Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Bone Joint J. 2020 Mar;102-B(3):365-370. doi: 10.1302/0301-620X.102B3.BJJ-2019-1153.R1.
Patient-specific instrumentation has been shown to increase a surgeon's precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning.
A case-based survey presented surgeons with a patient's history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts.
A total of 59 surgeons completed the survey. For all surgeons, the use of the PSP significantly increased agreement with the experts in glenoid classification (x = 8.54; p = 0.014) and surgical planning (x = 37.91; p < 0.001). The additional information provided by the PSP also showed a significantly higher impact on surgical decision-making for surgeons who undertake fewer than ten shoulder arthroplasties annually (p = 0.017).
The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. Cite this article: 2020;102-B(3):365-370.
患者特定的仪器已经证明可以提高外科医生在肩关节置换术中放置关节盂组件的精确性和准确性。然而，关于这种手术使用患者特定规划 (PSP) 工具的信息很少。尚不清楚这些工具如何改变肩部外科医生的决策模式。本研究旨在调查与使用普通 X 光片或选择的静态 CT 图像相比，PSP 是否会影响对关节盂病理和手术计划的理解。
基于病例的调查向外科医生展示了患者的病史、体格检查，以及依次展示 X 光片、选择的静态 CT 图像和 3D 成像程序的 PSP。对于每种成像方式，外科医生被要求识别关节盂的 Walch 分类，并提出手术治疗方案。根据他们每年进行的肩关节置换术数量，将参与的外科医生分为不同的组，并将他们的回答与两位专家的建议进行比较。
共有 59 名外科医生完成了这项调查。对于所有外科医生，使用 PSP 显著增加了他们在关节盂分类（x = 8.54；p = 0.014）和手术计划（x = 37.91；p < 0.001）方面与专家的一致性。PSP 提供的额外信息也显示，对于每年进行少于 10 例肩关节置换术的外科医生，对手术决策的影响显著更大（p = 0.017）。
PSP 提供的信息对低容量外科医生（每年进行少于 10 例肩关节置换术的医生）的手术决策影响最大，并且 PSP 使所有外科医生在关节盂分类和手术计划方面更接近专家的建议。引用本文：2020；102-B（3）：365-370。
