在反向肩关节成形术的背景下,关节盂底板放置的一些参数遵循既定的黄金法则,而其他参数仍未达成共识。对关节盂基板未来位置的关节盂磨损的评估因外科医生而异。这项研究的目的是分析虚拟术前计划期间关节盂基板3D定位的观察者间可重复性。
4名肩关节外科医师在30名退行性肩关节的CT扫描中规划了一个反向关节成形术的关节盂底板位置。外科医生之间比较了关节盂导销进入点和关节盂基板中心的位置。还分析了底板的版本和倾斜度。
对于近100%的肩部,在±4mm内实现了销钉进入点的3D定位。超级下级,基板中心的前后和中外侧位置在±2mm内达到77.2%,计划的67.8%和39.4%,分别。四位外科医生之间在±10°内的关节盂基板的3D方向不一致(弱一致性,K=0.31,p=0.17)。
外科医生之间关节盂导针的放置非常一致。相反,在偏侧化问题上几乎没有达成一致,在外科医生之间定位关节盂基板的版本和倾斜标准。这些参数需要在临床实践中进一步研究以建立黄金规则。术前计划的三维信息有助于评估关节盂畸形并限制其对不同外科医生获得的基板位置的影响。
III.病例对照研究。
In the context of reverse shoulder arthroplasty, some parameters of glenoid baseplate placement follow established golden rules, while other parameters still have no
consensus. The assessment of glenoid wear in the future location of the glenoid baseplate varies among surgeons. The objective of this study was to analyze the inter-observer reproducibility of glenoid baseplate 3D positioning during virtual pre-operative planning.
Four shoulder surgeons planned the glenoid baseplate position of a reverse arthroplasty in the CT scans of 30 degenerative shoulders. The position of the glenoid guide pin entry point and the glenoid baseplate center was compared between surgeons. The baseplate\'s version and inclination were also analyzed.
The 3D positioning of the pin entry point was achieved within ± 4 mm for nearly 100% of the shoulders. The superoinferior, anteroposterior and mediolateral positions of the baseplate center were achieved within ± 2 mm for 77.2%, 67.8% and 39.4% of the plans, respectively. The 3D orientation of the glenoid baseplate within ± 10° was inconsistent between the four surgeons (weak agreement, K=0.31, p=0.17).
The placement of the glenoid guide pin was very consistent between surgeons. Conversely, there was little agreement on the lateralization, version and inclination criteria for positioning the glenoid baseplate between surgeons. These parameters need to be studied further in clinical practice to establish golden rules. Three-dimensional information from pre-operative planning is beneficial for assessing the glenoid deformity and for limiting its impact on the baseplate position achieved by different surgeons.
III. Case control study.