Eraly Koen, Stoffelen Danny, Vander Sloten Jos, Jonkers Ilse, Debeer Philippe
Department of Mechanical Engineering, Katholieke Universiteit Leuven, Heverlee, Belgium; R&D Department, Mobelife, Heverlee, Belgium.
Orthopaedics, GasthuisZusters Antwerpen (GZA) St Augustinus Hospital, Wilrijk, Belgium.
J Shoulder Elbow Surg. 2016 May;25(5):837-45. doi: 10.1016/j.jse.2015.09.034. Epub 2015 Dec 15.
Glenoid component and screw malpositioning in cases of severe glenoid defects might result in complications. We examined the efficacy of a surgical method to treat severe glenoid defects, including a custom-made glenoid component and accurate screw positioning, using a patient-specific positioning guide.
Glenoid defects were created in 10 cadaveric shoulders. Computed tomography images were used to plan reversed shoulder arthroplasty and design patient-specific glenoid components. A patient-specific positioning guide was designed for 5 specimens. The remaining 5 specimens were implanted without the guide. Computed tomography images were used to determine the postoperative glenoid component and screw positions. Differences from the preoperatively planned implant and screw positions were calculated.
The patient-specific positioning guide significantly reduced the angular deviations from the planned glenoid implant positioning (P < .05) and also significantly improved the positioning of the screws (P < .001). In the group without the guide, the average total intraosseous screw length was 52% of the ideal preoperatively planned length compared with 89% for the group with the guide. A strong correlation (r = -0.85) was found between the orientation of the implant and the postoperative total intraosseous screw length.
A patient-specific positioning guide significantly improves the position and fixation of a custom-made glenoid component in cases of severe glenoid defects.
在严重肩胛盂缺损的病例中，肩胛盂假体组件和螺钉位置不当可能会导致并发症。我们使用患者特异性定位导向器，研究了一种治疗严重肩胛盂缺损的手术方法的疗效，该方法包括定制肩胛盂假体组件和精确的螺钉定位。
在10具尸体肩部制造肩胛盂缺损。使用计算机断层扫描图像规划反肩置换术并设计患者特异性肩胛盂假体组件。为5个标本设计了患者特异性定位导向器。其余5个标本在不使用导向器的情况下植入。使用计算机断层扫描图像确定术后肩胛盂假体组件和螺钉位置。计算与术前规划的植入物和螺钉位置的差异。
患者特异性定位导向器显著降低了与计划的肩胛盂植入物定位的角度偏差（P < 0.05），并且还显著改善了螺钉的定位（P < 0.001）。在没有导向器的组中，平均骨内螺钉总长度为术前计划理想长度的52%，而使用导向器的组为89%。在植入物的方向与术后骨内螺钉总长度之间发现了强相关性（r = -0.85）。
在严重肩胛盂缺损的病例中，患者特异性定位导向器显著改善了定制肩胛盂假体组件的位置和固定。
