Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1737-1749. doi: 10.1007/s00068-021-01773-2. Epub 2021 Aug 31.
The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities.
A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan.
Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: '3D virtual visualization', '3D printed hand-held fracture models', 'Pre-contouring of osteosynthesis plates', '3D printed surgical guides', and 'Intra-operative 3D imaging'. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23).
Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.
本系统评价旨在概述 3D 技术在胫骨平台骨折手术治疗中的当前应用，并评估与基于传统影像学的手术相比，3D 辅助手术是否能带来更好的临床结果。
在 Pubmed 和 Embase 上进行文献检索，以获取报告 3D 技术在胫骨平台骨折手术治疗中应用的文章。本系统评价是按照 PRISMA 指南进行的。根据 McMaster 批判性评估指南，评估了方法学质量和偏倚风险。使用 RevMan 中的逆方差加权法评估 3D 辅助手术和传统手术之间在手术时间、失血量、透视频率、术中修正率和患者报告的结果方面的差异。
共纳入 20 项评估 948 例 3D 辅助手术治疗和 126 例传统手术治疗患者的研究。确定了 5 种不同的 3D 辅助手术概念：“3D 虚拟可视化”、“3D 打印手持骨折模型”、“预塑形接骨板”、“3D 打印手术导板”和“术中 3D 成像”。3D 辅助手术可缩短手术时间（104.7 分钟 vs. 126.4 分钟；P<0.01）、减少失血量（241 毫升 vs. 306 毫升；P<0.01）、减少透视频率（5.8 次 vs. 9.1 次；P<0.01）。在功能结果方面没有差异（特种外科医院膝关节评分：88.6 分 vs. 82.8 分；P=0.23）。
过去十年中出现了 5 种 3D 辅助胫骨平台骨折手术管理的概念。这些概念包括 3D 虚拟骨折可视化、用于手术计划的 3D 打印手持骨折模型、用于预塑形接骨板的 3D 打印模型、3D 打印手术导板和术中 3D 成像。3D 辅助手术可能对手术时间、失血量和透视频率有积极影响。
