3D导板技术在反肩关节置换中的应用

Application of 3D guide plate technology in reverse shoulder joint replacement

目的研究探讨3D导板技术在反肩关节置换中的应用效果。方法选取2020年10月至2022年10月本院收治的29例行反肩关节置换术患者为对象,随机数字表法分为观察组11例、对照组18例。观察组:男2例、女9例;年龄46~83岁,平均年龄(65.27±11.56)岁;ASA分级:I级2例、II级5例、Ⅲ级3例、Ⅳ级1例;手术位置:左肩2例、右肩9例;原发疾病:肱骨粉碎性骨折5例、肱骨头坏死1例、肩关节骨性关节炎2例、肩袖型关节病3例。对照组:男6例、女12例;年龄52~80岁,平均年龄(65.00±9.99)岁;ASA分级:I级1例、II级12例、Ⅲ级5例;手术位置:左肩7例、右肩11例;原发疾病:肱骨粉碎性骨折12例、肩关节骨性关节炎3例、肩袖型关节病3例。组间一般资料比较差异无统计学意义(P>0.05)。观察组采用3D打印导板技术进行反肩关节置换术治疗,对照组行常规反肩关节置换术治疗。结果对两组患者手术进行情况、并发症发生率、肩关节活动功能评分、生活质量评分进行评估对比。观察组患者手术时间、术中出血量、开始下床活动时间均低于对照组(P<0.05)。观察组术后并发症发生率为0.00%(0/11),低于对照组患者为33.33%(6/18,P<0.05)。术后3个月,观察组Constant-Murley肩关节功能评分包括疼痛、活动度评分均高于对照组(P<0.05),而Constant-Murley肩关节功能评分中的日常生活活动、肌力评分以及术后3个月观察组世界卫生组织生活质量-100量表各项评分的比较差异无统计学意义(P>0.05)。结论3D导板技术可以较好的应用在反肩关节置换中,能够减少手术时间、术中出血量,有利于患者早期下地,缓解疼痛,降低术后并发症发生率,改善患者的肩关节活动度。

Background Reverse shoulder arthroplasty is a common joint replacement in orthopedic clinics.The main indications of this operation include proximal humeral comminution,humeral head necrosis,shoulder osteoarthritis,rotator cuff arthritis,etc.Due to the severe fracture or lesion,the prosthesis is implanted through replacement during the operation.Reverse shoulder arthroplasty has promising applications in treating various shoulder diseases due to its advantages of an excellent postoperative rehabilitation effect,faster functional recovery,and good local appearance.However,the anatomical structure of the shoulder joint is complex,especially in patients with bone diseases,and defects or deformities often accompany the glenoid.Therefore,treating the glenoid side in reverse shoulder arthroplasty is difficult.If the position of the glenoid base is not good,postoperative complications such as joint loosening and joint detachment are prone to occur,affecting patients'prognosis.In recent years,with the improvement of orthopedic surgical techniques and the application of 3D printing technology,preoperative three-dimensional reconstruction of the implanted prosthesis and preparation of physical composite models of the fracture site can significantly improve the matching degree of the implanted prosthesis,thereby improving the surgical effect.This technology also provides new ideas for the improvement of reverse shoulder arthroplasty.Objective To investigate the application effect of 3D navigation template technology in reverse shoulder arthroplasty.Methods A total of 29 patients who underwent reverse shoulder arthroplasty in our hospital from October 2020 to October 2022 were included in this study.Using a random number table,they were randomly divided into an observation group(n=11)and a control group(n=18).In the observation group,there were 2 males and 9 females,with an age range of 46 to 83 years and an average age of(65.27±11.56)years.The ASA classification was grade I in 2 cases,grade II in 5 cases,grade III in 3 cases,and grade IV in 1 case.The surgical positions were 2 cases in the left shoulder and 9 cases in the right shoulder,with primary diseases including comminuted fractures of the humerus in 5 cases,avascular necrosis of the humeral head in 1 case,osteoarthritis of the shoulder joint in 2 cases,and shoulder cuff-related joint disease in 3 cases.In the control group,there were 6 males and 12 females,with an age range of 52 to 80 years and an average age of(65.00±9.99)years.The ASA classification was grade I in 1 case,grade II in 12 cases,and grade III in 5 cases.The surgical positions were 7 cases in the left shoulder and 11 cases in the right shoulder,with primary diseases including comminuted fractures of the humerus in 12 cases,osteoarthritis of the shoulder joint in 3 cases,and shoulder cuff-related joint disease in 3 cases.The two groups had no statistically significant difference in general data(P>0.05).The observation group underwent reverse shoulder arthroplasty using 3D printing navigation template technology,while the control group underwent conventional reverse shoulder arthroplasty.Results The surgical duration,intraoperative blood loss,and time to initiate ambulation in the observation group were all lower than those in the control group(P<0.05).The postoperative complication rate in the observation group was 0.00%(0/11),which was lower than that in the control group(33.33%,6/18,P<0.05).At 3 months postoperatively,the Constant-Murley shoulder joint function scores,including pain and mobility scores,were higher in the observation group than in the control group(P<0.05).However,there was no statistically significant difference in the scores for daily life activities,muscle strength,and the World Health Organization Quality of Life-100 scale between the two groups at 3 months postoperatively(P>0.05).Conclusion 3D navigation template technology can be effectively applied in reverse shoulder arthroplasty,reducing surgical duration and intraoperative blood loss,facilitating early mobilization,alleviating pain,lowering the incidence of postoperative complications,and improving shoulder joint mobility.