METHODS: Three experienced shoulder surgeons inserted 2.5 mm K-wires into polyurethane cast glenoid models of type Walch A, B and C (in total 180 models). Every surgeon placed guide wires into 10 glenoids of each type with a standard guide by DePuy Synthes in group (I) and with a PSAD in group (II). Deviation from planned version, inclination and entry point was measured, as well as investigation of a possible learning curve.
RESULTS: Maximal deviation in version in B- and C-glenoids in (I) was 20.3° versus 4.8° in (II) (p < 0.001) and in inclination was 20.0° in (I) versus 3.7° in (II) (p < 0.001). For B-glenoid, more than 50% of the guide wires in (I) had a version deviation between 11.9° and 20.3° compared to ≤ 2.2° in (II) (p < 0.001). 50% of B- and C-glenoids in (I) showed a median inclination deviation of 4.6° (0.0°-20.0°; p < 0.001) versus 1.8° (0.0°-4.0°; p < 0.001) in (II). Deviation from the entry point was always less than 5.0 mm when using PSAD compared to a maximum of 7.7 mm with the standard guide and was most pronounced in type C (p < 0.001).
CONCLUSIONS: PSAD enhance precision and accuracy of guide wire placement particularly for deformed B and C type glenoids compared to a standard guide in vitro. There was no learning curve for PSAD. However, findings of this study cannot be directly translated to the clinical reality and require further corroboration.
方法:三位经验丰富的肩关节外科医师将2.5mmK线插入WalchA型聚氨酯铸型关节盂模型中,B和C(共180种型号)。每位外科医生在组(I)中使用DePuySynthes的标准指南,在组(II)中使用PSAD,将导丝放入每种类型的10个腺体中。偏离计划版本,测量了倾斜度和进入点,以及可能的学习曲线的调查。
结果:(I)中B-和C-腺体的最大版本偏差为20.3°,(II)中4.8°(p<0.001),倾斜度为20.0°(I)中3.7°(p<0.001)。对于B关节盂,与(II)中≤2.2°相比,(I)中超过50%的导丝的版本偏差在11.9°至20.3°之间(p<0.001)。(I)中50%的B-和C-腺样体显示中值倾斜度偏差为4.6°(0.0°-20.0°;p<0.001),而(II)中的1.8°(0.0°-4.0°;p<0.001)。使用PSAD时,与进入点的偏差始终小于5.0mm,而标准指南的最大偏差为7.7mm,在C型中最明显(p<0.001)。
结论:与体外标准指南相比,PSAD提高了导丝放置的精度和准确性,特别是对于变形的B型和C型腺体。PSAD没有学习曲线。然而,这项研究的发现不能直接转化为临床现实,需要进一步的佐证。