PDF(Pubmed)
Abstract：
Background Inaccurate positioning of the glenoid component has been well described as the most common cause of early failure following a reverse shoulder arthroplasty (RSA). Among the latest developments in operative technique, three-dimensional preoperative planning and navigation intraoperative systems have been developed to improve the accuracy of the baseplate positioning during RSA. The primary purpose of this retrospective analysis was to investigate the mid-term results of patients who underwent an elective RSA or for acute highly comminuted proximal humerus fractures. The secondary goal was to investigate the role of navigation in the execution of preoperative planning, especially in the management of glenoid bone loss. Methodology In total, 101 cases were included in this study. Patients were divided into the following two groups: 88 cases of RSA performed without the use of navigation (conventional RSA) and 13 cases performed using intraoperative navigation (navigated RSA). For all patients included in the study, preoperative planning software was employed. Patient demographics, gender, past medical history, indication of procedure, operated site, type of glenoid component used, length of baseplate screws, and clinical assessment scores (Oxford Shoulder Score, OSS) were reported for all patients. Cases of revision shoulder arthroplasty were excluded from this study. Results The postoperative clinical assessment of patients revealed that following RSA, all patients improved significantly with a consistently upward trend of the OSS noted for both groups (conventional and navigated RSA) throughout the postoperative assessment. Despite no statistically significant difference detected, the clinical scores of the navigated RSA group outperformed those of the conventional RSA group in the postoperative period. A higher incidence of augmented baseplate use was noted in the navigated RSA group than in the conventional group (23.07% vs. 5.68%, p < 0.001). Conclusions Our results indicate that the use of intraoperative navigation appears to be a valuable tool in preoperative planning, providing accurate positioning of the baseplate, a better understanding of the glenoid anatomy, and real-time monitoring of the length and direction of the baseplate screws. It is difficult to conclude if the use of navigation leads to superior clinical outcomes, and the cost-effectiveness of its use needs to be further analyzed. Prospective randomized trials are required to assess the cost-effectiveness of routine use of navigation in RSA.
摘要：
背景技术关节盂部件的不准确定位已被很好地描述为反向肩关节成形术(RSA)后早期失败的最常见原因。在手术技术的最新发展中，已经开发了三维术前计划和导航术中系统，以提高RSA期间基板定位的准确性。这项回顾性分析的主要目的是调查接受选择性RSA或急性肱骨近端高度粉碎性骨折的患者的中期结果。次要目标是研究导航在执行术前计划中的作用，尤其是在关节盂骨丢失的处理中。方法总的来说，101例病例纳入本研究。将患者分为以下两组：88例未使用导航的RSA（常规RSA）和13例使用术中导航的RSA（导航RSA）。对于纳入研究的所有患者，采用术前计划软件。患者人口统计学，性别,既往病史,程序指示，经营现场,使用的关节盂部件的类型，底板螺钉的长度,和临床评估评分(牛津肩评分，所有患者均报告了OSS）。本研究排除了翻修肩关节成形术的病例。结果对患者的术后临床评估显示,RSA,在整个术后评估期间,两组(常规和导航RSA)的OSS均呈持续上升趋势,所有患者均有显著改善.尽管没有检测到统计学上的显著差异，导航RSA组的临床评分在术后优于常规RSA组.导航RSA组使用增加底板的发生率高于常规组(23.07%vs.5.68%,p<0.001)。结论我们的结果表明，术中导航的使用似乎是术前计划的一个有价值的工具，提供基板的精确定位，更好地了解关节盂解剖结构，并实时监测底板螺钉的长度和方向。很难得出结论，如果使用导航导致更好的临床结果，其使用的成本效益有待进一步分析。需要前瞻性随机试验来评估RSA中常规使用导航的成本效益。
