Department of Mechanical Engineering, University of Victoria, Victoria, British Columbia, Canada.
Department of Mechanical Engineering, Imperial College London, London, United Kingdom.
PLoS One. 2021 May 21;16(5):e0251880. doi: 10.1371/journal.pone.0251880. eCollection 2021.
To develop and assess a novel guidance technique and instrumentation system for minimally invasive short-stemmed total shoulder arthroplasty that will help to reduce the complications associated with traditional open replacement such as poor muscle healing and neurovascular injury. We have answered key questions about the developed system including (1) can novel patient-specific guides be accurately registered and used within a minimally invasive environment?; (2) can accuracy similar to traditional techniques be achieved?
A novel intra-articular patient-specific guide was developed for use with a new minimally invasive posterior surgical approach that guides bone preparation without requiring muscle resection or joint dislocation. Additionally, a novel set of instruments were developed to enable bone preparation within the minimally invasive environment. The full procedure was evaluated in six cadaveric shoulders, using digitizations to assess accuracy of each step.
Patient-specific guide registration accuracy in 3D translation was 2.2±1.2mm (RMSE±1 SD; p = 0.007) for the humeral component and 2.7±0.7mm (p<0.001) for the scapula component. Final implantation accuracy was 2.9±3.0mm (p = 0.066) in translation and 5.7-6.8±2.2-4.0° (0.001<p<0.009) across the humerus implants' three rotations. Similarly, the glenoid component's implantation accuracy was 3.0±1.7mm (p = 0.008) in translation and 2.3-4.3±2.2-4.4° (0.008<p<0.09) in rotation.
This system achieves minimally invasive shoulder replacement with accuracy similar to traditional open techniques while avoiding common causes of complications.
This novel technique could lead to a paradigm shift in shoulder arthroplasty for patients with moderate arthritis, which could significantly improve rehabilitation and functional outcomes.
开发和评估一种新的微创短柄全肩关节置换术指导技术和仪器系统，以帮助减少传统开放式置换术相关的并发症，如肌肉愈合不良和神经血管损伤。我们已经回答了有关开发系统的关键问题，包括：（1）新型个体化患者专用导板能否在微创环境中准确注册和使用？；（2）能否达到类似传统技术的准确性？
为使用新的微创后入路开发了一种新型关节内个体化患者专用导板，该导板引导骨准备，无需肌肉切除或关节脱位。此外，还开发了一套新的器械，使微创环境下的骨准备成为可能。在六个尸体肩部评估了整个手术过程，通过数字化评估来评估每个步骤的准确性。
在 3D 平移中，患者专用导板的注册精度为肱骨组件 2.2±1.2mm（均方根误差±1 标准差；p = 0.007），肩胛骨组件 2.7±0.7mm（p<0.001）。最终植入物的平移精度为 2.9±3.0mm（p = 0.066），肱骨植入物的三个旋转方向的角度精度为 5.7-6.8±2.2-4.0°（0.001<p<0.009）。同样，肩胛盂组件的植入物精度为 3.0±1.7mm（p = 0.008），平移精度为 2.3-4.3±2.2-4.4°（0.008<p<0.09）。
该系统通过避免常见并发症的原因，以类似于传统开放式技术的精度实现微创肩部置换。
这种新的技术可能会导致中度关节炎患者的肩关节置换术发生范式转变，这可能会显著改善康复和功能结果。
