Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, Clermont Ferrand, France.
Université Clermont Auvergne, SIGMA Clermont CNRS, UMR 6296, Clermont-Ferrand, France.
PLoS One. 2018 Aug 22;13(8):e0201759. doi: 10.1371/journal.pone.0201759. eCollection 2018.
Total Shoulder Arthroplasty (TSA) anatomical, reverse or both is an increasingly popular procedure but the glenoid component is still a weak element, accounting for 30-50% of mechanical complications and contributing to the revision burden. Component mal-positioning is one of the main aetiological factors in glenoid failure and thus Patient-Specific Instrumentation (PSI) has been introduced in an effort to optimise implant placement. The aim of this systematic literature review and meta-analysis is to compare the success of PSI and Standard Instrumentation (STDI) methods in reproducing pre-operative surgical planning of glenoid component positioning.
A search (restricted to English language) was conducted in November 2017 on MEDLINE, the Cochrane Library, EMBASE and ClinicalTrials.gov. Using the search terms "Patient-Specific Instrumentation (PSI)", "custom guide", "shoulder", "glenoid" and "arthroplasty", 42 studies were identified. The main exclusion criteria were: no CT-scan analysis results; studies done on plastic bone; and use of a reusable or generic guide. Eligible studies evaluated final deviations from the planning for version, inclination, entry point and rotation. Reviewers worked independently to extract data and assess the risk of bias on the same studies.
The final analysis included 12 studies, comprising 227 participants (seven studies on 103 humans and five studies on 124 cadaveric specimens). Heterogeneity was moderate or high for all parameters. Deviations from the pre-operative planning for version (p<0.01), inclination (p<0.01) and entry point (p = 0.02) were significantly lower with the PSI than with the STDI, but not for rotation (p = 0.49). Accuracy (deviation from planning) with PSI was about 1.88° to 4.96°, depending on the parameter. The number of component outliers (>10° of deviation or 4mm) were significantly higher with STDI than with PSI (68.6% vs 15.3% (p = 0.01)).
This review supports the idea that PSI enhances glenoid component positioning, especially a decrease in the number of outliers. However, the findings are not definitive and further validation is required. It should be noted that no randomised clinical studies are available to confirm long-term outcomes.
全肩关节置换术（TSA）解剖型、反式或两者均是一种日益流行的手术方法，但肩胛盂假体仍是一个薄弱环节，占机械并发症的 30-50%，并导致翻修负担增加。假体位置不良是肩胛盂失败的主要病因之一，因此引入了患者特异性假体（PSI）以优化假体的放置。本系统文献回顾和荟萃分析旨在比较 PSI 和标准假体（STDI）方法在复制肩胛盂假体位置术前手术计划方面的成功率。
2017 年 11 月，我们在 MEDLINE、Cochrane 图书馆、EMBASE 和 ClinicalTrials.gov 上进行了搜索（仅限于英文）。使用的搜索词是“Patient-Specific Instrumentation (PSI)”、“custom guide”、“shoulder”、“glenoid”和“arthroplasty”，共确定了 42 项研究。主要排除标准是：没有 CT 扫描分析结果；研究对象为塑料骨；以及使用可重复使用或通用的引导器。合格的研究评估了最终偏离规划的版本、倾斜度、入口点和旋转度。审查员独立工作，对相同的研究提取数据并评估偏倚风险。
最终分析纳入了 12 项研究，包括 227 名参与者（7 项研究涉及 103 名人类，5 项研究涉及 124 名尸体标本）。所有参数的异质性均为中度或高度。与 STDI 相比，PSI 可显著降低术前规划的版本（p<0.01）、倾斜度（p<0.01）和入口点（p = 0.02）的偏差，但旋转度（p = 0.49）无显著差异。PSI 的准确性（与规划的偏差）约为 1.88°至 4.96°，具体取决于参数。使用 STDI 的肩胛盂假体的离群值（>10°的偏差或 4mm）数量明显高于 PSI（68.6%比 15.3%（p = 0.01））。
本综述支持 PSI 可增强肩胛盂假体的定位，尤其是减少离群值的观点。然而，研究结果并不确定，需要进一步验证。值得注意的是，目前尚无随机临床试验来证实长期结果。
