Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA.
J Shoulder Elbow Surg. 2020 Nov;29(11):2257-2263. doi: 10.1016/j.jse.2020.03.014. Epub 2020 Jun 9.
Commercially available preoperative planning software is now widely available for shoulder arthroplasty. However, without the use of patient-specific guides or intraoperative visual guidance, surgeons have little in vivo feedback to ensure proper execution of the preoperative plan. The purpose of this study was to assess surgeons' ability to implement a preoperative plan in vivo during shoulder arthroplasty.
Fifty primary shoulder arthroplasties from a single institution were retrospectively reviewed. All surgical procedures were planned using a commercially available software package with both multiplanar 2-dimensional computed tomography and a 3-dimensional implant overlay. Following registration of intraoperative visual navigation trackers, the surgeons (1 attending and 1 fellow) were blinded to the computer navigation screen and attempted to implement the plan by simulating placement of a central-axis guide pin. Malposition was assessed (>4 mm of displacement or >10° error in version or inclination). Data were then blinded, measured, and evaluated.
Mean displacement from the planned starting point was 3.2 ± 2.0 mm. The mean error in version was 6.4° ± 5.6°, and the mean error in inclination was 6.6° ± 4.9°. Malposition was observed in 48% of cases after preoperative planning. Malposition errors were more commonly made by fellow trainees vs. attending surgeons (58% vs. 38%, P = .047).
Despite preoperative planning, surgeons of various training levels were unable to reproducibly replicate the planned component position consistently. Following completion of fellowship training, significantly less malposition resulted. Even in expert hands, the orientation of the glenoid component would have been malpositioned in 38% of cases. This study further supports the benefit of guided surgery for accurate placement of glenoid components, regardless of fellowship training.
目前市面上有许多商业化的术前规划软件可用于肩关节置换。然而，由于没有使用患者专用的导板或术中视觉导航，外科医生在术中几乎无法获得反馈，以确保术前计划的正确执行。本研究旨在评估外科医生在肩关节置换术中实施术前计划的能力。
回顾性分析了一家单中心的 50 例初次肩关节置换术。所有手术均使用商业化软件包进行规划，该软件包同时具有多平面二维计算机断层扫描和三维植入物叠加。在注册术中视觉导航跟踪器后，术者（1 名主治医生和 1 名住院医生）被屏蔽于计算机导航屏幕之外，并尝试通过模拟中央轴导针的放置来实施计划。评估位置不良（＞4mm 的移位或＞10°的旋转或倾斜误差）。然后对数据进行盲法、测量和评估。
与计划起始点的平均偏差为 3.2±2.0mm。平均旋转误差为 6.4°±5.6°，平均倾斜误差为 6.6°±4.9°。术前规划后，48%的病例出现位置不良。住院医生比主治医生更容易出现位置不良错误（58% vs. 38%，P =.047）。
尽管进行了术前规划，但不同培训水平的术者仍无法始终如一地重复复制计划中的组件位置。在完成住院医生培训后，位置不良的发生率显著降低。即使是在经验丰富的术者手中，在 38%的情况下，肩胛盂组件的方向也会出现位置不良。本研究进一步支持了在准确放置肩胛盂组件方面，使用导航手术的优势，而与住院医生培训无关。
