导航下反肩关节置换术中肩盂基座螺钉置入精确性与安全性研究

The Accuracy and Safety of Navigated Glenoid Baseplate Screw Placement in Reverse Shoulder Arthroplasty

目的:建立导航下反肩关节置换术中肩盂基座螺钉置入的研究模型,并对传统反肩关节置换术与导航下反肩关节置换术中肩盂基座螺钉置入的精确性与安全性进行对比研究。方法:以3D打印技术基于10名患者术前CT扫描数据制备肩胛骨模型,10个为一组,共计2组,分别为传统手术组和导航手术组。传统手术组中,由同一高年资手术医师完成10例反肩关节置换术中肩盂基座螺钉置入操作;导航手术组中,由同一高年资手术医师在实时导航辅助下完成10例肩盂基座螺钉置入操作。对所有术后肩胛骨模型投照肩胛正位X线片,记录肩胛上切迹最低点距肩盂基座上方螺钉长轴的垂直距离,作为安全性指标;直视下测量螺钉穿出肩胛骨皮质外的裸露长度,作为精确性指标。对比分析传统手术组与导航手术组的肩盂基座螺钉置入操作的安全性与精确性。结果:肩胛上切迹最低点距肩盂基座上方螺钉长轴的垂直距离:导航手术组4.4±4.0 mm,传统手术组-4.0±6.4 mm(负值表示钉尾穿出肩胛骨皮质),两组比较差异有统计学意义(P<0.05);导航手术组中有2例(20%)螺钉尾部穿出肩胛上切迹皮质,传统手术组中有7例(70%)钉尾穿出肩胛上切迹皮质。螺钉穿出肩胛骨皮质外的裸露长度:导航手术组1.8±1.5 mm,传统手术组8.2±5.2 mm,两组比较差异有统计学意义(P<0.05)。结论:与传统手术相比,导航下肩盂基座螺钉置入操作具有较高的精确性和较好的安全性。

Objective To compare the accuracy and safety of the conventional and navigated glenoidbaseplate screw placement in the reverse shoulder arthroplasty.MethodsTen pairs of scapular modelswere made using the 3 D printing technique based on the preoperative CT scans. Then they were ran-domly divided into a conventional surgery group and a navigated surgery group,each of ten scapularmodels. In the conventional surgery group,one senior surgeon completed all the procedures of routine-ly placing the glenoid baseplate screws into the scapular models, while in the navigated surgerygroup, all the procedures were performed by the same surgeon under the real-time navigation. Thetrue AP view was obtained for all the scapular models postoperatively. The vertical distance betweenthe lowest point of the suprascapular notch and the axial line along the upper screw of baseplate wasrecorded. The length of the screw portion which penetrated out of the glenoid vault was measured. Theaccuracy and safety of the baseplate screw placement was compared between the two groups.Results The vertical distance between the lowest point of the suprascapular notch and the axial line along theupper screw of baseplate was of significant difference between the navigated surgery group(4.4 ± 4.0mm) and the conventional surgery group(-4.0 ± 6.4 mm,negative value means the screw penetratedout from the suprascapular notch,P<0.05). There were two models(20%) with screw penetrating outof the suprascapular notch in the navigated surgery group,but seven(70%) in the conventional sur-gery group. Significant differences were found between the navigated group(1.8 ± 1.5 mm) and the con-ventional group(8.2 ± 5.2 mm) in the length of the screw portion that penetrated out of the glenoidvault(P<0.05).ConclusionCompared with the conventional surgery, the navigated glenoid baseplatescrew placement in reverse shoulder arthroplasty is a more accurate and safer procedure.