Lädermann Alexandre, Chagué Sylvain, Preissmann Delphine, Kolo Franck C, Rime Olivier, Kevelham Bart, Bothorel Hugo, Charbonnier Caecilia
Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Avenue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Medical Research Department, Artanim Foundation, Meyrin, Switzerland.
Orthop Traumatol Surg Res. 2020 Jun;106(4):651-659. doi: 10.1016/j.otsr.2020.02.010. Epub 2020 May 19.
There is no consensus on how to perform acromioplasty, particularly regarding the level and extent of bone resection, which depend on scapular and humeral morphologies.
We aimed to determine whether computer-assisted acromioplasty planning helps surgeons remove impinging bone, reduce unnecessary resections, and improve short-term outcomes of rotator cuff tears (RCR).
We randomized 64 patients undergoing RCR of full-thickness supraspinatus tears into two groups: 'guided acromioplasty' (GA) and 'freehand acromioplasty' (FA). The pre- and post-operative scapula models were reconstructed using computed-tomography scans to quantify impinging bone removal, unnecessary bone resections, and identify zones of acromial bone removal. All patients were evaluated preoperatively and at 6 months to assess their range of motion (ROM), functional scores and tendon integrity using ultrasound.
The two groups did not differ in demographics, clinical or morphologic characteristics. Compared to FA, GA tended to lower impinging bone removal (55±26% vs. 43±27%, p=0.087) and to increase unnecessary resection of the total bone removed (49±22% vs. 57±27%, p=0.248). GA resulted in significant anterior under-resection, while FA resulted in significant medial over-resection. Clinical outcomes and ROM improved significantly for all patients, except for internal rotation in the GA group. There were no other significant differences between the two groups, neither in terms of post-operative scores nor in terms of clinical net improvements, nor tendon repair integrity.
This computer-assisted planning for acromioplasty during RCR proved no benefits in terms of bone removal, tendon healing, or clinical outcomes. Nonetheless such planning tools could help less experienced surgeons improve the efficacy of acromioplasty.
I, Randomized controlled trial (Therapeutic study).
对于如何进行肩峰成形术尚无共识，尤其是在骨切除的水平和范围方面，这取决于肩胛骨和肱骨的形态。
我们旨在确定计算机辅助肩峰成形术规划是否有助于外科医生去除撞击骨、减少不必要的切除，并改善肩袖撕裂（RCR）的短期疗效。
我们将64例全层冈上肌撕裂行RCR的患者随机分为两组：“引导式肩峰成形术”（GA）组和“徒手肩峰成形术”（FA）组。使用计算机断层扫描重建术前和术后的肩胛骨模型，以量化撞击骨的去除、不必要的骨切除，并确定肩峰骨切除区域。所有患者在术前和术后6个月接受评估，使用超声评估其活动范围（ROM）、功能评分和肌腱完整性。
两组在人口统计学、临床或形态学特征方面无差异。与FA组相比，GA组倾向于减少撞击骨的去除（55±26%对43±27%，p=0.087），并增加切除的总骨中不必要的切除（49±22%对57±27%，p=0.248）。GA组导致明显的前部切除不足，而FA组导致明显的内侧切除过度。除GA组的内旋外，所有患者的临床疗效和ROM均有显著改善。两组之间在术后评分、临床净改善或肌腱修复完整性方面均无其他显著差异。
在RCR期间进行的这种计算机辅助肩峰成形术规划在骨切除、肌腱愈合或临床疗效方面未显示出益处。尽管如此，这种规划工具可能有助于经验不足的外科医生提高肩峰成形术的疗效。
I，随机对照试验（治疗性研究）。
