Orthopaedic Unit and Kirk Kilgour Sports Injury Center, S. Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Ospedale Israelitico di Roma, Rome, Italy.
Arch Orthop Trauma Surg. 2024 Jan;144(1):91-102. doi: 10.1007/s00402-023-05038-y. Epub 2023 Aug 31.
While the use of computer-assisted navigation systems in prosthetic implantation is steadily increasing, its utility in reverse shoulder arthroplasty (RSA) remains unclear. The purpose of this study was to evaluate the clinical utility of an intraoperative navigation system in patients undergoing RSA.
Patients undergoing navigated or standard RSA at a single institution between September 2020 and December 2021 were prospectively enrolled. Exclusion criteria included noncompliance with study procedures or humeral fracture. Outcome measures included postoperative version and inclination, range of motion (ROM), complications, and patient-reported outcome measurements (PROMs: American Shoulder and Elbow Surgeons score [ASES], Disabilities of the Arm, Shoulder, and Hand score [DASH], Simple Shoulder Test [SST], and Visual Analog Scale [VAS]) at final follow-up.
The final cohort contained 16 patients with navigation and 17 with standard RSA at a mean follow-up of 16 months (range 12-18 months). Average age was 72 years (range 66-80 years), 8 male (24%) and 25 female (76%). There were no differences in demographics between groups (p > 0.05). At baseline, the navigated group had a greater proportion of Walch B1 and B2 glenoids (p = 0.04). There were no differences between groups regarding baseplate type and native/planned/postoperative glenoid version and inclination. In both groups, planned and postoperative versions were not significantly different (p = 0.76). Patients who did not have navigation demonstrated significant differences between planned and postoperative inclination (p = 0.04), while those with navigation did not (p = 0.09). PROM scores did not differ between groups at final follow-up for SST (p = 0.64), DASH (p = 0.38), ASES (p = 0.77), or VAS (p = 0.1). No difference in final ROM was found between groups (p > 0.05). Over 50% of all screws in both groups were positioned outside the second cortex (p = 0.37), albeit with no complications.
There were no statistically significant differences in ROM, PROMs, and satisfaction between patients receiving computer-navigated and standard RSA at a short-term follow-up. Despite more severe preoperative glenoid erosion in the navigated group, all patients were able to achieve an appropriate neutral axis postoperatively. The cost effectiveness and appropriate use of computer-navigated RSA warrant specific investigation in future studies.
II, prospective cohort study.
9/1/2020 to 12/31/2021.
虽然在假体植入中使用计算机辅助导航系统的情况在稳步增加，但在反式肩关节置换术（RSA）中的应用效果尚不清楚。本研究的目的是评估术中导航系统在 RSA 患者中的临床应用效果。
在 2020 年 9 月至 2021 年 12 月期间，在一家机构接受导航或标准 RSA 的患者被前瞻性纳入。排除标准包括不遵守研究程序或肱骨干骨折。主要观察指标包括术后关节窝的位置和倾斜度、活动范围（ROM）、并发症和患者报告的结果测量（PROM：美国肩肘外科医师评分[ASES]、上肢残疾量表[DASH]、简易肩部测试[SST]和视觉模拟量表[VAS]）在最终随访时的情况。
最终队列包含 16 名接受导航和 17 名接受标准 RSA 的患者，平均随访时间为 16 个月（12-18 个月）。平均年龄为 72 岁（66-80 岁），8 名男性（24%）和 25 名女性（76%）。两组患者的人口统计学特征无差异（p>0.05）。在基线时，导航组的 Walch B1 和 B2 型关节窝比例更大（p=0.04）。两组之间的基板类型、固有/计划/术后关节窝位置和倾斜度无差异。两组中，计划和术后的位置均无显著差异（p=0.76）。未进行导航的患者在计划和术后倾斜度方面存在显著差异（p=0.04），而进行导航的患者则无显著差异（p=0.09）。在最终随访时，两组患者的 SST（p=0.64）、DASH（p=0.38）、ASES（p=0.77）和 VAS（p=0.1）评分无差异。两组患者的最终 ROM 无差异（p>0.05）。两组中超过 50%的螺钉均位于第二皮质之外（p=0.37），但无并发症发生。
在短期随访中，接受计算机导航 RSA 和标准 RSA 的患者在 ROM、PROM 和满意度方面没有统计学上的显著差异。尽管导航组患者术前关节窝侵蚀更严重，但所有患者术后均能达到合适的中立轴。计算机导航 RSA 的成本效益和适当应用值得在未来的研究中进行专门的调查。
II 级，前瞻性队列研究。
2020 年 9 月 1 日至 2021 年 12 月 31 日。
