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亚洲人群中使用导航系统的反式全肩关节置换术的短期临床和放射学结果:一项回顾性比较研究

Short-term clinical and radiologic outcomes of reverse total shoulder arthroplasty with navigation system in the Asian population: a retrospective comparative study.

作者信息

Kim Jae Soo, Kim Su Cheol, Park Jong Hun, Kim Hyun Gon, Kim Dong Hyun, Jung Hyoung Seok, Lee Sang Min, Yoo Jae Chul

机构信息

Department of Orthopaedic Surgery, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Gyeonggi-do, Republic of Korea.

Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.

出版信息

JSES Int. 2024 Oct 18;9(2):422-430. doi: 10.1016/j.jseint.2024.09.025. eCollection 2025 Mar.

Abstract

BACKGROUND

In reverse total arthroplasty (rTSA), glenoid component positioning is a critical factor for outcomes especially in Asian populations with smaller glenoids. The purpose of this study was to compare the clinical and radiologic outcomes of rTSA with and without the navigation system with a minimum follow-up of 2 years in the Asian population.

METHODS

This was a retrospective comparative study of 33 rTSAs with the navigation system (NAV group) and 40 conventional rTSAs (CON group). Radiologic measurements regarding the position of the glenoid component, glenoid vault perforation by the central cage, and scapular notching, as well as clinical outcomes including range of motion, functional scores, and complications were compared. Number, length, and angulation of screws were assessed.

RESULTS

The mean age was 73.9 ± 5.9 years with a mean follow-up of 30.1 ± 6.4 months. The NAV group more frequently utilized augmented baseplate ( < .001), showed less superior inclination ( = .030) and had lower incidence of glenoid vault perforation ( = .040). The length of superior ( = .001) and inferior screws ( = .045) was longer in the NAV group. In the NAV group compared to the CON group, more inferior orientation of superior screws ( < .001), more anterior orientation for inferior screws ( = .031), and anterior screws ( = .003) were observed. The NAV group showed significantly less penetration into the suprascapular fossa by a superior screw ( = .007). Final range of motion, functional scores, and complications showed no significant differences between the 2 groups.

CONCLUSION

In the short-term follow-up, the use of a navigation system in rTSA showed no significant difference in clinical outcomes and complications compared to conventional implantation. However, it enabled a lower superior inclination and a reduced glenoid vault perforation by the central cage, simultaneously allowing for the insertion of longer peripheral screws in a safer direction compared to conventional implantation.

摘要

背景

在反向全肩关节置换术(rTSA)中,肩胛盂假体的定位是影响手术效果的关键因素,对于肩胛盂较小的亚洲人群尤为如此。本研究旨在比较在亚洲人群中,采用和不采用导航系统的rTSA在至少2年随访期后的临床和影像学结果。

方法

这是一项回顾性比较研究,纳入了33例采用导航系统的rTSA(导航组)和40例传统rTSA(传统组)。比较了肩胛盂假体位置、中央假体导致的肩胛盂穹窿穿孔、肩胛切迹的影像学测量结果,以及包括活动范围、功能评分和并发症在内的临床结果。评估了螺钉的数量、长度和角度。

结果

平均年龄为73.9±5.9岁,平均随访时间为30.1±6.4个月。导航组更频繁地使用增强型基板(P<0.001),显示出较小的上倾角(P=0.030),肩胛盂穹窿穿孔的发生率较低(P=0.040)。导航组的上螺钉(P=0.001)和下螺钉(P=0.045)长度更长。与传统组相比,导航组的上螺钉更偏向下方(P<0.001),下螺钉和前螺钉更偏向前方(P=0.031和P=0.003)。导航组的上螺钉进入肩胛上窝的深度明显更小(P=0.007)。两组的最终活动范围、功能评分和并发症无显著差异。

结论

在短期随访中,与传统植入相比,rTSA中使用导航系统在临床结果和并发症方面无显著差异。然而,与传统植入相比,它能降低上倾角,减少中央假体导致的肩胛盂穹窿穿孔,同时允许以更安全的方向插入更长的周边螺钉。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2de7/11962556/3d7961631203/gr1.jpg

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