这项研究的目的是执行一项基于证据的审查,回答以下问题(PICO):“做患者特异性植入物(PSI),使用计算机辅助技术制造或设计,改善结果(轨道体积变化,眼球内陷,复视,和手术时间)与成人患者创伤性眼眶损伤后眼眶重建的常规方法相比?“我们根据PRISMA指南进行了系统回顾和荟萃分析。纳入标准包括任何比较论文,其中计算机辅助技术用于植入物的预制或设计过程,以用于创伤后眼眶重建。排除儿科患者人群。系统检索了8个数据库进行相关研究。通过NOS和RoB2工具评估偏倚风险。在可能的情况下,使用随机效应模型来识别组间结果的差异。使用R4.0.0进行分析。纳入了4784项确定的研究中的11项,包括628名成年患者,患者特定组和常规组分别有302名和326名患者,分别。对于患者特定组和常规组,未受影响的眼眶容积与术后眼眶容积之间的加权平均差为0.32ml(SD0.75)和0.95ml(SD1.03)。分别。使用PSI在术后眼眶容积重建中发现了显着改善,与传统植入物相比,在5项报告研究中的3项。同样,在患者特异性组中,术后眼球内陷的严重程度趋于降低,在特定患者组中有11.2%的患者受影响,在常规组中有19.2%的患者受影响,在6项报告研究中,有3项使用PSI显著缩短了手术时间.尽管倾向于支持PSI,meta分析未发现关键结局的统计学差异.尽管有一些令人鼓舞的数据支持在创伤后重建中使用患者特定的眼眶植入物改善结果,有,目前,根据现有的比较研究,没有统计学显著的证据客观地支持它们相对于传统植入物的使用。根据这项研究的结果,使用的植入物的选择应该,因此,由外科医生自行决定。
The purpose of this study is to execute an evidence-based
review answering the following question (PICO): \"Do patient-specific implants (PSI), manufactured or designed using computer-assisted technology, improve outcomes (orbital volume change, enophthalmos, diplopia, and operative duration) compared to conventional methods in orbital reconstruction following traumatic orbital injury in the adult patient population?\" We performed a systematic
review and meta-analysis in accordance with PRISMA guidelines. Inclusion criteria included any comparative paper whereby computer-assisted technology was used in the prefabrication or design process of implants for use in post-traumatic orbital reconstruction. Paediatric patient populations were excluded. Eight databases were systematically searched for relevant studies. Risk of bias was assessed through the NOS and RoB2 tools. Random-effects models were used to identify differences in outcomes between groups where possible. Analysis was performed using R 4.0.0. Eleven of 4784 identified studies were included, comprising 628 adult patients, with 302 and 326 patients in the patient-specific and conventional groups, respectively. Weighted mean difference between unaffected and post-operative orbital volume was 0.32 ml (SD 0.75) and 0.95 ml (SD 1.03) for patient-specific and conventional groups, respectively. Significant improvement was identified in post-operative orbital volume reconstitution with the use of PSI, compared to conventional implants, in 3 of the 5 reporting studies. Equally, post-operative enophthalmos trended towards lower severity in the patient-specific group, with 11.2% of patients affected in the patient-specific group and 19.2% in the conventional group, and operative duration was significantly reduced with the use of PSI in 3 of the 6 reporting studies. Despite a tendency to favour PSI, no statistically significant differences in key outcomes were identified on meta-analysis. Although there is some encouraging data to support improved outcomes with the use of patient-specific orbital implants in post-traumatic reconstruction, there is, at present, no statistically significant evidence to objectively support their use over conventional implants based on the currently available comparative studies. Based on the results of this study, the choice of implant used should, thus, be left to the discretion of the surgeon.