| Purpose:(1)To evaluate the application and complications of 3D printing-assisted surgery and traditional surgery in the treatment of Schatzker Ⅳ～Ⅵ type tibial plateau fractures by Meta analysis.(2)Explore the effectiveness and multi-factor analysis of function evaluation of ellipse fitting measurement method based on Taylor spatial frame,compared with the open reduction and internal fixation,to correct the deformities of the tibial plateau fracture exactly.Methods:(1)Pub Med,Cochrane Library,Web of Science,CNKI,CBM,Wan Fang and other Chinese and foreign databases were systematically searched by computer until December 2019.Two researchers independently screened,evaluated and extracted the included literature,and statistically analyzed the included literature using Stata 15.0 software.(2)A retrospective review was conducted on the clinical data of 30 patients who had tibial plateau treated with Taylor external fixation and ORIF in department of orthopedic trauma of Tianjiin Hospital from May 2016 to December 2019.15 cases of Taylor spatial frame treatment as the experimental group,15 patients treated by open reduction and internal fixation for the control group.The operative time,bleeding volume,times of intraoperative fluroscopy,mean healing time,knee flexion angle,AKSS score,HSS score,The medial tibial plateau angle、the posterior tibial slope,the femoral tibial angle and the mechanical axis deviation of lower extremity were analyzed and compared in the two groups.Multi-factor linear regression was used to analyze the influence of radiological data on HSS score and AKSS score.Result:(1)A total of 15 Chinese literatures were included,including a toal of 758 patients,of which 342 underwent surgery assisted by 3D printing technology,416 underwent traditional surgical treatment.The results of meta-analysis showed:operation time in the 3D printing group[SMD=-2.023;95%CI=-2.418 ～-1.628,P<0.05],operative blood loss[SMD=-1.981;95%CI=-2.489 ～-1.474,P<0.05],intraoperative fluoroscopy [ SMD=-3.183;95%CI=-5.758 ～-0.608,P<0.05 ],fracture healing time[SMD=-0.797;95%CI=-1.504 ～-0.090,P <0.05],complication rate[RR=0.383;95%CI= 0.215 ～ 0.680,P <0.05]were significantly lower than thetraditional group,In the 3D printing group,the HSS 6m score was [ RR=0.779;95%CI= 0.510 ～ 1.048,P <0.05],the HSS 12 m score was[RR=0.603;95%CI=0.334 ～ 0.871,P <0.05],the excellent and good rate of HSS[RR=1.206;95%CI=1.092 ～ 1.331,P <0.05],and the excellent and good rate of Rasmussen[RR=1.178;95%CI= 1.037 ～ 1.338,P <0.05]were significantly better than the traditional group.(2)All patients were completely follow-up,with an average follow-up time of 13.3months,two groups of operation time(97.6min±8.89vs142.8min±7.64),blood loss(160.13ml±7.11vs305.87ml±11.84),intraoperative fluoroscopy times operation(7.93times±1.95vs16times±2.07),the average healing time(4.1m±0.30vs4.61m±0.24)compared with significant statistical significance,and TSF group of operation time,surgical blood loss,intraoperative fluoroscopy times and the average healing time was significantly lower than internal fixation group(P<0.05).the total complication rate was 26.7%.The medial proximal tibia angle(87.33°±1.60vs88.61°±1.86),posterior tibial slope(8.79°±2.53vs12.14°±2.71),femorotibial angle(175.67°±3.46vs171.74°±3.01)and mechanical axis deviation(28.07%±12.45vs44.4%±17.84)were significantly different between the two groups(P<0.05).There were no statistically significant differences in knee flexion(127.13°±6.21vs124.6°±6.85,P=0.68),HSS score(86.47±8.17vs81.93±9.33),AKSS score(85±6.36 vs 81.4±7.64)and grade scores between the two groups(P<0.05).The proximal medial tibial angle(P=0.001)and the posterior tibial inclination angle(P=0.017)were negatively correlated with the AKSS function score in the TSF group.Conclusion:(1)Schatzker type Ⅳ ～ Ⅵ tibial plateau fracture surgery in the 3D printing technology can shorten the operation time,less surgical blood loss,fewer complications,less intraoperative fluoroscopy,the advantages of the fracture healing fast can improve the precision of tibial plateau fractures and the postoperative knee function recovery.(2)The treatment of tibial plateau fracture with ellipse fitting measurement method based on Taylor spatial frame has lower operation time,less blood loss,fewer fluoroscopy times and average healing time,fewer complications,higher postoperative imaging evaluation and functional score. |
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