演示如何使用反向肩关节置换术(RSA)计划软件来改善受训者如何定位关节盂和肱骨植入物并获得最佳的模拟运动范围(ROM)。
我们选择了四组,每组五个不同级别的参与者:医学生(MS),初级居民(JR),高级居民(SR),和肩部专家(SE)。此后,20名参与者在经过验证的计划软件上为RSA计划了5例关节炎的肩膀,分为三个阶段:(1)没有指南和ROM反馈,(2)指南,但没有ROM反馈,和(3)指南和ROM反馈。我们评估了最终模拟的无撞击ROM,植入物的选择(基板尺寸,移植,卵球),和关节盂植入物定位。
MS计划仅通过ROM反馈得到了显着改善。JR在最终结果中充分利用了指南和ROM。在屈曲方面,SR计划的表现不如SE进入第一阶段,外部旋转,和内收(分别为-10°,p=0.03;-11°,p=0.003;和-3°,p=0,03),但在第三阶段达到了类似的结果(分别为-2°,p=0.329;-4°,p=0.44;-2°,p=0.319)。对于MS,JR,SR,我们观察到该协议在学习课程上有系统的改进。即使对于SE,关节盂直径也保持高度可变。比较关节盂植入位置与SE,距离误差随相位提前而减小。
规划软件可用作模拟训练工具,以改善肩关节成形术中的植入物定位。
To demonstrate how reverse shoulder arthroplasty (RSA) planning software could be used to improve how the trainees position glenoid and humeral implants and obtain optimal simulated range of motion (ROM).
We selected four groups of five various level participants: medical student (MS), junior resident (JR), senior resident (SR), and shoulder expert (SE). Thereafter, the 20 participants planned five cases of arthritic shoulders for a RSA on a validated planning software following three phases: (1) no
guidelines and no ROM feedback, (2)
guidelines but no ROM feedback, and (3)
guidelines and ROM feedback. We evaluated the final simulated impingement-free ROM, the choice of the implant (baseplate size, graft, glenosphere), and the glenoid implant positioning.
MS planning were significantly improved by the ROM feedback only. JR took the best advantage of both
guidelines and ROM in final results. SR planning were less performant than SE into phase 1 regarding flexion, external rotation, and adduction (respectively - 10°, p = 0.03; - 11°, p = 0.003; and - 3°, p = 0,03), but reached similar results into phase 3 (respectively - 2°, p = 0.329; - 4°, p = 0.44; - 2°, p = 0.319). For MS, JR, and SR, we observed a systematic improvement in the agreement over the study course. The glenoid diameter remained highly variable even for SE. Comparing glenoid implant position to SE, the distance error decreased with advancing phases.
Planning software can be used as a simulation training tool to improve implant positioning in shoulder arthroplasty procedures.