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三维肩胛盂假体模板的可靠性及其与术中假体选择的相关性

Reliability of 3-Dimensional Glenoid Component Templating and Correlation to Intraoperative Component Selection.

作者信息

Saifi Comron, Noticewala Manish N, Greiwe R Michael, Lester Jonathan D, Gardner Thomas R, Cadet Edwin, Levine William N, Bigliani Louis U, Ahmad Christopher S

机构信息

Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY.

出版信息

Am J Orthop (Belle Mead NJ). 2017 Sep/Oct;46(5):E280-E292.

Abstract

Although implant-specific intraoperative targeting devices for glenoid sizing exist, a validated method for preoperatively templating glenoid component size in primary total shoulder arthroplasty (TSA) based on digital imaging does not. We conducted a study to determine if 3-dimensional (3-D) digital imaging could be used for preoperative templating of glenoid component size and to compare templated glenoid sizes with implanted glenoid sizes. We created 3-D digital models from 3 glenoid component implant sizes and preoperative scapular computed tomography scans of 24 patients who underwent primary TSA. In study arm 1, surgeons templated the 3-D components using only 2 df (superior-inferior and anterior-posterior planes). In study arm 2, surgeons templated the 3-D components using 6 df (superior-inferior, anterior-posterior, and rotational planes). Overall intraobserver agreement was substantial (0.67) in study arm 1 (P < .001) and moderate (0.58) in study arm 2 (P < .001). In arm 1, overall interobserver agreement was fair (0.36) for trial 1 (P < .001) and fair (0.32) for trial 2 (P < .001). In arm 2, overall interobserver agreement was moderate (0.54) for trial 1 (P < .001) and moderate (0.43) for trial 2 (P < .001). In both arms, surgeons tended to template glenoid components smaller than those implanted intraoperatively, particularly for female patients. Our findings show that 3-D digital models can be consistently and reliably used for preoperative templating of glenoid com-ponent size.

摘要

尽管存在用于关节盂尺寸测量的特定植入物术中靶向装置,但在初次全肩关节置换术(TSA)中,基于数字成像对关节盂假体尺寸进行术前模板化的有效方法却不存在。我们进行了一项研究,以确定三维(3-D)数字成像是否可用于关节盂假体尺寸的术前模板化,并将模板化的关节盂尺寸与植入的关节盂尺寸进行比较。我们根据3种关节盂假体植入尺寸以及24例行初次TSA患者的术前肩胛部计算机断层扫描创建了3-D数字模型。在研究组1中,外科医生仅使用2个维度(上下和前后平面)对3-D组件进行模板化。在研究组2中,外科医生使用6个维度(上下、前后和旋转平面)对3-D组件进行模板化。研究组1中,观察者内总体一致性较高(0.67)(P <.001),研究组2中为中等(0.58)(P <.001)。在第1组中,观察者间总体一致性在试验1中为一般(0.36)(P <.001),在试验2中为一般(0.32)(P <.001)。在第2组中,观察者间总体一致性在试验1中为中等(0.54)(P <.001),在试验2中为中等(0.43)(P <.001)。在两组中,外科医生倾向于将关节盂组件模板化得比术中植入的组件小,尤其是女性患者。我们的研究结果表明,3-D数字模型可一致且可靠地用于关节盂组件尺寸的术前模板化。

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