DJO肩关节假体的Matchpoint一定可靠吗？

1. 

DJO假体

2.

Matchpoint

3. 09-08-2022 

Correspondence

Diagnosis

Rheumatoid arthritis affecting bilateral shoulders and elbows.

类风湿性关节炎影响双侧肩膀和肘部。

Treatment to Date

Right DJO reverse total shoulder replacement, 29 July 2019

2019年7月29日右DJO反向全肩置换术

Plan

TCl planned for this month for DJO reverse left total shoulder replacement

TCl计划于本月进行DJO左肩置换术

I met with Mrs XXX in clinic today prior to admission only because it has been such a long time since she and I last met face-to-face. The right shoulder continues to function extremely well. The left shoulder continues to be very painful and stiff as does the left elbow.

我今天在诊所见了即将住院的XXX女士，只是因为我和她已经有很长时间没有见面了。右肩的功能仍然非常好。左肩和左肘部仍然非常疼痛和僵硬。

We re-discussed the planned surgery in that I may need to use some additional bone graf because of the wear on her left shoulder socket and we re-discussed the risks including bleeding, infection, loosening, instability and fracture and the need for her to be in a sling for six weeks postsurgery. My hope is that she is as happy with this side as the right side.

我们重新讨论了手术计划，因为她左肩的磨损，我可能需要使用一些额外的骨移植，我们重新讨论了风险，包括出血、感染、松动、不稳定和骨折，以及术后6周需要用吊带。我希望她左边和右边一样快乐。

We did discuss how symptomatic the left elbow was and we discussed whether she would in fact prefer me to do the left elbow first but after careful consideration in clinic, decided that the left shoulder remains the more problematic of the two. 

我们确实讨论了左肘部的症状，我们讨论了她是否更喜欢我先做左肘部，但在临床仔细考虑后，认为左肩仍然是两个中更有问题的。

4. 

Preopreative Examination

09-Aug-2022 CR

28-Aug-2021 CT

5. 12-02-2023

Planning Report

5-1. Pre-op Anatomical Conditions

5-2. Approved Glenoid Surgical Plan Parameters

5-3. Peripheral Screw Lengths

5-4. Approved Humerus Surgical Plan Parameters

6. 16-02-2023

Operation Notes

Diagnosis

Inflammatory arthritis left shoulder with significant glenoid erosion

左肩炎性关节炎伴明显的关节盂缺损

Operation

Humeral head resection and bone autograft to left glenoid

采用切除的肱骨头行左关节盂自体植骨

Findings

Collapsed HH with sever glenoid erosion and significant medialisation. Posterior glenoid extremely thin. Bone both soft and sclerotic. Extensive synovitis and adhesions within GH joint. Cuff thin, scarred and inflamed. Good deltoid and PM.

HH塌陷。严重关节盂糜烂和明显内移，后方关节盂极薄，硬化与囊性变并存，GH关节内广泛滑膜炎和粘连。肩袖菲薄，大量疤痕增生。三角形和胸大肌功能良好。

Procedure

DP approach. ACH vessel ligated and divided. Cranial P Major release. SSc tenotomy. MCN and axillary nerve stimulated. Inferior capsule release. Proximal humerus osteotomy with jig. Humerus rasped and metaphysis reamed. Unable to visualise glenoid so partial conjoint release for exposure. Glenoid exposed and Matchpoint guide used for central dril hole. Central hole tapped and glenoid effaced. On effacing glenoid vertical crack through central drill hole and posterior wall fragmented. Decision made that glenoid required a custom glenoid and to therefore stage surgery. 

DP入路。ACH血管结扎并分离。SSc腱切开。刺激MCN和腋窝神经。关节囊松解。用截骨导板行肱骨近端截骨。肱骨干骺端变形。无法看到关节盂，因此部分释放部分连接以暴露。关节盂外露，Matchpoint导板下行中心钻孔，通过中心孔制备和磨锉关节盂的过程中，关节盂后壁粉碎。我们决定对关节盂进行定制手术。

7. 17-02-2023

Postoperative Re-examination

7. Why？Why？Why？

难道Matchpoint无用？

Matchpoint数据显示, 本病例Superior inlination 17°; Anterversion 4°; 34% Subluxation。即本患者肩胛盂是上倾和前倾状态，因此，术前计划采用切除的肱骨头行关节盂自体植骨以恢复生理性的肩胛盂参数。因患者类风湿病史导致了肩胛盂后壁表面结构的完整性，但术中在磨锉肩胛盂的过程中，发现肩胛盂后壁内部结构处于大量囊性变和硬化夹杂结构，因Matchpoint是依据肩胛盂的表面形态实现的规划，因此，本患者，在没有感染的情况下，一期采用Spacer置入，二期定制肩胛盂假体。

这道数学题，您学会了吗？

致谢:

浙大二院骨科：叶招明主任

浙大二院国际交流办公室：杨明丽处长

浙江省卫生健康委员会合作交流处：陈正方处长

英国伦敦圣乔治医院：张伟副院长

英国皇家国立骨科医院：Miss Deborah Higgs