目的:本系统综述的目的是概述3D技术在胫骨平台骨折手术治疗中的当前应用,并评估3D辅助手术与基于常规成像方式的手术相比是否能改善临床疗效。
方法:在Pubmed和Embase中进行了文献检索,以获取有关3D技术在胫骨平台骨折手术治疗中使用的文章。本系统评价是根据PRISMA指南进行的。根据McMaster关键评估指南评估方法学质量和偏倚风险。操作时间的差异,失血,透视频率,评估了3D辅助手术和常规手术之间的术中翻修率和患者报告结局.使用RevMan中的方差逆加权方法汇集数据。
结果:20篇文章评估了948例接受3D辅助手术治疗的患者和126例常规手术治疗的患者。确定了五个不同的3D辅助手术概念:“3D虚拟可视化”,\'3D打印手持式骨折模型\',\'接骨板前轮廓\',\'3D打印手术指南\',和“术中3D成像”。3D辅助手术减少了手术时间(104.7vs.126.4分钟;P<0.01),少失血(241毫升vs.306ml;P<0.01),透视检查频率降低(5.8与9.1倍;P<0.01)。未发现功能结局差异(特殊手术医院膝关节评定量表:88.6vs.82.8;P=0.23)。
结论:在过去的十年中,出现了3D辅助手术治疗胫骨平台骨折的五个概念。这些包括3D虚拟裂缝可视化,用于手术计划的3D打印手持式骨折模型,用于接骨板前轮廓的3D打印模型,3D打印手术指南,和术中3D成像。3D辅助手术可能会对手术时间产生积极影响,失血,和透视频率。
OBJECTIVE: The aim of this systematic
review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities.
METHODS: A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic
review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan.
RESULTS: Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: \'3D virtual visualization\', \'3D printed hand-held fracture models\', \'Pre-contouring of osteosynthesis plates\', \'3D printed surgical guides\', and \'Intra-operative 3D imaging\'. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23).
CONCLUSIONS: Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.