Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.
Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.
J Neurol Surg A Cent Eur Neurosurg. 2023 Mar;84(2):188-197. doi: 10.1055/a-1938-0254. Epub 2022 Sep 7.
There is a lack of attention to screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between the 3D-printed navigation template technique and the freehand technique during corrective surgery for scoliosis in children and adolescents.
A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean placement time per screw, and mean times for fluoroscopy.
The seven articles analyzed in this study involved 229 patients altogether. A total of 2,805 pedicle screws were placed by the two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the freehand technique in pedicle screw placement (odds ratio [OR] =2.96; 95% confidence interval [CI]: 2.24-3.91; < 0.000) with a lower complication rate (OR = 0.21; 95% CI: 0.06-0.78; = 0.02). The operation time (mean difference [MD] = -34.37; 95% CI: -67.47 to -1.28; = 0.04) and mean placement time per screw (MD = -3.11; 95% CI: -6.13 to -0.09; = 0.04) and mean times for fluoroscopy (MD = -6.60; 95% CI: -8.66 to -4.55; < 0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the freehand technique group. In addition, the two techniques had no significant statistical difference in blood loss.
Compared with the traditional freehand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for surgical treatment of scoliosis in children and adolescents, and is worth popularizing and validating through more prospective clinical studies.
对于儿童和青少年脊柱侧弯的手术治疗，螺钉放置技术往往没有得到足够的重视。本研究旨在比较儿童和青少年脊柱侧弯矫形手术中使用 3D 打印导航模板技术和徒手技术时，椎弓根螺钉置钉的准确性和安全性。
检索了截至 2021 年 12 月，PubMed、Embase、MEDLINE、Cochrane 和 Web of Science 等数据库中有关这两种技术的相关文章。系统的荟萃分析比较了两种技术的椎弓根螺钉置钉效果，包括螺钉置钉准确性、并发症发生率、手术时间、出血量、每枚螺钉平均置钉时间和透视次数。
本研究共纳入了 7 篇文章，共计 229 例患者。共使用这两种方法放置了 2805 枚椎弓根螺钉。研究结果显示，3D 打印导航模板技术在椎弓根螺钉置钉方面比徒手技术更准确（比值比 [OR] =2.96；95%置信区间 [CI]：2.24-3.91； < 0.000），且并发症发生率更低（OR =0.21；95% CI：0.06-0.78； = 0.02）。3D 打印导航模板组的手术时间（均数差 [MD] =-34.37；95% CI：-67.47 至 -1.28； = 0.04）、每枚螺钉平均置钉时间（MD =-3.11；95% CI：-6.13 至 -0.09； = 0.04）和透视次数（MD =-6.60；95% CI：-8.66 至 -4.55； < 0.000）均显著低于徒手技术组。此外，两组在出血量方面无显著统计学差异。
与传统的徒手技术相比，3D 打印导航模板在儿童和青少年脊柱侧弯手术治疗中螺钉放置的准确性和安全性更高，是一种很有前途的技术，值得通过更多前瞻性临床研究来推广和验证。
