Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
J Shoulder Elbow Surg. 2018 Oct;27(10):1792-1799. doi: 10.1016/j.jse.2018.04.013. Epub 2018 May 28.
Three-dimensional (3D) surgical planning for unlinked total elbow arthroplasty (TEA) would be helpful for estimation of the implant size and accurate placement of implants.
We included 28 patients who underwent TEA with an unlinked total elbow implant in this study. All patients underwent computed tomography scans of the elbow before surgery, and a 3D digital model of the elbow was reconstructed. After the appropriate size and position of the prosthesis were determined, 10 points around the bone tunnel (4 on the humerus and 6 on the ulna) were measured to plan the insertion of the humeral and ulnar stems. Two-dimensional planning was also performed using anteroposterior and lateral radiographs. Intraoperatively, the surgeon measured the planned parameters using a slide gauge to reproduce the 3D planned position of the stem insertion.
The stem sizes were accurately estimated in 57% of patients for the humerus and 68% for the ulna with 2-dimensional planning and in 86% for the humerus and 96% for the ulna with 3D planning. The mean differences between the positions of the prostheses after surgery with reference to the planned positions were 0.8° of varus and 1.5° of flexion for the humeral component and 0.7° of varus and 2.9° of flexion for the ulnar component. We did not evaluate rotational positioning in this study.
The 3D surgical planning allowed accurate estimation of the implant size and appropriate placement of implants. This method may contribute to a reduced incidence of complications and improved long-term outcomes from TEA.
对于非连接式全肘关节置换术（TEA），三维（3D）手术规划有助于估计植入物的大小和准确放置植入物。
我们纳入了 28 名接受非连接式全肘假体置换术的患者进行这项研究。所有患者在手术前均进行肘部 CT 扫描，并重建肘部 3D 数字模型。在确定合适的假体大小和位置后，测量骨隧道周围的 10 个点（肱骨 4 个，尺骨 6 个），以规划肱骨和尺骨柄的插入位置。还使用前后位和侧位 X 线片进行二维规划。术中，外科医生使用测隙规测量计划参数，以重现柄插入的 3D 计划位置。
在 2 维规划中，肱骨和尺骨的假体尺寸分别有 57%和 68%得到了准确估计，在 3 维规划中，肱骨和尺骨的假体尺寸分别有 86%和 96%得到了准确估计。术后与计划位置相比，假体位置的平均差异为肱骨组件 0.8°的内翻和 1.5°的屈曲，尺骨组件 0.7°的内翻和 2.9°的屈曲。我们在这项研究中未评估旋转定位。
3D 手术规划可准确估计植入物大小和适当放置植入物。这种方法可能有助于降低 TEA 的并发症发生率并改善长期结果。
