Ren J T, Xu C, Wang J S, Liu X L
Department of Joint Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, HeBei Province, China.
Zhonghua Wai Ke Za Zhi. 2017 Oct 1;55(10):775-781. doi: 10.3760/cma.j.issn.0529-5815.2017.10.012.
To evaluate the effects of three-dimensional printing patient-specific instrumentation(PSI) versus conventional instrumentation(CI) in the total knee arthroplasty. According to "patient-specific" , "patient-matched" , "custom" , "Instrumentation" , "Guide Instrumentation" , "cutting blocks" , "total knee arthroplasty" , "total knee replacement" , "TKA" and "TKR" , the literature on PubMed, EMbase, Cochrane library, CBM and WanFang were searched. According to the inclusion and exclusion criteria, the high quality randomized control trial (RCT) studies about three-dimensional (3D) printing patient-specific instrumentation versus conventional instrumentation in the total knee arthroplasty were collected. The post-operative limb mechanical axis outlier, the position of the components outlier, post-operative knee function, operative time, post-operative blood transfusion and complications were analyzed by RevMan 5.3 software. A total of 13 high quality RCT studies were included. The results of Meta-analysis show that there were no statistical differences in the post-operative limb mechanical axis outlier(=0.55, =0.58, 95% 0.78 to 1.56), femoral coronal component outlier(=0.38, =0.71, 95% 0.69 to 1.72), tibia coronal component outlier(=1.95, =0.05, 95% 1.00 to 3.38), femoral rotation angle outlier(=0.36, =0.72, 95% 0.49 to 1.64), post-operative knee function(=1.18, =0.24, 95% : -0.66 to 2.63), post-operative blood transfusions(=0.74, =0.46, 95% -0.10 to 0.05) and complications(=0.18, =0.86, 95% -0.07 to 0.05) between the PSI group and the CI group. But there are statistical differences in the operation time(=2.66, =0.01, 95% -15.97 to -2.41)and tibia sagittal component outlier (=3.69, =0.00, 95% 1.43 to 3.18)between the PSI group and the CI group. In the primary total knee arthroplasty the PSI is not superior over the CI for the knee without severe knee varus or valgus deformity or contracture deformity, without the deformity around the knee and without the knee bone loss and obesity. The use of PSI in the primary total knee arthroplasty are not recommend.
评估全膝关节置换术中三维打印个体化器械（PSI）与传统器械（CI）的效果。根据“个体化”“患者匹配”“定制”“器械”“导向器械”“截骨模块”“全膝关节置换术”“全膝关节置换”“TKA”和“TKR”等关键词，检索了PubMed、EMbase、Cochrane图书馆、中国生物医学文献数据库（CBM）和万方数据库中的文献。根据纳入和排除标准，收集了关于全膝关节置换术中三维（3D）打印个体化器械与传统器械的高质量随机对照试验（RCT）研究。采用RevMan 5.3软件分析术后肢体机械轴异常、假体位置异常、术后膝关节功能、手术时间、术后输血情况及并发症。共纳入13项高质量RCT研究。Meta分析结果显示，PSI组与CI组在术后肢体机械轴异常（I² = 0.55，P = 0.58，95%CI：0.78至1.56）、股骨冠状位假体异常（I² = 0.38，P = 0.71，95%CI：0.69至1.72）、胫骨冠状位假体异常（I² = 1.95，P = 0.05，95%CI：1.00至3.38）、股骨旋转角度异常（I² = 0.36，P = 0.72，95%CI：0.49至1.64）、术后膝关节功能（I² = 1.18，P = 0.24，95%CI： -0.66至2.63）、术后输血情况（I² = 0.74，P = 0.46，95%CI： -0.10至0.05）及并发症（I² = 0.18，P = 0.86，95%CI： -0.07至0.05）方面无统计学差异。但PSI组与CI组在手术时间（I² = 2.66，P = 0.01，95%CI： -15.97至 -2.41）和胫骨矢状位假体异常（I² = 3.69，P = 0.00，95%CI：1.43至3.18）方面存在统计学差异。在初次全膝关节置换术中，对于无严重膝内翻或膝外翻畸形、挛缩畸形，膝关节周围无畸形，无膝关节骨丢失及肥胖的患者，PSI并不优于CI。不推荐在初次全膝关节置换术中使用PSI。
