Łajczak Paweł, Łajczak Anna
Medical University of Silesia, Katowice, Poland.
Indian J Orthop. 2025 May 9;59(7):888-900. doi: 10.1007/s43465-025-01401-w. eCollection 2025 Jul.
Congenital scoliosis (CS) is a spinal deformity with a heterogeneous presentation, significantly affecting spinal development if untreated. Pedicle screw instrumentation is a common surgical intervention for CS, but the freehand technique often leads to inaccuracies, increasing the risk of complications. Recently, 3D-printed drill guides have emerged as a cost-effective and accurate alternative to computer-assisted navigation systems. This study systematically reviewed and compared the effectiveness of 3D-printed drill guides and the freehand technique in pedicle screw placement for children with CS.
A systematic search across five databases identified eligible studies comparing 3D-printed drill guides with freehand for pedicle screw instrumentation in CS patients. A total of three studies, involving 123 patients (60 in the 3D printing group and 63 in the freehand group), were included. Outcomes assessed included screw placement accuracy, complication rates, operation time, and surgical outcomes. Statistical analyses were conducted using a random-effects model in R software.
3D-printed drill guides demonstrated statistically significant improvements in screw placement accuracy (GR 0: OR 1.80, = 0.015; GR 0 + 1: OR 3.69, < 0.001) and reduced rates of severe screw misplacement (GR 3: OR 0.20, = 0.019). Additionally, the 3D printing group experienced significantly fewer complications (OR 0.16, = 0.02). No statistically significant differences were observed in operation time, operation time per screw, bleeding volume, or spinal curve correction outcomes between the two techniques.
3D-printed drill guides offer a superior alternative to FH techniques in improving pedicle screw accuracy and reducing complication rates for CS surgery without increasing operation time or bleeding. While promising, the limited sample size and focus on a single geographic region highlight the need for further multicenter studies to validate these findings and explore broader clinical applications.
先天性脊柱侧凸（CS）是一种表现多样的脊柱畸形，若不治疗会严重影响脊柱发育。椎弓根螺钉内固定术是治疗CS的常见手术干预方式，但徒手技术常常导致不准确，增加了并发症风险。近来，3D打印钻孔导向器已成为一种经济高效且准确的替代计算机辅助导航系统的方法。本研究系统评价并比较了3D打印钻孔导向器与徒手技术在CS患儿椎弓根螺钉置入中的有效性。
在五个数据库中进行系统检索，以确定比较3D打印钻孔导向器与徒手技术用于CS患者椎弓根螺钉内固定术的合格研究。共纳入三项研究，涉及123例患者（3D打印组60例，徒手组63例）。评估的结果包括螺钉置入准确性、并发症发生率、手术时间和手术效果。使用R软件中的随机效应模型进行统计分析。
3D打印钻孔导向器在螺钉置入准确性方面显示出统计学上的显著改善（GR 0：OR 1.80，P = 0.015；GR 0 + 1：OR 3.69，P < 0.001），并降低了严重螺钉误置率（GR 3：OR 0.20，P = 0.019）。此外，3D打印组的并发症明显更少（OR 0.16，P = 0.02）。两种技术在手术时间、每颗螺钉的手术时间、出血量或脊柱侧弯矫正效果方面未观察到统计学上的显著差异。
在提高椎弓根螺钉准确性和降低CS手术并发症发生率方面，3D打印钻孔导向器是优于徒手技术的选择，且不增加手术时间或出血量。尽管前景乐观，但样本量有限且集中于单一地理区域，这凸显了进一步开展多中心研究以验证这些发现并探索更广泛临床应用的必要性。
