Baraza Njalalle, Chapman Chris, Zakani Sima, Mulpuri Kishore
Department of Orthopaedic Surgery, BC Children's Hospital, 1D.66-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya.
3D Print Med. 2020 Nov 10;6(1):34. doi: 10.1186/s41205-020-00087-0.
The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons.
A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research question: "What is the clinical impact of using 3D printed PSI for proximal femoral or pelvic osteotomy in paediatric orthopaedics?" Two reviewers, using predetermined inclusion criteria, independently performed title and abstract review in order to select articles for full text review. Data extracted included effect on operating time and intraoperative image use, as well as osteotomy and screw positioning accuracy. Data were combined in a narrative synthesis; meta-analysis was not performed given the diversity of study designs and interventions.
In total, ten studies were included: six case control studies, three case series and a case report. Five studies directly compared operating time using PSI to conventional techniques, with two showing a significant decrease in the number of intraoperative images and operative time. Eight studies reported improved accuracy in executing the surgical plan compared to conventional methods.
Compared to conventional methods of performing femoral or pelvic osteotomy, use of PSI has led to improved accuracy and precision, decreased procedure times, and decreased intra-operative imaging requirements. Additionally, the technology has become more cost effective and accessible since its initial inception and use.
儿科患者群体在解剖结构上存在很大差异。基于计算机断层扫描（CT）的数字模型用于设计三维打印的患者特异性器械（PSI），最近已应用于骨科手术中的畸形矫正。本综述旨在确定该技术目前在小儿骨科中的现有应用，并评估其可能为患者和外科医生带来的潜在益处。
对MEDLINE、EMBASE和CENTRAL数据库中的已发表文献进行综述，并对Web of Science和clinicaltrials.gov数据库中的灰色文献进行检索。搜索策略围绕研究问题展开：“在小儿骨科中使用3D打印的PSI进行股骨近端或骨盆截骨术的临床影响是什么？”两名评审员根据预先确定的纳入标准，独立进行标题和摘要评审，以选择进行全文评审的文章。提取的数据包括对手术时间和术中图像使用的影响，以及截骨术和螺钉定位的准确性。数据采用叙述性综合分析；鉴于研究设计和干预措施的多样性，未进行荟萃分析。
总共纳入了十项研究：六项病例对照研究、三项病例系列研究和一项病例报告。五项研究直接比较了使用PSI与传统技术的手术时间，其中两项研究显示术中图像数量和手术时间显著减少。八项研究报告称，与传统方法相比，执行手术计划的准确性有所提高。
与传统的股骨或骨盆截骨术方法相比，使用PSI提高了准确性和精确性，缩短了手术时间，并减少了术中成像需求。此外，自该技术最初出现和使用以来，其成本效益更高，也更容易获得。
