Dept of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, USA.
Dept of Orthopaedic Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
Arch Orthop Trauma Surg. 2022 Nov;142(11):3141-3147. doi: 10.1007/s00402-021-03931-y. Epub 2021 May 12.
Three-dimensional planning of humeral head osteotomy in shoulder arthroplasty (SA) is understudied. This study evaluated whether a standard osteotomy technique along the anterosuperior anatomic neck (ASOT) could be surgically reproduced as pre-operatively planned on 3D-CT models.
Pre-operative planning in 12 cadaver shoulders was performed on a 3D-CT model of the humerus to calculate the planned osteotomy plane (planned OP). The osteotomy was then performed using a free-hand technique, and a post-operative CT scan was obtained for analysis (performed OP). Planes were compared with regards to inclination, retroversion, and resected humeral head thickness so the accuracy could be quantified.
The absolute errors between the performed and planned OP were 2° (0-10°), 5° (0-14°), and 4 mm (1-7 mm) for inclination, retroversion, and resected head thickness, respectively. Deviation < 10° for inclination and retroversion and < 5 mm for resected humeral head thickness between planned and performed OP was achieved in 92%, 83%, 58% of cases, respectively. No differences were found for inclination (p = 0.289), whereas retroversion and resected head thickness were smaller than planned (p ≤ 0.027).
Pre-operative planning of the ASOT using a 3D-CT model is accurate within a threshold of 10° when using a free-hand technique in 92% of cases for inclination. Retroversion and resected head thickness differed from the pre-operative plan, thereby limiting the unrestricted use of humeral head osteotomy planning from 3D-CT models in SA. These findings are a reference for further studies to develop and quantify the accuracy of pre-operative planning software including cutting guides for SA using 3D-CT models.
Basic science article.
肩关节置换术（shoulder arthroplasty，SA）中肱骨截骨的三维规划研究较少。本研究评估了是否可以沿前上解剖颈（anterosuperior anatomic neck，ASOT）的标准截骨技术在术前的肱骨 3D-CT 模型上进行手术重现。
对 12 具尸体肩部的术前规划在肱骨的 3D-CT 模型上进行，以计算计划的截骨平面（planned OP）。然后使用徒手技术进行截骨，并获得术后 CT 扫描进行分析（performed OP）。比较了平面的倾斜度、后倾度和截骨后的肱骨头部厚度，以量化准确性。
在 performed OP 和 planned OP 之间，倾斜度、后倾度和截骨后肱骨头部厚度的绝对误差分别为 2°（0-10°）、5°（0-14°）和 4mm（1-7mm）。92%、83%和 58%的病例中，计划和实施的 OP 之间的倾斜度和后倾度偏差<10°，截骨后的肱骨头部厚度偏差<5mm。倾斜度无差异（p=0.289），而后倾度和截骨后肱骨头部厚度小于计划值（p≤0.027）。
在 92%的病例中，使用徒手技术时，使用 3D-CT 模型对 ASOT 进行术前规划在 10°的阈值内是准确的。后倾度和截骨后的肱骨头部厚度与术前计划不同，从而限制了从 3D-CT 模型在 SA 中对肱骨截骨规划的无限制使用。这些发现为进一步研究提供了参考，以开发和量化包括用于 SA 的 3D-CT 模型的截骨引导的术前规划软件的准确性。
基础科学文章。
