3D打印导航模板与计算机导航系统在辅助椎弓根螺钉置入准确性与安全性的Meta分析OACSTPCD
Accuracy and safety of 3D printed navigation template and computer navigation system for vertebral pedicle screw placement:a meta-analysis
目的 系统评价3D打印导航模板与计算机导航系统在椎弓根螺钉置入术中的临床疗效与安全性.方法 系统检索中国知网、万方数据库和维普网、PubMed、Web of Science及The Cochrane Library数据库中有关3D打印导航模板与计算机导航系统在椎弓根螺钉置入术中的临床对照试验文献,检索时间范围为建库至2022-11,由2名研究者分别根据纳入、排除标准进行文献筛选,并进一步对数据进行提取和质量评价,使用RevMan 5.3软件对所提取出的数据进行分析.结果 共纳入7篇文献,包含3篇随机对照试验,其质量评价均为中等偏倚风险,4个回顾性研究,根据NOS量表进行评分,结果均>7分,为高质量文献;所纳入的文献共包含346例患者,其中3D打印组178例,计算机导航组168例.Meta分析显示,3D 打印组和计算机导航组在手术时间(MD=-41.10,95%CI:-74.54～-7.67,P<0.05)、平均置钉(MD=-4.92,95%CI:-8.50～-1.35,P<0.05)和置钉准确率(RR=1.09,95%CI:1.04～1.15,P=0.001)上差异均有统计学意义,但两者的术中出血量(MD=-10.97,95%CI:-29.38～7.44,P=0.24)、术中透视次数(MD= 0.81,95%CI:-0.85～2.46,P=0.34)、术后6个月的JOA评分(MD=0.10,95%CI:-0.50～0.70,P=0.73)和VAS评分(MD=-0.01,95%CI:-0.16～0.13,P=0.84)及术后并发症发生率(RR=0.81,95%CI:0.10～6.52,P= 0.84)差异均无统计学意义.结论 与计算机导航系统置钉相比,3D打印导航模板辅助置钉的手术时间和平均置钉时间更短,且置钉准确率更高,安全性更高.本次Meta分析纳入的文献数量且质量有限,未来仍需大样本、高质量、多中心的随机对照试验来证明分析结果的有效性.
Objective To systematically evaluate the clinical efficacy and safety of 3D printed navigation template and computer navigation system in pedicle screw placement.Methods This paper systematically retrieved the clinical controlled trial articles about 3D printed navigation template and computer navigation system in pedicle screw placement from CNKI,WanFang and VIP databases,PubMed,the Cochrane Library and Web of Science.The retrieval period was from the establishment of the database to November 2022.According to the inclusion and exclusion criteria,two researchers conducted literature screening,data extraction and quality evaluation.The obtained outcome indicators were analyzed using RevMan 5.3.Results Seven studies were included in the meta-analysis,of which,the quality of three RCTs was assessed as medium risk of bias,and the NOS scores of four retrospective studies were all greater than 8 points,indicating that they were high-quality articles.A total of 346 patients were included in the study,including 178 cases in the 3D printing group and 168 cases in the computer navigation group.Meta-analysis results showed that in the 3D printing group and the computer navigation group,the operation time(MD=-41.10,95%CI:-74.54 to-7.67,P<0.05),mean staple placement(MD=-4.92,95%CI:-8.50 to-1.35,P<0.05)and accuracy of pedicle screw placement(RR=1.09,95%CI:1.04 to 1.15,P=0.001),but there were no significant differences in the intraoperative amount of bleeding(MD=-10.97,95%CI:-29.38 to 7.44,P=0.24),the number of intraoperative fluoroscopy(MD=0.81,95%CI:-0.85 to 2.46,P=0.34),the JOA score was performed 6 months after operation(MD=0.10,95%CI:-0.50 to 0.70,P=0.73),the VAS score was performed 6 months after operation(MD=-0.01,95%CI:-0.16 to 0.13,P= 0.84),and postoperative complication rate(RR=0.81,95%CI:0.10 to 6.52,P=0.84).Conclusion Compared with the pedicle screw placement by the computer navigation system,the accuracy of pedicle screw placement by the 3D printing navigation template technology is higher,the operation time and the average screw placement time are shorter,and the safety is higher.However,the number and quality of articles included in the meta-analysis were limited,and large-sample,high-quality,and multi-center randomized controlled trial was still needed to prove the accuracy of this conclusion.
王一迪;范利娟;刘永辉;王向阳;崔宏勋
河南中医药大学,河南 郑州 450000河南省洛阳正骨医院(河南省骨科医院),河南郑州 450000
临床医学
脊柱3D打印计算机导航系统椎弓根螺钉Meta分析
Spine3D printingComputer navigation systemPedicle screwsMeta-analysis
《中国实用神经疾病杂志》 2024 (003)
311-319 / 9
全国中医药创新骨干人才项目(编号:国中医人教[2019]128号);河南省首批中医药拔尖人才项目(编号:豫中医科教[2018]25号)
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