PDF(Pubmed)
Abstract：
BACKGROUND: Patient-specific aiming devices (PSAD) may improve precision and accuracy of glenoid component positioning in total shoulder arthroplasty, especially in degenerative glenoids. The aim of this study was to compare precision and accuracy of guide wire positioning into different glenoid models using a PSAD versus a standard guide.
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.
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.
摘要：
背景：患者专用瞄准装置（PSAD）可能会提高全肩关节置换术中关节盂部件定位的精度和准确性，尤其是在退行性腺样体中。这项研究的目的是比较使用PSAD和标准指南将导丝定位到不同关节盂模型中的精度和准确性。
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。
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。
