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计算机导航和患者特异性器械在肩关节置换术中的应用：日常实践、仅适用于特殊病例还是真正在培训外科医生？

The Use of Computer Navigation and Patient Specific Instrumentation in Shoulder Arthroplasty: Everyday Practice, Just for Special Cases or Actually Teaching a Surgeon?

作者信息

Jahic Dzenan, Suero Eduardo M, Marjanovic Benjamin

机构信息

Orthopaedics and Traumatology Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.

Department of General Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany.

出版信息

Acta Inform Med. 2021 Jun;29(2):130-133. doi: 10.5455/aim.2021.29.130-133.

DOI:10.5455/aim.2021.29.130-133
PMID:34584337
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8443132/
Abstract

BACKGROUND

The use of computer assisted surgery, navigation (NAV) in shoulder arthroplasty is still under discussion, regarding the clinical outcome and prosthesis longevity, especially when combining these factors with cost, time and surgeon's experience. Beside the NAV, there has been in use patient-specific instrumentation (PSI) as an additional tool for more precise glenoid implant position. Surgical NAV and PSI for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty are in last years under observation and discussion.

OBJECTIVE

To critically review and evaluate the current literature regarding the use of computer navigation and PSI in shoulder arthroplasty.

METHODS

Critical review of the existing literature.

RESULTS

Cost-effectiveness, prosthesis longevity and revision arthroplasty rate have not yet been proven clinically. Moreover, heterogeneity is high in studies that include different positioning systems (NAV, PSI and standard instrumentation). Heterogeneity is due to differences in surgical technique, implants, surgeon's expertise, radiographic image analysis technique.

CONCLUSION

The use of navigation systems and PSI should be clinically proven in the shoulder arthroplasty. Independent experts' opinion and independent high level studies lack at the moment. There will be still a lot of talk regarding this topic in future.

摘要

背景

在肩关节置换术中使用计算机辅助手术导航（NAV），在临床疗效和假体使用寿命方面仍存在争议，尤其是当将这些因素与成本、时间和外科医生的经验相结合时。除了导航系统外，还使用了定制器械（PSI）作为更精确放置盂肱关节植入物的辅助工具。近年来，在解剖型和反置式全肩关节置换术中用于盂肱关节植入物定位的手术导航和定制器械一直受到关注和讨论。

目的

批判性地回顾和评估当前关于计算机导航和定制器械在肩关节置换术中应用的文献。

方法

对现有文献进行批判性回顾。

结果

成本效益、假体使用寿命和翻修置换率尚未得到临床验证。此外，纳入不同定位系统（导航系统、定制器械和标准器械）的研究中异质性较高。异质性源于手术技术、植入物、外科医生专业知识、影像学图像分析技术的差异。

结论

在肩关节置换术中使用导航系统和定制器械应得到临床验证。目前缺乏独立专家的意见和独立的高水平研究。未来关于这个话题仍会有很多讨论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218f/8443132/a4f621964075/AIM-29-130-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218f/8443132/6c0c46e7b62f/AIM-29-130-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218f/8443132/318554a71236/AIM-29-130-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218f/8443132/a4f621964075/AIM-29-130-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218f/8443132/6c0c46e7b62f/AIM-29-130-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218f/8443132/318554a71236/AIM-29-130-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/218f/8443132/a4f621964075/AIM-29-130-g003.jpg

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本文引用的文献

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Instr Course Lect. 2020;69:583-594.
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Computer navigation of the glenoid component in reverse total shoulder arthroplasty: a clinical trial to evaluate the learning curve.计算机导航下全肩关节置换术中盂肱关节假体的安装：评估学习曲线的临床试验。
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Glenoid component positioning and guidance techniques in anatomic and reverse total shoulder arthroplasty: A systematic review and meta-analysis.
肩关节置换术中的三维规划、导航、个性化器械和混合现实：一场数字骨科的复兴。
EFORT Open Rev. 2024 Jun 3;9(6):517-527. doi: 10.1530/EOR-23-0200.
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