Accuracy of 3-Dimensional Planning, Implant Templating, and Patient-Specific Instrumentation in Anatomic Total Shoulder Arthroplasty
Accuracy of 3-Dimensional Planning, Implant Templating, and Patient-Specific Instrumentation in Anatomic Total Shoulder Arthroplasty
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DOI：
10.2106/jbjs.17.01614
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发表时间：
2019-03-06
影响因子：
5.3
通讯作者：
Ricchetti, Eric T.
中科院分区：
文献类型：
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作者：
Iannotti, Joseph P.;Walker, Kyle;Ricchetti, Eric T.
背景资料：已证明使用三维（3D）计算机断层扫描（CT）术前计划和患者特定器械可提高全肩关节置换术（TSA）中关节盂植入物放置的准确性。本研究的目的是比较不同类型的仪器与3D CT术前planning.Methods：173例终末期盂肱关节炎患者的关节盂种植体放置在原发性TSA之间的准确性纳入3项前瞻性研究，评估患者特定的仪器和3D术前规划。所有患者均接受术前3D CT计划，以根据外科医生偏好确定最佳关节盂组件和导针位置。患者被放入用于术中导针放置的5个器械组中的1个：（1）标准器械，（2）标准器械结合使用包含导销的3D关节盂骨模型，（3）3D关节盂骨模型结合使用一次性患者专用器械，（4）3D关节盂骨模型结合使用可重复使用的患者专用器械，以及（5）使用具有可调节的、可重复使用的基座的可重复使用的患者专用仪器。术后，所有患者均接受了3D CT，以比较实际与计划的关节盂组件位置。根据绝对差异和离群值分析，比较各组与计划的偏离（方向和位置）。进行单变量和多变量比较。由于初步分析显示，在研究中，第1组和第2组之间或第4组和第5组之间的术前因素或计划偏离无显著差异，因此最终分析跨3个主要治疗组进行：标准器械（第1组和第2组）、一次性患者专用工具（第3组）和可重复使用患者专用工具结果：在几乎所有的比较中，与计划的偏差没有显著差异3个主要治疗组之间关节盂植入物方向或位置的绝对差异或离群值频率。这项研究并没有证明任何类型的病人-在3D CT术前计划的情况下，特定的器械导致初次TSA中关节盂植入物放置准确性的一致差异。与不使用患者专用工具的2D成像相比，外科医生有多种患者专用工具可供选择，以提高关节盂植入物放置的准确性。
Background: Use of 3-dimensional (3D) computed tomography (CT) preoperative planning and patient-specific instrumentation has been demonstrated to improve the accuracy of glenoid implant placement in total shoulder arthroplasty (TSA). The purpose of this study was to compare the accuracy of glenoid implant placement in primary TSA among different types of instrumentation used with the 3D CT preoperative planning.Methods: One hundred and seventy-three patients with end-stage glenohumeral arthritis were enrolled in 3 prospective studies evaluating patient-specific instrumentation and 3D preoperative planning. All patients underwent preoperative 3D CT planning to determine optimal glenoid component and guide pin position based on surgeon preference. Patients were placed into 1 of 5 instrument groups used for intraoperative guide pin placement: (1) standard instrumentation, (2) standard instrumentation combined with use of a 3D glenoid bone model containing the guide pin, (3) use of the 3D glenoid bone model combined with single-use patient-specific instrumentation, (4) use of the 3D glenoid bone model combined with reusable patient-specific instrumentation, and (5) use of reusable patient-specific instrumentation with an adjustable, reusable base. Postoperatively, all patients underwent 3D CT to compare actual versus planned glenoid component position. Deviation from the plan (in terms of orientation and location) was compared across groups on the basis of absolute differences and outlier analysis. Univariable and multivariable comparisons were performed. As the initial analyses showed no significant differences in preoperative factors or in deviation from the plan between Groups 1 and 2 or between Groups 4 and 5 across studies, the final analysis was across 3 major treatment groups: standard instrumentation (Groups 1 and 2), single-use patient-specific instrumentation (Group 3), and reusable patient-specific instrumentation (Groups 4 and 5).Results: In nearly all comparisons, there were no significant differences in the deviation from the plan (absolute differences or outlier frequency) for glenoid implant orientation or location across the 3 major treatment groups.Conclusions: This study did not demonstrate that any type of patient-specific instrumentation resulted in consistent differences in accuracy of glenoid implant placement in primary TSA with 3D CT preoperative planning. Surgeons have multiple patient-specific instrumentation options available for improving accuracy of glenoid implant placement when compared with 2D imaging without patient-specific instrumentation.