3D打印技术辅助全膝关节置换临床疗效的Meta分析

目的 对3D打印技术辅助全膝关节置换术与传统全膝关节置换术的临床疗效比较行Meta分析。方法 通过PubMed、Embase、Cochrane Library、中国知网、万方医学数据库等电子期刊数据库检索建库至2021年2月的比较3D打印辅助与传统全膝关节置换术临床疗效的随机对照试验。严格按照纳入标准和排除标准筛选文献进行质量评价，提取数据，采用RevMan 5.3软件对提取的数据进行Meta分析。对二分类变量评估其比值比（OR）及95%可信区间（CI），对连续型变量计算其标准均值差（SMD）及95%区间（CI），对统计结果进行综述。结果 共纳入39篇文献，2 443例患者，3D打印组1 209例，常规组1 234例，两组各指标行Meta分析后结果为：3D打印组的手术时间SMD=-17.87，95%CI（-25.75，-10.00），P<0.00001]和术中出血量SMD=-123.65，95%CI（-182.92，-64.38），P<0.0001]比常规组少；3D打印组的术后KSS评分比常规组高SMD=2.83，95%CI（0.70，4.96），P=0.009]；3D打印组的术后VAS评分比常规组低SMD=-0.36，95%CI（-0.64，-0.08），P=0.01]；3D打印组术后髋膝踝角（HKA）较常规组准确，提高了手术准确度SMD=1.03，95%CI（0.11，1.95），P=0.03]；3D打印组术后aMFTA比常规组低，提高了手术准确度SMD=-0.84，95%CI（-1.30，-0.37），P=0.0004]；3D打印组术后aLDFA比常规组高，提高了手术准确度SMD=0.69，95%CI（0.16，1.22），P=0.01]； 3D打印组术后并发症较常规组少OR=0.44，95%CI（0.22，0.91），P=0.03]；以上指标的差异均具有统计学意义。结论 3D打印辅助TKA比常规TKA的短期临床效果更好，明显提高手术的有效率、术后力线精准度，改善术后膝关节功能，无明显不良反应，值得广泛推广。

Meta-analysis of clinical efficacy of total knee arthroplasty assisted by 3D printing technology

Objective To compare the clinical efficacy of 3D-print-assisted total knee arthroplasty with that of traditional total knee arthroplasty using meta-analysis. Methods Randomized controlled trials comparing the clinical efficacy of 3D print-assisted total knee replacement (TKA)and conventional TKA with a published expiration date of February 2021 were retrieved through PubMed, Embase, Cochrane Library, CNKI, Wanfang Medical Database and other electronic journal databases. The literatures were screened in strict accordance with the inclusion criteria and exclusion criteria, and the quality evaluation was carried out. The data were extracted, and the Meta-analysis was performed on the extracted data using the Revman 5.3 software. The odds ratio (OR) and 95% confidence interval (CI) were evaluated for binary variables, and the standard mean difference (SMD) and 95% interval (CI) were calculated for continuous variables. The statistical results were reviewed. Results A total of 39 literatures including 2 443 patients were included, including 1 209 cases in the 3D printing group and 1 234 cases in the routine group. The results of meta-analysis of each index in the two groups were as follows: The operation timeSMD=-17.87, 95%CI (-25.75, -10.00), P<0.00001] and the amount of intraoperative blood lossSMD=-123.65, 95%CI (-182.92, -64.38), P<0.0001] of the 3D printing group was less than that of the conventional group. The postoperative KSS score of the 3D printing group was higher than that of the conventional group SMD=2.83, 95%CI (0.70, 4.96), P=0.009]. The postoperative VAS score of the 3D printing group was lower than that of the conventional group SMD=-0.36, 95%CI(-0.64, -0.08), P=0.01]. The hip, knee and ankle angle (HKA) of the 3D printing group was more accurate than that of the conventional group, and the surgical accuracy was improved SMD=1.03, 95%CI (0.11, 1.95),P=0.03]. The 3D printing group had lower postoperative aMFTA than the conventional group, and improved the surgical accuracySMD=-0.84, 95%CI (-1.30, -0.37), P=0.0004]. ALDFA was higher in the 3D printing group than in the conventional group, and the surgical accuracy was improved SMD=0.69, 95%CI (0.16, 1.22), P=0.01]. Postoperative complications in the 3D printing group were less than those in the conventional group OR=0.44, 95%CI(0.22, 0.91), P=0.03]. The differences of the above indicators were statistically significant. Conclusion Compared with conventional total knee arthroplasty, 3D printing assisted total knee arthroplasty has better short-term clinical effect, significantly improves the effective rate of surgery,increases the accuracy of postoperative force line, improves postoperative knee joint function, and has no obvious adverse reactions. Therefore, it is worthy of extensive promotion.