背景:通过头戴式显示器(HMD)的导航增强现实(AR)已导致在体外设置的反向肩关节成形术(RSA)中准确放置关节盂组件。这项研究的目的是评估计划之间的偏差,intra-,和术后倾斜度,逆行,RSA期间关节盂组件放置的进入点和深度,通过HMD导航AR,在手术环境中。
方法:前瞻性,进行了多中心研究。所有在两个机构接受RSA的连续患者,在2021年8月至2023年1月期间,被认为有可能纳入研究。纳入标准为:年龄>18岁,由AR通过HMD辅助的手术,和术后6周的计算机断层扫描(CT)扫描。所有参与者同意参与研究,并在所有情况下提供知情同意书。所有病例均进行了术前CT扫描,并用于三维(3D)计划。术中,在所有患者中,关节盂的制备和组件的放置均由导航AR系统通过HMD辅助。系统记录术中参数。术后6周进行CT扫描,并采用三维重建获得术后参数。计划之间的偏差,intra-,和术后倾斜度,逆行,入口点,并计算了关节盂组件放置的深度。异常值定义为倾斜和后倾>5°,入口点>5mm。
结果:17例患者(9例女性,12右肩),平均年龄72.8±9.1岁(范围,47.0至82.0)符合纳入标准。术中和术后测量之间的平均偏差为1.5°±1.0°(范围,0.0°至3.0°)用于倾斜,2.8°±1.5°(范围,1.0°至4.5°)用于逆行,1.8±1.0mm(范围,0.7mm至3.0mm)用于入口点,和1.9±1.9mm(范围,深度为0.0mm至4.5mm)。计划值与术后值之间的平均偏差为2.5°±3.2°(范围,0.0°至11.0°)用于倾斜,3.4°±4.6°(范围,0.0°至18.0°)用于逆行,2.0±2.5mm(范围,0.0°至9.7°)用于入口点,和1.3±1.6mm(范围,1.3mm至4.5mm)用于深度。术中和术后值之间没有异常值,计划值和术后值之间有三个异常值。跟踪器单元放置和肩胛骨配准的平均时间(分钟:秒)为03:02(范围,01:48至04:26)和08:16(范围,02:09至17:58),分别。
结论:通过RSA中的HMD使用导航AR系统导致计划之间的低偏差,关节盂组件放置的术中和术后参数。
BACKGROUND: Navigated augmented reality (AR) through a head-mounted display (HMD) has led to accurate glenoid component placement in reverse shoulder arthroplasty (RSA) in an in-vitro setting. The purpose of this study is to evaluate the deviation between planned, intra-, and postoperative inclination, retroversion, entry point and depth of the glenoid component placement during RSA, assisted by navigated AR through a HMD, in a surgical setting.
METHODS: A prospective, multicenter study was conducted. All consecutive patients undergoing RSA in two institutions, between August 2021 and January 2023, were considered potentially eligible for inclusion in the study. Inclusion criteria were: age >18 years, surgery assisted by AR through a HMD, and postoperative computed tomography (CT) scans at six weeks. All participants agreed to participate in the study and an informed consent was provided in all cases. Preoperative CT scans were undertaken for all cases and used for three-dimensional (3D) planning. Intra-operatively, glenoid preparation and component placement were assisted by a navigated AR system through a HMD in all patients. Intraoperative parameters were recorded by the system. A postoperative CT scan was undertaken at 6 weeks, and 3D reconstruction was used for obtaining postoperative parameters. The deviation between planned, intra-, and postoperative inclination, retroversion, entry point, and depth of the glenoid component placement was calculated. Outliers were defined as >5° for inclination and retroversion and >5 mm for entry point.
RESULTS: 17 patients (9 females, 12 right shoulders) with a mean age of 72.8±9.1 years old (range, 47.0 to 82.0) met inclusion criteria. The mean deviation between intra- and postoperative measurements was 1.5°±1.0° (range, 0.0° to 3.0°) for inclination, 2.8°±1.5° (range, 1.0° to 4.5°) for retroversion, 1.8±1.0 mm (range, 0.7mm to 3.0mm) for entry point, and 1.9±1.9 mm (range, 0.0mm to 4.5mm) for depth. The mean deviation between planned and postoperative values was 2.5°±3.2° (range, 0.0° to 11.0°) for inclination, 3.4°±4.6° (range, 0.0° to 18.0°) for retroversion, 2.0±2.5 mm (range, 0.0° to 9.7°) for entry point, and 1.3±1.6 mm (range, 1.3mm to 4.5mm) for depth. There were no outliers between intra- and postoperative values and there were three outliers between planned and postoperative values. The mean time (minutes:seconds) for the tracker unit placement and the scapula registration was 03:02 (range, 01:48 to 04:26) and 08:16 (range, 02:09 to 17:58), respectively.
CONCLUSIONS: The use of a navigated AR system through a HMD in RSA led to low deviations between planned, intra-operative and postoperative parameters for glenoid component placement.