术前计划中应用3D打印模型辅助全髋关节置换治疗髋关节疾病的系统评价与Meta分析

文题释义：3D打印：又称增制材料，通过计算机建模软件建模，再将建成的三维模型“分区”成逐层的截面，即切片，从而指导打印机逐层打印构造物体的技术，目前被广泛应用于临床之中，尤其是骨科领域。 全髋关节置换：主要适用于髋臼破坏严重导致关节活动明显受限、股骨头无菌性坏死和陈旧性股骨颈骨折并发股骨头坏死，并严重变形、塌陷和继发髋关节骨性关节炎等。 背景：近年来，3D打印技术辅助全髋关节置换在术前规划、术中指导定位、制作个体化植入物等方面发挥着重要作用，对髋关节疾病的治疗具有重要的临床意义。 目的：运用系统评价和Meta分析评价术前计划应用3D打印模型辅助全髋关节置换的临床疗效。 方法：电子检索PubMed、Embase、Cochrane Libray、中国知网、万方医学数据库，检索时间为数据库建立到2019年12月，以“全髋关节置换”“人工髋关节置换”“3D打印”“hip arthroplasty”“hip replacement”“THA”“3D Printing”“Three Dimensional Printing”等为关键词检索，纳入比较3D打印模型辅助与非3D打印辅助人工髋关节置换手术治疗髋关节疾病的的临床对照试验。根据纳入与排除标准筛选文献、提取数据并采用Cochrane 5.1.0偏倚风险评估工具对纳入研究质量进行评价，随后采用RevMan 5.3 软件进行数据分析。 结果与结论：①共纳入14篇对照研究，受试者共601例，其中3D打印组279例，非3D打印组322例；②Meta结果显示：在初次髋关节置换中，3D打印组手术时间短于非3D打印组SMD=-0.89，95%CI(-1.15，-0.64)，P < 0.05]，两组Harris评分比较差异无显著性意义SMD=0.64，95%CI(-0.26，1.54)，P > 0.05]。在翻修手术中，3D打印组手术时间短于非3D打印组SMD=-1.39，95%CI(-1.92，-0.86)，P < 0.05]，Harris评分高于非3D打印组SMD=1.51，95%CI(0.05，2.96)，P < 0.05]。3D打印组术中出血量、术后引流量均少于非3D打印组SMD=-1.90，95%CI(-2.82，-0.99)，P < 0.05；SMD=-2.87，95%CI(-3.36，-2.37)，P < 0.05]，前倾角及外展角较非3D打印组更接近术前设计角度SMD=-1.24，95%CI(-1.57，-0.91)，P < 0.05；SMD=-1.71，95%CI(-2.96，-0.45)，P < 0.05]。③结果表明与传统全髋关节置换相比，3D打印辅助全髋关节置换能明显缩短手术时间、减少术中出血量与术后引流量、提高全髋关节置换的精确度，且更能缓解疼痛，提高生活质量。但由于纳入的文献质量不高，仍需要更高质量的大样本、多中心的随机对照试验以证实临床疗效。 ORCID: 0000-0002-7539-5268(颜炎) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Systematic evaluation and meta-analysis of total hip arthroplasty with three-dimensional printing model in preoperative planning

BACKGROUND:Three-dimensional(3D)printing-assisted total hip arthroplasty plays an important role in preoperative planning,intraoperative guidance and positioning,and production of individualized implants.It has important clinical significance for the treatment of hip joint diseases.OBJECTIVE:To evaluate the clinical efficacy of preoperative planning using 3D printed models to assist total hip arthroplasty by systematic evaluation and meta-analysis.METHODS:PubMed,Embase,Cochrane Libray,CNKI,Wanfang databases were retrieved electronically for the articles published before December 2019.The keywords were“hip arthroplasty,hip replacement,THA,3D printing,three dimensional printing”in Chinese and English,respectively.The clinical controlled trials of 3D printed models versus non-3D printed models to assist total hip arthroplasty in the treatment of hip joint diseases were enrolled.The literature was screened according to the inclusion and exclusion criteria;data were extracted;and the quality of the included studies was evaluated using the Cochrane 5.1.0 bias risk assessment tool,followed by data analysis using RevMan 5.3 software.RESULTS AND CONCLUSION:(1)Fourteen controlled studies were included,involving 601 participants,including 279 cases in the 3D group and 322 cases in the traditional surgery group.(2)Meta-analysis results showed that during the first hip arthroplasty,the operation time in the 3D group was shorter than that in the traditional surgery groupSMD=-0.89,95%CI(-1.15,-0.64),P<0.05].There was no significant difference in the Harris score between two groupsSMD=0.64,95%CI(-0.26,1.54),P>0.05].During revision surgery,the operation time in the 3D group was shorter than that in the traditional surgery groupSMD=-1.39,95%CI(-1.92,-0.86),P<0.05],and Harris score was higher than that in the traditional surgery groupSMD=1.51,95%CI(-0.05,2.96),P<0.05].The intraoperative blood loss and postoperative drainage volume in the 3D group were less than those in the traditional surgery groupSMD=-1.90,95%CI(-2.82,-0.99),P<0.05;SMD=-2.87,95%CI(-3.36,-2.37),P<0.05].The anteversion angle and abduction angle in the 3D group were closer to the preoperative design angle compared with the traditional surgery groupSMD=-1.24,95%CI(-1.57,-0.91),P<0.05;SMD=-1.71,95%CI(-2.96,-0.45),P<0.05].(3)These results show that compared with traditional total hip arthroplasty,3D printing assisted total hip arthroplasty can significantly shorten the operation time,reduce the amount of intraoperative blood loss and postoperative drainage,improve the accuracy of total hip arthroplasty,and can better relieve pain,and improve the quality of life.However,due to the low quality of the included literature,high-quality large-sample,multi-center randomized controlled trials are still needed to confirm the clinical efficacy.