Xiao Lin, Tang Peiyuan, Yang Shengwu, Su Jingyue, Ma Wenbo, Tan Han, Zhu Ying, Xiao Wenfeng, Wen Ting, Li Yusheng, Liu Shuguang, Deng Zhenhan
Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Xiangya School of Medicine, Central South University, Changsha, China.
J Orthop Traumatol. 2025 Jan 22;26(1):3. doi: 10.1186/s10195-025-00819-0.
The objective of this review is to evaluate the methodological quality of meta-analyses and observe the consistency of the evidence they generated to provide comprehensive and reliable evidence for the clinical use of three-dimensional (3D) printing in surgical treatment of fracture.
We searched three databases (PubMed, Embase, and Web of Science) up until August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were adhered to in this review. The Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 was used to rate the quality and reliability of the meta-analyses (MAs), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to grade the outcomes. Furthermore, Graphical Representation of Overlap for Overviews (GROOVE) was employed to examine overlap, and the resulting evidence was categorized into four groups according to established criteria for evidence classification.
Results from 14 meta-analyses were combined. AMSTAR 2 gave six meta-analyses a high rating, six MAs a moderate rating, and two MAs a low rating. Three-dimensional printing shows promising results in fracture surgical treatment, significantly reducing operation time and loss of blood for tibial plateau fracture. For acetabular fracture, apart from the positive effects on operation time (ratio of mean (ROM) = 0.74, 95% confidence interval (CI), 0.66-0.83, I = 93%) and blood loss (ROM = 0.71, 95% CI 0.63-0.81, I = 71%), 3D printing helps reduce postoperative complications (odds ratio (OR) = 0.42, 95% CI, 0.22-0.78, I = 9%). For proximal humerus fracture, 3D printing helps shorten operation time (weighted mean difference (WMD) = -19.49; 95% CI -26.95 to -12.03; p < 0.05; I = 91%), reduce blood loss (WMD = -46.49; 95% CI -76.01 to -16.97; p < 0.05; I = 98%), and get higher Neer score that includes evaluation of pain, function, range of motion, and anatomical positioning (WMD = 9.57; 95% CI 8.11 to 11.04; p < 0.05; I = 64%). Additionally, positive results are also indicated for other fractures, especially for operation time, blood loss, and postoperative complications.
Compared with traditional fracture surgical treatment, 3D-printing-assisted surgery has significant advantages and great effectiveness in terms of operation time, loss of blood, and postoperative complications in the treatment of many different types of fractures, with less harm to patients.
本综述的目的是评估Meta分析的方法学质量，并观察其产生的证据的一致性，以为三维（3D）打印在骨折手术治疗中的临床应用提供全面可靠的证据。
截至2024年8月，我们检索了三个数据库（PubMed、Embase和Web of Science）。本综述遵循系统评价和Meta分析的首选报告项目（PRISMA）标准。使用系统评价评估测量工具（AMSTAR）2对Meta分析（MAs）的质量和可靠性进行评分，并使用推荐分级评估、制定和评价（GRADE）对结果进行分级。此外，采用概述重叠的图形表示（GROOVE）来检查重叠情况，并根据既定的证据分类标准将所得证据分为四组。
合并了14项Meta分析的结果。AMSTAR 2给六项Meta分析评为高分，六项MAs评为中等分，两项MAs评为低分。3D打印在骨折手术治疗中显示出有前景的结果，显著减少了胫骨平台骨折的手术时间和失血量。对于髋臼骨折，除了对手术时间（平均比值（ROM）=0.74，95%置信区间（CI），0.66 - 0.83，I=93%）和失血量（ROM = 0.71，95% CI 0.63 - 0.81，I = 71%）有积极影响外，3D打印有助于减少术后并发症（比值比（OR）=0.42，95% CI，0.22 - 0.78，I = 9%）。对于肱骨近端骨折，3D打印有助于缩短手术时间（加权平均差（WMD）=-19.49；95% CI -26.95至-12.03；p<0.05；I = 91%），减少失血量（WMD=-46.49；95% CI -76.01至-16.97；p<0.05；I = 98%），并获得更高的Neer评分，该评分包括对疼痛、功能、活动范围和解剖定位的评估（WMD = 9.57；95% CI 8.11至11.04；p<0.05；I = 64%）。此外，对于其他骨折也显示出积极结果，特别是在手术时间、失血量和术后并发症方面。
与传统骨折手术治疗相比，3D打印辅助手术在治疗多种不同类型骨折的手术时间、失血量和术后并发症方面具有显著优势和良好效果，对患者的伤害较小。
