Hess Silvan, Husarek Julius, Müller Martin, Eberlein Sophie C, Klenke Frank M, Hecker Andreas
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital University of Bern Bern Switzerland.
Faculty of Medicine University of Bern Bern Switzerland.
J Exp Orthop. 2024 Aug 12;11(3):e12096. doi: 10.1002/jeo2.12096. eCollection 2024 Jul.
Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers.
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee).
Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA.
Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases.
Level 3 (meta-analysis including Level 3 studies).
个性化手术导板（PSSG）被提倡用于减少辐射暴露、缩短手术时间并提高手术精度。然而，现有的准确性评估仅限于特定手术，不同解剖部位、三维（3D）打印技术和制造商（传统方式与床边打印）之间的准确性差异仍存在不确定性。本研究旨在评估创伤学和骨科手术中PSSG的准确性，同时考虑解剖区域、打印方法和制造商。
按照系统评价和Meta分析的首选报告项目指南进行系统评价。纳入标准为：（1）通过比较术前规划和术后结果在至少两个不同平面评估PSSG的准确性；（2）使用计算机断层扫描或磁共振成像；（3）涵盖骨科手术或创伤学领域；（4）文献为英文或德文。采用“定量研究质量评估工具”进行方法学质量评估。给出描述性统计结果，包括均值、标准差和范围。进行随机效应Meta分析，以确定每个解剖区域（肩部、髋部、脊柱和膝部）术前规划与术后结果之间的合并平均绝对偏差。
在最初符合条件的4212项研究中，33项被纳入最终分析（肩部8项、髋部5项、脊柱5项、膝部14项、创伤1项）。全膝关节置换术（TKA）、全肩关节置换术（TSA）、全髋关节置换术（THA）和脊柱手术（腰椎融合术中椎弓根螺钉置入）的合并平均偏差（95%置信区间）分别为1.82°（1.48，2.15）、2.52°（1.9，3.13）、3.49°（3.04，3.93）和2.67°（1.64，3.69）。TKA与THA以及TKA与TSA之间的准确性存在差异。
PSSG的准确性取决于手术类型，但平均与规划的偏差约为2 - 3°。对于某些复杂病例，可考虑使用PSSG。
3级（包括3级研究的Meta分析）。
