Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Department of Orthopaedics and Trauma Surgery, Hospital San José-Clínica Santa María, Santiago, Chile.
Department of Orthopaedics and Traumatology, Kantonsspital, St.Gallen, Switzerland.
J Shoulder Elbow Surg. 2022 Sep;31(9):1929-1937. doi: 10.1016/j.jse.2022.02.025. Epub 2022 Mar 26.
Patient-specific instrumentation (PSI) may potentially improve humeral osteotomy in shoulder arthroplasty. The purpose of this study was to compare the deviation between planned and postosteotomy humeral inclination, retrotorsion, and height in shoulder arthroplasty, using PSI vs. standard cutting guides (SCG).
Twenty fresh-frozen cadaveric specimens were allocated to undergo humeral osteotomy using either PSI or SCG, such that the 2 groups have similar age, gender, and side. Preosteotomy computed tomography (CT) scan was performed and used for the 3-dimensional (3D) planning. The osteotomy procedure was performed using a PSI designed for each specimen or an SCG depending on the group. A postosteotomy CT scan was performed. The preosteotomy and postosteotomy 3D CT scan reconstructions were superimposed to calculate the deviation between planned and postosteotomy inclination, retrotorsion, and height. Outliers were defined as cases with 1 or more of the following deviations: >5° inclination, >10° retrotorsion, and >3 mm height. The deviation and outliers in inclination, retrotorsion, and height were compared between the 2 groups.
The deviations between planned and postosteotomy parameters were similar among the PSI and SCG groups for inclination (P = .260), whereas they were significantly greater in the SCG group for retrotorsion (P < .001) and height (P = .003). There were 8 outliers in the SCG group, compared with only 1 outlier in the PSI group (P = .005). Most outliers in the SCG group were due to deviation >10° in retrotorsion.
After 3D planning, PSI had less deviation between planned and postosteotomy humeral retrotorsion and height, relative to SCG.
患者特异性器械（PSI）可能会改善肩关节置换术中的肱骨截骨术。本研究的目的是比较 PSI 与标准截骨导向器（SCG）在肩关节置换术中截骨术后计划与实际肱骨倾斜度、后旋转和高度的偏差。
20 例新鲜冷冻尸体标本被分配进行肱骨截骨术，使用 PSI 或 SCG，使得两组具有相似的年龄、性别和侧别。进行截骨术前 CT 扫描，并用于 3D 规划。根据组别的不同，使用为每个标本设计的 PSI 或 SCG 进行截骨术。进行截骨术后 CT 扫描。将截骨术前和术后的 3D CT 扫描重建叠加，以计算计划与术后倾斜度、后旋转和高度之间的偏差。离群值定义为存在以下 1 个或多个偏差的病例：>5°倾斜度、>10°后旋转和>3mm 高度。比较了 2 组之间在倾斜度、后旋转和高度方面的偏差和离群值。
在 PSI 和 SCG 组中，计划与术后参数之间的偏差在倾斜度方面相似（P=0.260），而在 SCG 组中，后旋转（P<0.001）和高度（P=0.003）的偏差明显更大。在 SCG 组中有 8 个离群值，而在 PSI 组中只有 1 个离群值（P=0.005）。SCG 组中的大多数离群值是由于后旋转偏差>10°。
与 SCG 相比，3D 规划后 PSI 具有更小的计划与术后肱骨后旋转和高度之间的偏差。
