3D打印模型辅助全髋关节置换术治疗成人先天性髋关节发育不良的Meta分析  

Meta-analysis of the efficacy of three-dimensional printing technology assisted total hip arthroplasty for the treatment of adult developmental dysplasia of the hip

作　　者：周建伟 魏锦强 周俊德 吴炳鑫 陈海云 Zhou Jianwei;Wei Jinqiang;Zhou Junde;Wu Bingxin;Chen Haiyun(Guangdong Hospital of Chinese Medicine/The Second Clinical College of Guangzhou University of Chinese Medicine,Guangzhou Guangdong,510006,China)

机构地区：[1]广东省中医院/广州中医药大学第二临床医学院,广东广州510006

出　　处：《生物骨科材料与临床研究》2022年第1期58-66,共9页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的评价术前应用3D打印模型辅助THA对比传统THA治疗成人DDH的临床疗效和安全性。方法选择CNKI、WanFang Data、CBM、VIP、PubMed、Embase、The Cochrane Library等数据库,检索建库至2021年3月关于术前应用3D打印模型辅助全髋关节置换术治疗成人先天性髋关节发育不良的临床对照试验文献。根据纳入和排除标准由两人独立进行筛选文献、整理数据及评价文献质量,采用RevMan 5.3软件对纳入的研究结果进行分析和处理。并通过制作漏斗图的方式评价发表偏倚。结果共纳入13篇文献,包含5个随机对照研究和8个非随机对照研究。各研究基线一致,Meta分析结果显示,术前应用3D打印模型辅助THA治疗成人DDH比传统THA的术中出血量更少[SMD=-1.44,95%CI(-2.13,-0.75),P<0.0001],手术时间更短[SMD=-0.75,95%CI(-1.24,-0.27),P=0.002],术后引流量更少[SMD=-2.31,95%CI(-3.31,-1.31),P<0.00001]。相比于传统THA,3D打印模型辅助THA术后前倾角、外展角与术前设计的偏差更小[SMD=-1.51,95%CI(-2.47,-0.54),P=0.002]、[SMD=-2.48,95%CI(-3.41,-1.56),P<0.00001]。同时,在随访中,3D打印模型辅助THA组患者具有更高的术后Harris评分[SMD=0.34,95%CI(0.10,0.57),P=0.005]和更大的术后髋关节外展角[SMD=0.48,95%CI(0.08,0.88),P=0.02]。漏斗图表明本研究存在发表偏倚的可能性较小。结论3D打印模型辅助THA在协助术前规划、指导术中定位及假体选择等方面发挥着重要作用,相比于传统THA手术,可提高术中假体安放的精准度,并具有更好的疗效和安全性。但因纳入研究的数量和质量有限,目前结果仍需开展更多同质、高质量研究加以验证。Objective To evaluate the clinical efficacy and safety of preoperative 3D printing model assisted THA compared with traditional THA in the treatment of adult DDH.Methods The databases of CNKI、WanFang Data、CBM、VIP、PubMed、Embase、The Cochrane Library were used for researching literature on the application of 3D printing assisted THA in the treatment of adult DDH from the beginning of database building to March 2021.Two researchers independently screened the literature,extracted data,and conducted quality evaluation according to inclusion and exclusion criteria.The outcomes included were processed by RevMan 5.3.The funnel plot was used to assess the publication bias.Results A total of 13 literatures were included,including 5 randomized controlled trials and 8 non-randomized controlled trials with similar baseline characteristics across studies.Results showed that the adult DDH with the treatment of 3D printing assisted THA had less intraoperative blood loss[SMD=-1.44,95%CI(-2.13,-0.75),P<0.0001],shorter operation time[SMD=-0.75,95%CI(-1.24,-0.27),P=0.002],and less postoperative drainage volume[SMD=-2.31,95%CI(-3.31,-1.31),P<0.00001].Compared with the traditional THA,the deviation of postoperative anteversion and abduction angle between THA and preoperative design was smaller[SMD=-1.51,95%CI(-2.47,-0.54),P=0.002],[SMD=-2.48,95%CI(-3.41,-1.56),P<0.00001].At the same time,patients in the 3D printing assisted THA group had higher postoperative Harris score[SMD=0.34,95%CI(0.10,0.57),P=0.005]and larger postoperative hip abduction angle[SMD=0.48,95%CI(0.08,0.88),P=0.02]during the follow-up period.The funnel plot test indicated that there was no significant publication bias in the meta-analysis.Conclusion 3D printing technique plays an important role in assisting preoperative planning,guiding intraoperative localization and prosthesis selection.Comparing with traditional THA surgery,it improves the accuracy of acetabular prosthesis placement and has more advantages in efficacy and safety.However,limited by the qu

关 键 词：3D打印技术 全髋关节置换 成人先天性髋关节发育不良 META分析 

分 类 号：R687.4[医药卫生—骨科学]