP,Wanfang Data,etc.The retrieval time was from their establishment to March 2022.The literatures were screened out by the inclusion and exclusion standards.The quality of the included literatures was evaluated by using the modified Jadad scale.The various data in the ultimately included literatures were extracted,and the meta analysis was performed by using the RevMan5.3 software.Results Eight literatures were included,including 5 Chinese literatures and 3 English literatures.The operative time and intraoperative blood loss amount were included in 8 RCTs for conducting the meta analysis.The results showed that compared with the conventional operation group,the operative time in the 3D printing group was significantly shortened[MD=-29.06,95%CI(-41.98--16.14),P<0.01],and the intraoperative blood loss amount was significantly reduced[MD=-49.13,95%CI(-74.18--24.08),P<0.01].The intraoperativ e C-arm fluoroscopy times,postoperative fracture healing time,postoperative drainage volume and postoperative Neer function score were included in 3,6,2 and 2 RCTs for conducting the meta analysis,and the results showed that the intraoperative C-arm fluoroscopy times[MD=-3.04,95%CI(-3.37--2.72),P<0.01]and postoperative drainage volume[MD=-8.30,95%CI(-10.91--5.68),P<0.01]in the 3D printing group were significantly decreased compared with the conventional operation group,the postoperative Neer functional score was significantly higher than that in the conventional operation group[MD=2.98,95%CI(1.82-4.14),P<0.01],and the postoperative fracture healing time had no significant difference between the two groups(P>0.05).Conclusion Assisted by 3D printing,proximal humeral fracture surgery could obtain the benefit in the aspects of shortening the operative time,reducing intraoperative bleeding amount,intraoperative C-arm fluoroscopy times and postoperative drainage,moreover,could accelerate postoperative motor function recovery.