Medical Research Department, Artanim Foundation, 40 chemin du Grand-Puits, 1217, Meyrin, Switzerland.
Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland.
Int J Comput Assist Radiol Surg. 2018 Dec;13(12):2009-2019. doi: 10.1007/s11548-018-1707-9. Epub 2018 Feb 9.
We present a computer-assisted planning solution "ArthroPlanner" for acromioplasty based on 3D anatomical models, computed tomography and joint kinematic simulations.
In addition to a standard static clinical evaluation (anamnesis, radiological examination), the software provides a dynamic assessment of the shoulder joint by computing in real time the joint kinematics from a database of activities of daily living. During motion, the precise bone resection (location and amount) is computed based on detected subacromial impingements, providing surgeons with precise information about the surgical procedure. Moreover, to improve the subjective reading of medical images, the software provides 3D measurement tools based on anatomical models assisting in the analysis of shoulder morphological features.
We performed an in vivo assessment of the software in a prospective randomized clinical study conducted with 27 patients beneficiating from the planning solution and a control group of 31 patients without planning. Postoperatively, patient's pain decreased, and the shoulder range of motion and the functional outcomes improved significantly and the rotator cuff healing rate was good for both groups without intergroup differences. The amount of bone resected at surgery was comparable between the groups. The percentage of remaining impingement after surgery was in average reduced to 51% without groups difference.
ArthroPlanner software includes all required materials (images data, 3D models, motion, morphological measurements, etc.) to improve orthopedists' performance in the surgical planning of acromioplasty. The solution offers a perfect analysis of the patient's anatomy and the ability to precisely analyze a dynamic mechanism to fully apprehend the patient's condition and to fulfill his/her expectations. The study however failed to detect any statistically significant difference in clinical outcomes and bone resection between the groups. Short-term clinical and radiological results were excellent in both groups.
我们提出了一种基于 3D 解剖模型、计算机断层扫描和关节运动学模拟的计算机辅助肩峰成形术规划方案“ArthroPlanner”。
除了标准的静态临床评估（病史、影像学检查）外，该软件还通过计算日常生活活动数据库中的关节运动学，对肩关节进行动态评估。在运动过程中，根据检测到的肩峰下撞击情况，精确计算出骨切除的位置和数量，为外科医生提供有关手术过程的精确信息。此外，为了改善医学图像的主观解读，该软件提供了基于解剖模型的 3D 测量工具，辅助分析肩部形态特征。
我们在一项前瞻性随机临床试验中对该软件进行了体内评估，该试验纳入了 27 例受益于规划方案的患者和 31 例无规划的对照组患者。术后，患者疼痛减轻，肩关节活动范围和功能结局显著改善，两组患者的肩袖愈合率均良好，无组间差异。手术中切除的骨量在两组之间具有可比性。术后残留撞击的比例平均降低至 51%，两组之间无差异。
ArthroPlanner 软件包含了改善骨科医生在肩峰成形术手术规划方面表现所需的所有材料（图像数据、3D 模型、运动、形态测量等）。该方案提供了对患者解剖结构的完美分析，并能够精确分析动态机制，以充分了解患者的病情并满足其期望。然而，该研究未能检测到两组患者在临床结果和骨切除方面存在任何统计学显著差异。两组患者的短期临床和影像学结果均极佳。
