Virk Mandeep S, Steinmann Scott P, Romeo Anthony A, Zuckerman Joseph D
Instr Course Lect. 2020;69:583-594.
The glenoid is considered a weak link in total shoulder arthroplasty because failure on the glenoid side is one of the most common reasons for revision of total shoulder arthroplasty. Glenoid wear is commonly seen in glenohumeral arthritis and compromises glenoid bone stock and also alters the native version and inclination of the glenoid. It is critical to recognize glenoid wear and correct it intraoperatively to avoid component malposition, which can negatively affect the survivorship of the glenoid implant. The end point of correction for the glenoid wear in shoulder arthroplasty is controversial, but anatomic glenoid component positioning is likely to improve long-term survivorship of the total shoulder arthroplasty. Preoperative three-dimensional (3-D) computer planning software, based on CT, is commercially available. It allows the surgeon to plan implant type (anatomic versus reverse), size, and position on the glenoid, and also allows for templating deformity correction using bone graft and/or augments. Guidance technology in the form of computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) allows the surgeon to execute the preoperative plan during surgery with a greater degree of accuracy and precision and has shown superiority to standard instrumentation. However, the proposed benefits of this technology including improved glenoid survivorship, reduced revision arthroplasty rate and cost-effectiveness have not yet been demonstrated clinically. In this review, we present the current evidence regarding PSI and CAS in managing glenoid deformity in total shoulder arthroplasty.
肩胛盂被认为是全肩关节置换术中的薄弱环节，因为肩胛盂侧的失败是全肩关节置换术翻修的最常见原因之一。肩胛盂磨损在肩肱关节关节炎中很常见，会损害肩胛盂骨量，还会改变肩胛盂的原始角度和倾斜度。认识到肩胛盂磨损并在术中进行纠正以避免假体位置不当至关重要，因为这会对肩胛盂植入物的生存率产生负面影响。肩关节置换术中肩胛盂磨损的纠正终点存在争议，但解剖学上的肩胛盂假体定位可能会提高全肩关节置换术的长期生存率。基于CT的术前三维（3-D）计算机规划软件已商业化。它允许外科医生规划植入物类型（解剖型与反向型）、尺寸以及在肩胛盂上的位置，还允许使用骨移植和/或增强材料进行模板化畸形矫正。计算机辅助手术（CAS）和患者特异性器械（PSI）形式的引导技术使外科医生能够在手术期间更准确、精确地执行术前计划，并且已显示出优于标准器械。然而，这项技术所宣称的益处，包括提高肩胛盂生存率、降低翻修置换术发生率和成本效益，尚未在临床上得到证实。在本综述中，我们展示了关于PSI和CAS在全肩关节置换术中处理肩胛盂畸形方面的现有证据。
