Al-Saadawi A, Tehranchi S, Chekuri R, Oehlen A, Sedra F
School of Medicine, Faculty of Medicine and Dentistry, Queen Mary University of London, London, England.
Department of Trauma and Orthopaedic Surgery, Barts Health NHS Trust, Royal London Hospital, London, E11BB, England.
Musculoskelet Surg. 2025 Jan 12. doi: 10.1007/s12306-024-00879-1.
3D-printed (3DP) drill guides have demonstrated significant potential to accurately guide pedicle screw insertion in spinal surgery. However, their role in the upper cervical spine is not well established. This review aimed to compare the efficacy and safety of 3DP drill guides to the conventional fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine. A comprehensive literature search was conducted across five databases (Medline, Scopus, CENTRAL, Web of Science, and Embase). The meta-analysis compared the accuracy of pedicle screw placement, screw placement time, operative time, blood loss, fluoroscopy usage, and post-operative JOA and VAS scores between the two approaches. Seven studies were included in the review, encompassing 386 patients and 1,512 screws. The meta-analysis demonstrated that 3DP drill guides increased the rate of perfect screw insertion (OR: 4.34, P < 0.00001) and lowered the incidence of moderate (OR: 0.26, P < 0.00001) and poor (OR: 0.09, P < 0.00001) screw insertion compared to the free-hand technique. Additionally, operative time (MD: -36.07, P < 0.00001), blood loss (MD: -83.82, P < 0.00001), and fluoroscopy usage (MD: -3.47, P < 0.0001) was significantly reduced in the 3DP cohort. No significant difference was detected in screw placement time (MD: -2.65, P = 0.07), or post-operative JOA (MD: 0.17, P = 0.47), and VAS (MD: -0.09, P = 0.19) scores between the two cohorts. The review demonstrated that 3DP drill guides are a safe and effective tool to assist pedicle screw fixation in the upper cervical spine.
3D打印（3DP）钻孔导向器已显示出在脊柱手术中精确引导椎弓根螺钉植入的巨大潜力。然而，它们在上颈椎中的作用尚未完全确立。本综述旨在比较3DP钻孔导向器与传统透视引导徒手技术在上颈椎椎弓根螺钉植入中的疗效和安全性。对五个数据库（Medline、Scopus、CENTRAL、Web of Science和Embase）进行了全面的文献检索。荟萃分析比较了两种方法之间椎弓根螺钉置入的准确性、螺钉置入时间、手术时间、失血量、透视使用情况以及术后JOA和VAS评分。该综述纳入了七项研究，涵盖386例患者和1512枚螺钉。荟萃分析表明，与徒手技术相比，3DP钻孔导向器提高了完美螺钉植入率（OR：4.34，P＜0.00001），并降低了中等（OR：0.26，P＜0.00001）和差（OR：0.09，P＜0.00001）螺钉植入的发生率。此外，3DP队列的手术时间（MD：-36.07，P＜0.00001）、失血量（MD：-83.82，P＜0.00001）和透视使用情况（MD：-3.47，P＜0.0001）均显著减少。两组之间在螺钉置入时间（MD：-2.65，P = 0.07）、术后JOA（MD：0.17，P = 0.47）和VAS（MD：-0.09，P = 0.19）评分方面未检测到显著差异。该综述表明，3DP钻孔导向器是协助上颈椎椎弓根螺钉固定的一种安全有效的工具。
