PDF(Pubmed)
Abstract：
This review evaluates the current literature on the recent advances of preoperative planning in the management of complex proximal humerus fractures (PHF). PHFs can pose a considerable challenge for orthopaedic surgeons due to their diversity in presentation and complexity. Poor preoperative planning can lead to prolonged operations, increased blood loss, higher risk of complications, and increased stress on the surgical team. Recent advances have seen the evolution of preoperative planning from conventional methods to computer-assisted virtual surgical technology (CAVST) and three-dimensional (3D) printing, which have been highlighted as transformative tools for improving preoperative planning and postoperative outcomes. CAVST allows the creation of 3D renderings of patient-specific anatomy, clearly demonstrating fracture patterns and facilitating detailed planning for arthroplasty or surgical fixation. The early studies show promising outcomes however the literature calls for more high-quality randomised controlled trials. Using 3D printing for high-fidelity simulation involving patient-specific physical models offers an immersive experience for surgical planning. Preoperative planning with 3D printing reduces operative time, blood loss and use of fluoroscopy. The technology\'s potential to produce customisable surgical implants further improves its versatility. There is a need for a cost analysis for the use of these technologies within the orthopaedic field, particularly considering the high expense of 3D printing materials and extended hospital stays until the printed models are available. CAVST and 3D printing also show promising applications within high-fidelity simulation surgical training, with CAVST offering possibilities in virtual reality and haptic-enhanced simulations and 3D printing providing physical models for trainee surgeons to hone their skills. Moving forward, a reduction in the cost of 3D printing and the advancement of CAVST using artificial intelligence would lead to future improvement. In conclusion, preoperative planning supported by these innovative technologies will play a pivotal role in improving surgical outcomes and training for complex PHF cases.
摘要：
这篇综述评估了有关复杂肱骨近端骨折（PHF）的术前计划的最新进展的最新文献。PHF由于其表现多样性和复杂性而对整形外科医生构成相当大的挑战。不良的术前计划会导致手术时间延长,失血量增加,并发症的风险更高，增加了手术团队的压力。最近的进展已经看到了术前计划从传统方法到计算机辅助虚拟手术技术（CAVST）和三维（3D）打印的演变，已被强调为改善术前计划和术后结局的变革性工具。CAVST允许创建患者特定解剖结构的3D渲染，清楚地展示骨折模式，并促进关节成形术或手术固定的详细计划。早期研究显示了有希望的结果，但是文献要求更多高质量的随机对照试验。使用3D打印进行涉及患者特定物理模型的高保真模拟，为手术计划提供身临其境的体验。使用3D打印的术前计划减少了手术时间，失血和透视检查的使用。该技术生产可定制外科植入物的潜力进一步提高了其多功能性。在骨科领域使用这些技术需要进行成本分析，特别是考虑到3D打印材料的高成本和延长住院时间，直到打印模型可用。CAVST和3D打印在高保真模拟手术训练中也显示出有希望的应用。CAVST提供虚拟现实和触觉增强模拟的可能性，3D打印为受训外科医生提供物理模型，以磨练他们的技能。往前走,3D打印成本的降低和使用人工智能的CAVST的进步将导致未来的改进。总之,这些创新技术支持下的术前计划将在改善复杂PHF病例的手术结局和培训方面发挥关键作用.
