Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA.
Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA.
J Shoulder Elbow Surg. 2024 Dec;33(12):2629-2636. doi: 10.1016/j.jse.2024.04.002. Epub 2024 May 28.
Preoperative planning is an integral aspect of managing complex deformity in reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the success of patient-specific instrumentation (PSI) and 3D computer-assisted planning with standard instrumentation (non-PSI) in achieving planned corrections of the glenoid among patients undergoing RSA with severe bony deformity requiring glenoid bone grafts.
A retrospective case-control study was performed, including all patients that underwent RSA with combined bone grafting procedures (BIO-RSA or structural bone grafting) for severe glenoid deformity by a single study between June 2016 and July 2023. Patients were required to have preoperative and postoperative CT scans as well as preoperative 3D planning performed for inclusion. Patients were divided into two groups based on the use of 3D computer-assisted planning with or without PSI (PSI vs. non-PSI). The corrected inclination and version were measured by two separate reviewers on preoperative and postoperative 2D CT scans and compared to their corresponding preoperative planning goals utilizing bivariate analyses.
We identified 45 patients that met our inclusion criteria (22 PSI and 23 non-PSI). Preoperative inclination (mean ± SD) (PSI 10.12° ± 15.86°, non-PSI 9.43° ± 10.64°; P = .864) and version (PSI -18.78° ± 18.3°, non-PSI -17.82° ± 11.49°; P = .835) measurements were similar between groups. No significant differences in the mean deviation (error) between the postoperative and planned inclination (PSI 5.49° ± 3.72; non-PSI 6.91° ± 5.05; P = .437) and version (PSI 8.37° ± 5.7; non-PSI 5.37° ± 4.43; P = .054) were found between groups. No difference in the rate of outliers (>10° error) was noted in inclination (P = .135) or version (P = .445) between groups. Greater planned version correction was correlated with greater error when PSI was utilized (PSI r = 0.519, P = .013; non-PSI r = 0.362, P = .089).
Both PSI and 3D computer-assisted planning without PSI (non-PSI) appear to be useful techniques to achieve version and inclination correction among patients undergoing RSA with severe glenoid deformity required glenoid bone grafting with no clear superiority of one method over the other. Surgeons should be aware that when utilizing PSI, slightly greater error in achieving version goals may occur as version correction is increased.
术前规划是反肩置换术（RSA）中处理复杂畸形的一个重要组成部分。本研究的目的是比较在需要行盂骨移植术（BIO-RSA 或结构性骨移植术）的严重盂骨畸形 RSA 患者中，使用患者特异性器械（PSI）和 3D 计算机辅助规划与标准器械（非 PSI）在实现盂骨的计划矫正方面的成功率。
这是一项回顾性病例对照研究，纳入了 2016 年 6 月至 2023 年 7 月间由同一位研究者进行的所有因严重盂骨畸形而行 RSA 并联合行盂骨移植术的患者。所有患者均需有术前和术后 CT 扫描以及术前 3D 规划，以符合纳入标准。根据是否使用 3D 计算机辅助规划和/或 PSI 将患者分为两组（PSI 组与非 PSI 组）。两名独立的评估者在术前和术后 2D CT 扫描上测量矫正后的倾斜度和外展角，并利用双变量分析比较其与术前规划目标的差异。
我们共纳入了 45 名符合条件的患者（PSI 组 22 例，非 PSI 组 23 例）。术前倾斜度（PSI 组 10.12°±15.86°，非 PSI 组 9.43°±10.64°；P=0.864）和外展角（PSI 组-18.78°±18.3°，非 PSI 组-17.82°±11.49°；P=0.835）在两组间相似。术后与计划倾斜度之间的平均偏差（误差）（PSI 组 5.49°±3.72°；非 PSI 组 6.91°±5.05°；P=0.437）和外展角（PSI 组 8.37°±5.7°；非 PSI 组 5.37°±4.43°；P=0.054）之间无显著差异。在倾斜度（P=0.135）或外展角（P=0.445）方面，两组间的离群值（>10°的误差）发生率无差异。当使用 PSI 时，计划的外展角矫正越大，误差也越大（PSI r=0.519，P=0.013；非 PSI r=0.362，P=0.089）。
PSI 和无 PSI 的 3D 计算机辅助规划（非 PSI）似乎都是用于治疗严重盂骨畸形、需要行盂骨移植术的 RSA 患者的有效技术，两种方法之间没有明显的优势。外科医生应注意，当使用 PSI 时，随着外展角矫正的增加，实现外展角目标的误差可能会略有增加。
