PDF(Pubmed)
Abstract：
Prosthetic instability is one of the most challenging complications to manage when considering reverse shoulder arthroplasty (RSA). Additional tools are available to improve accuracy in planning and execution of arthroplasties, such as 3-dimensional (3D) virtual planning based on computer tomography (CT) scan and intra-operative navigation. We report a case of an 84-year-old male treated for RSA prosthetic instability combined with severe glenoid deformity and bone loss, and subclinical periprosthetic joint infection (PJI). The definitive surgery consisted in implanting a customized metaglene component realized on the basis of the bone defect detected in the 3D-CT scan and implanted with the aid of computer-assisted intra-operative navigation. The patient was periodically followed-up for a year with clinical and radiological evaluations with the absence of further prosthetic dislocations nor PJI, a good overall satisfaction, a satisfying range of motion, and acceptable functional scores (American Shoulder and Elbow Surgeons Score 62, Constant-Murley Score 36). This is the first description, to our knowledge, of a customized glenoid baseplate implanted with the aid of intraoperative navigation. The combined use of 3D-CT planning and intra-operative computer-assisted navigation allows to manage complex cases of prosthetic revision surgery even where extensive bone defects are present.
摘要：
当考虑反向肩关节置换术（RSA）时，假体不稳定是最有挑战性的并发症之一。其他工具可用于提高关节置换术计划和执行的准确性，例如基于计算机断层扫描(CT)扫描和术中导航的三维(3D)虚拟规划。我们报告了一例84岁的男性，因RSA假体不稳定合并严重的关节盂畸形和骨丢失而接受治疗，和亚临床假体周围关节感染（PJI）。最终的手术包括根据3D-CT扫描中检测到的骨缺损植入定制的metaglene组件，并在计算机辅助的术中导航的帮助下植入。患者定期随访一年，并进行临床和放射学评估，没有进一步的假体脱位或PJI。良好的总体满意度，令人满意的运动范围，和可接受的功能评分（美国肩肘外科医师评分62，Constant-Murley评分36）。这是第一个描述，根据我们的知识，在术中导航的帮助下植入定制的关节盂基板。结合使用3D-CT计划和术中计算机辅助导航，即使存在大量骨缺损，也可以管理复杂的假体翻修手术病例。
