Karuna Pathirannehelage Narada R, Jayaram Jithuram, Bamunuarachchi Indika S, George Malal Joby J
Trauma and Orthopaedics, Bedfordshire Hospitals NHS Trust, Bedford, GBR.
Cureus. 2023 Dec 16;15(12):e50622. doi: 10.7759/cureus.50622. eCollection 2023 Dec.
Introduction Reverse polarity shoulder arthroplasty (RSA) is an evolving surgery, and its indications have expanded over time. Apart from cuff tear arthropathy (CTA), it is recommended for complex proximal humerus fractures in the elderly, inflammatory arthritis, primary osteoarthritis in the elderly, and revision for failed hemiarthroplasty. Glenoid base plate placement and fixation are important to prevent complications, especially glenoid base plate loosening, dislocation, and scapular notching, and to improve longevity. Guided personalized surgery (GPS)-navigated RSA was devised to optimize the glenoid base plate position and fixation. Methodology A retrospective study was carried out in a low-volume district general hospital in England. All the patients who underwent GPS-navigated RSA were included. Their preoperative glenoid version, bone stock, glenoid base plate, and glenoid screw lengths were analysed. Preoperative and post-surgery patient-reported outcomes were gathered using the Oxford Shoulder Score (OSS) at six months and annually thereafter. Results Fourteen patients have undergone GPS-navigated RSA in our institute since 2018. Ten patients were female. All of them had a retroverted glenoid with a mean value of 13.6 degrees. Ten out of 14 patients had an augmented glenoid base plate. This included six eight-degree posterior augmentations, three 10-degree superior augmentations, and one extended cage peg. The follow-up period was six months to five years, depending on the date of surgery, and none of the patients dropped out of follow-up. The OSS revealed statistically significant improvement from preoperative values to six months postoperative, an improvement of 21.64±7.175. It also showed progressive improvement over time during postoperative follow-up, and the three-year mean was 47. The commonest complication was fractures, which happened in four cases. There were no infections or dislocations. Discussion Guided personalized surgery-navigated RSA was performed on selected patients at our institution when they were not suitable for conventional RSA due to distorted glenoid anatomy. Glenoid base plate positioning and fixation are important to optimize the outcome of RSA. Guided personalized surgery navigation is helpful in achieving optimum glenoid base placement, especially when the normal glenoid anatomy is distorted. There were no dislocations, glenoid base plate loosening, or scapular notching in the study group. There were four reported fractures, which was comparable with the published literature.
引言
反向极性肩关节置换术（RSA）是一种不断发展的手术，其适应症随着时间的推移而扩大。除了肩袖撕裂性关节病（CTA）外，它还适用于老年复杂肱骨近端骨折、炎性关节炎、老年原发性骨关节炎以及半关节置换失败后的翻修手术。关节盂基板的放置和固定对于预防并发症，尤其是关节盂基板松动、脱位和肩胛切迹，并提高使用寿命非常重要。设计了引导式个性化手术（GPS）导航的RSA，以优化关节盂基板的位置和固定。
方法
在英国一家规模较小的地区综合医院进行了一项回顾性研究。纳入所有接受GPS导航RSA的患者。分析了他们术前的关节盂版本、骨量、关节盂基板和关节盂螺钉长度。术前和术后患者报告的结果使用牛津肩部评分（OSS）在术后6个月及之后每年收集一次。
结果
自2018年以来，我院有14例患者接受了GPS导航的RSA。10例为女性。他们的关节盂均为后倾，平均值为13.6度。14例患者中有10例使用了增强型关节盂基板。其中包括6例8度后倾增强、3例10度上倾增强和1例延长型笼式钉。随访期为6个月至5年，具体取决于手术日期，没有患者退出随访。OSS显示，从术前到术后6个月有统计学意义的改善，改善值为21.64±7.175。术后随访期间也显示出随时间的逐步改善，三年平均值为47。最常见的并发症是骨折，有4例发生。没有感染或脱位。
讨论
当选定的患者因关节盂解剖结构扭曲而不适合传统RSA时，我们机构对其进行了引导式个性化手术导航的RSA。关节盂基板的定位和固定对于优化RSA的结果很重要。引导式个性化手术导航有助于实现最佳的关节盂放置，尤其是当正常关节盂解剖结构扭曲时。研究组中没有脱位、关节盂基板松动或肩胛切迹。报告了4例骨折，与已发表的文献相当。
