打印技术辅助后路截骨治疗脊柱畸形的分析

背景：3D 打印技术在脊柱外科应用越来越广泛，有很好的辅助手术作用。但是目前缺乏循证医学证据证实3D 打印辅助后路截骨治疗脊柱畸形的疗效及安全性。

目的：系统评价3D 打印辅助后路截骨治疗脊柱畸形的疗效。

方法：计算机检索PubMed、Embase、Cochrane Library、CNKI、万方、维普和CBM 数据库自建库至2019年12月关于3D 打印治疗脊柱畸形患者的研究。英文检索词为“3D printing” “rapid prototyping” “Spinal deformity”等；中文检索词为“3D 打印”“快速成型技术”“脊柱畸形”等。由2 名研究人员独立进行文献筛选、数据提取和质量评价，采用 RevMan 5.3 软件对文献进行Meta 分析。

结果与结论：①共纳入6 篇文献，282 例患者，其中3D 打印组139 例，常规组143 例；②Meta 分析结果显示，3D 打印组在手术时间、手术出血量及手术放射暴露时间方面均小于常规组(P＜0.05)；③在Cobb 角、Cobb 角矫正率、置钉准确率及Oswestry 功能障碍指数评分方面均优于常规组(P＜0.05)；④3D 打印组和常规组在并发症方面差异无显著性意义(P＞0.05)；⑤上述数据证实，3D 打印辅助后路截骨能够明显降低手术间和手术出血量，改善手术效果。

BACKGROUND:3D printing technology was more and more widely used in spine surgery，and it had a good auxiliary surgery ，there is currently no evidence-based medical evidence to confirm the efficacy and safety of 3D printing-assisted posterior osteotomy for spinal deformities.

OBJECTIVE:To systematically evaluate the efficacy of 3D printing-assisted posterior osteotomy in the treatment of spinal deformity.

METHODS:Such databases as PubMed，Embase，Cochrane Library，CNKI，Wanfang，VIP，and CBM were searched from their inception to December 2019 for the research investigating 3D printing in the treatment of spinal and Chinese search terms were “3D printing”，“rapid prototyping”，“spinal deformity”.Literature review，data extraction，and quality evaluation were performed independently by two meta-analyses were performed using the RevMan 5.3 software.

RESULTS AND CONCLUSION:(1) Six literatures involving 282 patients were were 139 cases in the 3D printing group and 143 cases in the conventional group.(2) Meta-analysis results showed that in the 3D printing group，the operation time and surgical radiation exposure time were shorter，and intraoperative blood loss was less than in the conventional group (P＜0.05).(3) Cobb angle，Cobb angle correction rate，screw placement accuracy，and Oswestry disability index were all superior to the conventional group (P＜0.05).(4) In terms of complications，the difference was not statistically significant between the 3D printing group and conventional group (P＞0.05).(5) Above data verified that 3D printing-assisted posterior osteotomy can significantly reduce operation time and intraoperative blood loss and improve the surgical effect.

0 引言 Introduction

脊柱畸形表现为侧弯、前或后凸畸形等形式，是常见的骨科疾病，可发生于任何年龄，常见有特发性侧弯、结核导致的畸形、强直性脊柱炎导致的畸形等[1-2]。后路截骨矫形手术是目前治疗脊柱畸形的主流方法，可以获得满意的减压和畸形矫正效果，同时有利于脊柱的稳定和截骨的愈合[3-4]。但是由于脊柱解剖关系复杂，不同患者截骨节段、截骨数量及矫形度数不一样，一直困扰着脊柱外科医生[5-7]。新型技术3D打印可将虚拟的计算机辅助设计模型准确快速的转化为三维实物，为骨科手术提供了精准治疗[8]。在外伤性骨折、pilon骨折都有很好的应用，并且有循证医学依据证实其有效性[9-10]。但是目前3D打印技术辅助后路截骨治疗脊柱畸形的报道还比较少，并且尚缺乏系统评价证实其疗效及安全性。因此有必要对3D打印辅助后路截骨治疗脊柱畸形进行系统评价，为临床治疗方案提供参考。

1 资料和方法 Data and methods

1.1 检索策略 设定英文检索词为“3D printing”“rapid prototyping”“Spinal deformity”等；中文检索词为“3D打印”“快速成型技术”“脊柱畸形”等，由2名研究者分别独立在PubMed、Cochrane Library、EMBase、CNKI、万方、维普及CBM数据库进行检索，检索时间为建库至2019年12月。检索语种限制为英文和中文。

1.2 纳入与排除标准

纳入标准：根据PICOS原则筛选文献：①研究对象(patients)为脊柱畸形患者；②干预措施(intervention)为是否借助3D打印技术辅助后路截骨；③研究类型(study design)为比较3D打印模型辅助截骨与非3D打印辅助截骨的随机对照试验和非随机研究；④结局指标(outcome)包括：手术时间、手术出血量、Cobb角、Cobb角矫正率、Oswestry功能障碍指数(ODI)、手术放射暴露时间、置钉准确率和并发症。

文章来源：《中国循证医学杂志》 网址: http://www.zgxzyxzz.cn/qikandaodu/2021/0226/481.html