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24.09.2021 | Arthropedia | Online-Artikel

Patientenindividuelle glenoidale Implantate in der Schulterendoprothetik

Custom-made glenoid implants in shoulder arthroplasty

Die Behandlung ausgeprägter glenoidaler Knochendefekte ist herausfordernd. Patientenindividuelle glenoidale Implantate stellen diesbezüglich ein neues Verfahren dar, welches mit enormen potenziellen Vorteilen behaftet ist. Die eigenen Erfahrungen zeigen, dass mit dieser Technologie einerseits der glenoidale Knochendefekt reproduzierbar wiederherzustellen ist und andererseits eine stabile Verankerung und eine hochpräzise Implantatpositionierung entsprechend der präoperativen Planung erzielt werden kann. Dies stellt sich besonders im Vergleich zu Alternativverfahren, wie der knöchernen Glenoidaugmentation, als substanzieller Vorteil der Technik für diese häufig hochdefizitären und anspruchsvollen Situationen dar. Nach Durchführung einer Computertomographie (CT) der Schulter wird präoperativ das individuelle Implantatdesign dreidimensional detailliert computergestützt geplant. Von zentraler Bedeutung für die korrekte und planungsgetreue Positionierung des definitiven Implantats während der Operation ist eine präzise Einbringung eines Kirschner-Drahts mittels PSI(„patient specific instrumentation“)-Guide.. Nach Fixation der glenoidalen Komponente kann diese mit Standardimplantaten des jeweiligen Systems kombiniert werden. Die aktuell vorhandene Literatur ist ermutigend und zeigt, dass kurzfristig signifikante klinische Erfolge mit dem Verfahren erzielbar sind. Weitere Forschung im Sinne von biomechanischen Untersuchungen und längeren Nachuntersuchungszeiträumen ist wünschenswert, um die Wertigkeit des Verfahrens weiter zu präzisieren.

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