Raghoebar Iva Ilse, Dubois Leander, de Lange Jan, Schepers Tim, Don Griot Peter, Essig Harald, Rozema Frederik
Academic Center for Dentistry (ACTA), University of Amsterdam, 1012 WX Amsterdam, The Netherlands.
Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2023 Jul 13;12(14):4661. doi: 10.3390/jcm12144661.
To assess the difference between preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates for the treatment of skeletal fractures in terms of anatomical reduction, operation time, approach, patient outcomes, and complications.
MEDLINE (1950 to February 2023), EMBASE (1966 to February 2023), and the Cochrane Central Register of Controlled Trials (inception to February 2023) databases were searched. Eligible studies were randomised clinical trials, prospective controlled clinical trials, and prospective and retrospective cohort studies ( ≥ 10). Inclusion criteria were studies reporting the outcomes of preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates after treating skeletal fractures. Outcome measures included anatomical reduction, stability, operation time, hospitalisation days, patients' outcomes, and complications. Two independent reviewers assessed the abstracts and analysed the complete texts and methodologies of the included studies.
In total, 21 out of the 5181 primarily selected articles matched the inclusion criteria. A meta-analysis revealed a significant difference in operation time in favour of the preformed anatomical plates and patient-specific implants versus conventional plates. Significant differences in operation time were found for the orbital (95% CI: -50.70-7.49, = 0.008), upper limb (95% CI: -17.91-6.13, < 0.0001), and lower limb extremity groups (95% CI: -20.40-15.11, < 0.00001). The mean difference in the rate of anatomical reduction in the lower limb extremity group (95% CI: 1.04-7.62, = 0.04) was also in favour of using preformed anatomical plates and patient-specific implants versus conventional plates.
This systematic review showed a significant mean difference in surgery time favouring the use of preformed anatomical plates and patient-specific implants for orbital, upper, and lower limb extremity fractures. Additionally, preformed anatomical plates and patient-specific implants in the lower limb group result in a significantly higher rate of anatomical reduction versus conventional flat plates.
评估预制解剖形状接骨板和定制植入物与传统平板接骨板在治疗骨骼骨折方面，在解剖复位、手术时间、手术入路、患者预后及并发症方面的差异。
检索MEDLINE（1950年至2023年2月）、EMBASE（1966年至2023年2月）和Cochrane对照试验中央注册库（建库至2023年2月）数据库。符合条件的研究为随机临床试验、前瞻性对照临床试验以及前瞻性和回顾性队列研究（≥10例）。纳入标准为报告预制解剖形状接骨板和定制植入物与传统平板接骨板治疗骨骼骨折后结局的研究。结局指标包括解剖复位、稳定性、手术时间、住院天数、患者预后及并发症。两名独立 reviewer 评估摘要并分析纳入研究的全文及方法。
在5181篇初步筛选的文章中，共有21篇符合纳入标准。一项荟萃分析显示，与传统接骨板相比，预制解剖接骨板和定制植入物在手术时间上存在显著差异，且更具优势。在眼眶（95%CI：-50.70 - 7.49，P = 0.008）、上肢（95%CI：-17.91 - 6.13，P < 0.0001）和下肢组（95%CI：-20.40 - 15.11，P < 0.00001）中发现手术时间存在显著差异。下肢组解剖复位率的平均差异（95%CI：1.04 - 7.62，P = 0.04）也表明，与传统平板接骨板相比，使用预制解剖接骨板和定制植入物更具优势。
本系统评价显示，在眼眶、上肢和下肢骨折的手术时间上，使用预制解剖接骨板和定制植入物具有显著的平均差异优势。此外，下肢组中预制解剖接骨板和定制植入物的解剖复位率明显高于传统平板接骨板。
