Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (12): 1959-1968.doi: 10.3969/j.issn.2095-4344.3795

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A meta-analysis of clinical efficacy of preoperative use of three-dimensional printing in the treatment of tibial plateau fractures

Li Yang, Min Shengwei, Xie Feng, Zhang Mingyong   

  1. Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, Hubei Province, China
  • Received:2020-06-15 Revised:2020-06-19 Accepted:2020-07-20 Online:2021-04-28 Published:2020-12-26
  • Contact: Zhang Mingyong, Chief physician, Master, Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, Hubei Province, China
  • About author:Li Yang, Master candidate, Physician, Department of Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, Hubei Province, China

Abstract: OBJECTIVE: Because of the complex structure around the tibial plateau and the difficulty in treatment after the occurrence of fracture, it is very helpful to understand the location and type of fracture in detail before operation. The rise of three-dimensional (3D) printing technology, the virtual data can be transformed into a solid model, so that the operator can perform surgical exercises before operation, thus improving the quality of operation. Through meta-analysis and comparison of the difference between the preoperative use of 3D printing technology and the routine operation without 3D printing technology in the treatment of tibial plateau fracture, it provides the basis for its clinical application.
METHODS: The Cochrane library, PubMed, EBSCO, cambridge science abstracts (CSA), CNKI, VIP, and Wanfang databases were searched. The retrieval was all from inception to April 30, 2020). All related articles concerning the 3D printing auxiliary operation with the 3D printing technology of conventional surgical treatment of tibial plateau fractures were collected. Through keyword search, the literature was screened according to the inclusion and exclusion criteria. The Cochrane system evaluator manual and NOS score were used to evaluate the quality of the included literature, and data were extracted. The primary outcome measures (operation time, intraoperative blood loss, fracture healing time, HSS score and excellent and good rate, Rasmussen score and excellent and good rate) and secondary outcome measures (postoperative complications, anatomic reduction rate and intraoperative fluoroscopy times) were analyzed using RevMan 5.3 software.  
RESULTS: Thirty articles with high quality were included, and the total number of cases was 1 564, including 757 in 3D printing group and 807 in routine group. The meta-analysis results showed that (1) the operation time (SMD=-2.14, 95%CI:-2.46 to -1.81, P < 0.000 01), intraoperative blood loss (SMD=-1.44, 95%CI:-1.66 to -1.23, P < 0.000 01), HSS 6 months postoperatively and last HSS score (SMD=0.68, 95%CI:0.44-0.92, P < 0.000 01; SMD=0.96, 95%CI:0.79-1.13, P < 0.000 01), Rasmussen score (SMD=2.34, 95%CI:1.68-3.00, P < 0.000 01), the excellent and good rate of HSS and Rasmussen scores (OR=3.85, 95%CI:2.33-6.36, P < 0.000 01; OR=2.96, 95%CI:1.43-6.09, P=0.003), and the anatomical reduction rate (RR=1.49, 95%CI:1.21-1.83, P=0.000 2) were better in the 3D printing group than those in the routine group. (2) Bone healing time (SMD=-1.68, 95%CI:-2.21 to -1.16, P < 0.000 01), incidence of postoperative complications (RR=0.31, 95%CI:0.20-0.49, P < 0.000 01], and number of intraoperative fluoroscopy (SMD=-1.77, 95%CI:-2.65 to -0.88, P < 0.000 01) were less in the 3D printing group than those in the routine group. 
CONCLUSION: The clinical effect and prognosis of 3D printing auxiliary surgical treatment of tibial plateau fractures were better than conventional surgery. However, it is necessary to carry out large-scale multi-center high-quality clinical trials in the future.


Key words:  , bone, tibia, tibial plateau, fracture, 3D printing, model, meta-analysis

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