三维打印个性化导板与传统截骨工具在全膝关节置换术中疗效比较的Meta分析  

Meta analysis of three-dimensional printing patient-specific instrumentation versus conventional instrumentation in total knee arthroplasty

作　　者：任江涛[1] 徐丛[1] 王建松[1] 刘向林[1] Ren Jiangtao Xu Cong Wang Jiansong Liu Xianglin(Department of Joint Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, HeBei Province , Chin)

机构地区：[1]承德医学院附属医院关节外科,067000

出　　处：《中华外科杂志》2017年第10期775-781,共7页Chinese Journal of Surgery

摘　　要：目的 系统评价三维（3D）打印个性化导板与传统截骨工具在全膝关节置换术中的疗效.方法 以“patient-specific”、“patient-matched”、“custom＂ 、“instrumentation＂ 、“guide instrumentation＂、“cutting blocks”、“total knee arthroplasty”、“total knee replacement＂、“TKA”、“TKR”、“3D打印”、“个性化”、“截骨导板”、“全膝关节置换”为关键词检索PubMed、Ovid、Embase、Cochrane library,CBM和万方数据库,检索2016年8月以前公开发表的全膝关节置换术中应用3D打印个性化导板与传统截骨工具的前瞻性随机对照研究,收集符合纳入排除标准的文献.采用Review Manager5.3软件对术后下肢机械力线离群值、术后假体位置离群值、术后膝关节功能、手术时间、术后输血例数及并发症等进行Meta分析.结果 共纳入13篇高质量RCT文献,共1 090例患者,其中3D打印个性化导板组544例,传统截骨工具组549例.Meta分析结果显示,3D打印个性化导板与传统截骨工具在全膝关节置换术后下肢力线离群值（Z=0.55,P=0.58,95％ CI：0.78～ 1.56）、术后股骨冠状面假体位置离群值（Z=0.38,P=0.71,95％ CI：0.69～1.72）,胫骨冠状面假体位置离群值（Z=1.95,P=0.05,95％ CI：1.00～3.38）、股骨旋转对位离群值（Z=0.36,P=0.72,95％ CI：0.49～1.64）、术后膝关节功能（Z=1.18,P=0.24,95％ CI：-0.66～2.63）,术后输血例数（Z=0.74,P=0.46,95％ CI：-0.10～0.05）、术后并发症（Z=0.18,P=0.86,95％ CI：-0.07～0.05）方面差异无统计学意义;手术时间（Z=2.66,P=0.01,95％ CI：-15.97～-2.41）和胫骨侧位假体位置离群值（Z=3.69,P=0.00,95％ CI：1.43～3.18）差异有统计学意义.结论 3D打印个性化导板在膝关节内外翻及挛缩程度不严重,关节外畸形不明显,无明显膝关节骨质缺损及过度肥胖患者的初次全膝关节置换中无明显优势,手术时不常规推荐使用. Objective To evaluate the effects of three-dimensional printing patient-specific instrumentation（PSI） versus conventional instrumentation（CI） in the total knee arthroplasty.Methods According to ＂ patient-specific ＂,＂ patient-matched ＂,＂ custom ＂,＂ Instrumentation ＂,＂ Guide Instrumentation＂,＂ cutting blocks＂,＂ total knee arthroplasty＂,＂ total knee replacement＂,＂TKA＂ and ＂TKR＂,the literature on PubMed,EMbase,Cochrane library,CBM and WanFang were searched.According to the inclusion and exclusion criteria,the high quality randomized control trial （RCT） studies about threedimensional （3D） printing patient-specific instrumentation versus conventional instrumentation in the total knee arthroplasty were collected.The post-operative limb mechanical axis outlier,the position of the components outlier,post-operative knee function,operative time,post-operative blood transfusion and complications were analyzed by RevMan 5.3 software.Results A total of 13 high quality RCT studies were included.The results of Meta-analysis show that there were no statistical differences in the post-operative limb mechanical axis outlier（Z=0.55,P=0.58,95% CI：0.78 to 1.56）,femoral coronal component outlier （Z=0.38,P=0.71,95% CI：0.69 to 1.72）,tibia coronal component outlier（Z=1.95,P=0.05,95% CI：1.00 to 3.38）,femoral rotation angle outlier（Z =0.36,P =0.72,95% CI：0.49 to 1.64）,post-operative knee function （Z =1.18,P =0.24,95 % CI：-0.66 to 2.63）,post-operative blood transfusions （Z =0.74,P =0.46,95% CI：-0.10 to 0.05） and complications（Z=0.18,P=0.86,95%CI：-0.07 to 0.05） betweenthe PSI group and the CI group.But there are statistical differences in the operation time （Z =2.66,P =0.01,95% CI：-15.97 to-2.41）and tibia sagittal component outlier （Z=3.69,P=0.00,95% Cl：1.43 to 3.18）between the PSI group and the CI group.Conclusions In the primary total knee arthroplasty the PSI is not superior over the CI for the knee without severe knee varus

关 键 词：关节成形术 置换 膝 META分析 三维 传统截骨工具 个性化 

分 类 号：R687.4[医药卫生—骨科学]