背景:这项研究的主要目的是在反向肩关节成形术(RTSA)的关节盂底板放置的虚拟计划中,检查背侧坐位百分比变量对扩孔骨体积和接触面积的影响。次要目标是评估增强的关节盂基板组件的选择如何影响虚拟定位基板的扩孔体积和皮质接触面积。
方法:9名外科医生使用商用软件系统计划了30例RTSA病例。选择了30例,以跨越关节盂畸形的范围。该研究包括三个阶段。在第1阶段,计划将背面座位百分比盲化,并且没有选择增强的基板组件。在阶段2中,背面座椅参数未被遮蔽。在第3阶段中,添加了增强的基板组件作为选项。记录植入物版本和倾斜度。使用CAD模型,计算扩骨的总体积以及扩骨的皮质体积和松质体积。总计,还计算了皮质和松质基板的接触面积。最后,计算每个阶段的总关节盂侧化并进行比较.
结果:平均植入版本在临床上各期相似,但在第3阶段统计学上较低(与第1阶段相比,p=0.006,与第2阶段相比,p=0.001)。不同阶段的平均植入物倾斜度在临床上相似,但在第3阶段统计学上较低(p<0.001)。与阶段1和阶段2相比,阶段3具有统计学上显著较低的松质骨和总扩骨体积(对于所有比较,p<0.001)。第3阶段具有统计学上明显更大的皮质接触面积,较低的松质接触面积,与阶段1和阶段2相比,总接触面积更大(所有比较的p<0.001)。与第1阶段(平均7.8,p<0.001)和第2阶段(平均7.9,p<0.001)相比,第3阶段的关节盂侧化(平均10.5mm)明显更大。
结论:在虚拟手术计划期间,广泛的关节盂病理学,经验丰富的肩关节成形术外科医生经常选择增强底板,全楔形增强基板的选择导致了关节盂畸形的统计学显著更大的矫正,改善了总和皮质基板的接触面积,松质骨较少,和更大的关节盂侧向化。背面座椅信息对RTSA的关节盂基板的实际定位没有显著影响。也不影响底板接触面积或扩骨的体积。
BACKGROUND: The primary goal of this investigation was to examine the influence of a backside seating percentage variable on volume of reamed bone and contact area in virtual planning for glenoid baseplate placement for reverse total shoulder arthroplasty (RTSA). The secondary goal was to assess how the option of augmented glenoid baseplate components affected reamed volume and cortical contact area of virtually positioned baseplates.
METHODS: Nine surgeons virtually planned 30 RTSA cases using a commercially available software system. The 30 cases were chosen to span a spectrum of glenoid deformity. The study consisted of 3 phases. In phase 1, cases were planned with the backside seating percentage blinded and without the option of augmented baseplate components. In phase 2, the backside seating parameter was unblinded. In phase 3, augmented baseplate components were added as an option. Implant version and inclination were recorded. By use of computer-assisted design models, total volume of bone reamed, as well as reamed cortical volume and cancellous volume, was calculated. Total, cortical, and cancellous baseplate contact areas were also calculated. Finally, total glenoid lateralization was calculated for each phase and compared.
RESULTS: Mean implant version was clinically similar across phases but was statistically significantly lower in phase 3 (P = .006 compared with phase 1 and P = .001 compared with phase 2). Mean implant inclination was clinically similar across phases but was statistically significantly lower in phase 3 (P < .001). Phase 3 had statistically significantly lower cancellous and total reamed bone volumes compared with phase 1 and phase 2 (P < .001 for all comparisons). Phase 3 had statistically significantly larger cortical contact area, lower cancellous contact area, and larger total contact area compared with phase 1 and phase 2 (P < .001 for all comparisons). Phase 3 had significantly greater glenoid lateralization (mean, 10.5 mm) compared with phase 1 (mean, 7.8 mm; P < .001) and phase 2 (mean, 7.9 mm; P < .001).
CONCLUSIONS: Across a wide range of glenoid pathology during virtual surgical planning, experienced shoulder arthroplasty surgeons chose augmented baseplates frequently, and the option of a full-wedge augmented baseplate resulted in statistically significantly greater correction of glenoid deformity, improved total and cortical baseplate contact area, less cancellous reamed bone, and greater glenoid lateralization. Backside seating information does not have a significant impact on how glenoid baseplates are virtually positioned for RTSA, nor does it impact the baseplate contact area or volume of reamed bone.