Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-08-12 DOI:10.1002/jeo2.12096

Silvan Hess, Julius Husarek, Martin Müller, Sophie C. Eberlein, Frank M. Klenke, Andreas Hecker

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Abstract

Background

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.

Methods

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).

Results

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.

Conclusion

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 of Evidence

Level 3 (meta-analysis including Level 3 studies).

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三维打印手术导板在创伤学和骨科手术中的应用和准确性：系统综述与荟萃分析。

背景：患者特异性手术指南（PSSG）被认为可以减少手术辐射、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的手术，对于不同解剖部位、三维（3D）打印技术和制造商（传统与在护理点打印）之间的准确性差异还存在不确定性。本研究旨在评估 PSSGs 在创伤学和骨科手术中的准确性，同时考虑到解剖区域、打印方法和制造商：方法：按照《系统综述和元分析首选报告项目》指南进行了系统综述。符合以下条件的研究均可：（1）通过比较至少两个不同平面的术前计划和术后结果来评估 PSSG 的准确性；（2）使用计算机断层扫描或磁共振成像；（3）涵盖矫形外科或创伤学领域；（4）使用英语或德语。方法学质量评估采用 "定量研究质量评估工具"。报告中提供了描述性统计数字，包括平均值、标准差和范围。随机效应荟萃分析确定了每个解剖区域（肩部、髋部、脊柱和膝部）术前计划与术后结果之间的汇总平均绝对偏差：在 4212 项初步符合条件的研究中，有 33 项被纳入最终分析（肩关节 8 项、髋关节 5 项、脊柱 5 项、膝关节 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（脊柱切除术中椎弓根螺钉置入）的汇总平均偏差（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和THA之间以及TKA和TSA之间的准确性各不相同：结论：PSSG 的准确性取决于手术类型，但平均偏离计划约 2-3°。某些复杂病例可考虑使用PSSG：3级（包括3级研究的荟萃分析）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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