SAS Clinique Louis Pasteu, 7 rue Parmentier, 54270, Essey-lès-Nancy, France.
Chirurgie des Articulations et du Sport, Centre ARTICS, 24 rue du XXIe regiment d'Aviation, 54000, Nancy, France.
Int Orthop. 2018 Dec;42(12):2897-2906. doi: 10.1007/s00264-018-4037-1. Epub 2018 Jul 2.
Glenoid loosening after total shoulder arthroplasty (TSA) is influenced by the position of the glenoid component. 3D planning software and patient-specific guides seem to improve positioning accuracy, but their respective individual application and role are yet to be defined. The aim of this study was to evaluate the accuracy of freehand implantation after 3D pre-operative planning and to compare its accuracy to that of a targeting guide.
Seventeen patients scheduled for TSA for primary glenohumeral arthritis were enrolled in this prospective study. Every patient had pre-operative planning, based on a CT scan. Glenoid component implantation was performed freehand, guided by 3D views displayed in the operating room. The position of the glenoid component was determined by manual segmentation of post-operative CT scans and compared to the planned position. The results were compared to those obtained in a previous work with the use of a patient-specific guide.
The mean error for the central point was 2.89 mm (SD ± 1.36) with the freehand method versus 2.1 mm (SD ± 0.86) with use of a targeting guide (p = 0.05). The observed difference was more significant (p = 0.03) for more severely retroverted glenoids (> 10°). The mean errors for version and inclination were respectively 4.82° (SD ± 3.12) and 4.2° (SD ± 2.14) with freehand method, compared to 4.87° (SD ± 3.61) and 4.39° (SD ± 3.36) with a targeting guide (p = 0.97 and 0.85, respectively).
3D pre-operative planning allowed accurate glenoid component positioning with a freehand method. Compared to the freehand method, patient-specific guides slightly improved the position of the central point, especially for severely retroverted glenoids, but not the orientation of the component.
全肩关节置换术后（TSA）肩盂的松动受肩盂假体位置的影响。3D 规划软件和患者专用导板似乎可以提高定位精度，但它们各自的应用和作用尚待确定。本研究旨在评估 3D 术前规划后徒手植入的准确性，并比较其与定位导板的准确性。
本前瞻性研究纳入了 17 例拟行初次全肩关节置换术治疗的原发性肩袖关节炎患者。每位患者均行 CT 扫描术前规划。通过在手术室中显示 3D 视图，徒手植入肩盂假体。术后 CT 扫描手动分割确定肩盂假体位置，并与术前规划位置进行比较。将结果与之前使用患者专用导板的研究结果进行比较。
使用徒手方法时，中心点的平均误差为 2.89mm（SD±1.36），而使用定位导板时为 2.1mm（SD±0.86）（p=0.05）。对于更严重的后倾肩盂（>10°），观察到的差异更显著（p=0.03）。使用徒手方法时，假体的倾斜角和外展角的平均误差分别为 4.82°（SD±3.12）和 4.2°（SD±2.14），而使用定位导板时为 4.87°（SD±3.61）和 4.39°（SD±3.36）（p=0.97 和 0.85）。
3D 术前规划允许使用徒手方法实现准确的肩盂假体定位。与徒手方法相比，患者专用导板略微改善了中心点的位置，尤其是对于严重后倾的肩盂，但对假体的方向没有改善。
