Marescalchi Marina, El Motassime Alessandro, Andriollo Luca, Polizzi Alberto, Niccoli Giuseppe, Morea Vincenzo
Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy.
Dipartimento di Scienze geriatriche e ortopediche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
J Clin Med. 2025 Apr 17;14(8):2763. doi: 10.3390/jcm14082763.
Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty.
肩关节置换术，包括全肩关节置换术（TSA）和反式肩关节置换术（RSA），是治疗肩关节退行性、创伤后和炎症性疾病的成熟手术方法。这些手术的成功很大程度上取决于植入物的精确放置，这有助于恢复适当的关节力学，减少并发症，并延长假体的使用寿命。然而，实现准确的植入物定位可能具有挑战性，特别是在涉及严重骨质流失、解剖畸形或既往手术的情况下。对准不良可能导致不稳定、植入物松动以及需要进行翻修手术。计算机辅助导航已成为肩关节置换术中的重要工具，提供实时术中指导以提高手术准确性和一致性。通过将术前3D成像与术中跟踪相结合，导航技术使外科医生能够优化肩胛盂组件的放置，降低对准不良和机械故障的风险。研究表明，导航辅助技术提高了精度，改善了功能结果，甚至可能通过优化固定策略（如在RSA中使用更少但更长的螺钉）降低并发症发生率。尽管有这些好处，肩关节置换术中的导航并非没有挑战。它需要额外的手术时间，增加成本，并且对外科医生来说需要一个学习曲线。然而，随着人工智能、增强现实和机器人辅助手术的进步，导航有望变得更加有效和易于使用。这篇综述探讨了导航对临床结果的当前影响、其在复杂病例中的作用以及该技术的未来潜力。虽然早期结果很有希望，但需要进一步的长期研究来全面评估其价值并确立其在肩关节置换术中常规使用的最佳实践。
