3D打印技术制定个体化截骨角在拇外翻Chevron截骨矫形术中的应用

目的:探讨3D打印技术制定个体化截骨角在拇外翻Chevron截骨矫形术中的临床应用。方法:自2013年5月至2016年5月,采用Chevron截骨治疗轻中度拇外翻患者47例(66足),根据术前设计方案分为计算机截骨组(A组)和传统截骨组(B组)。其中A组25例(33足),男4例(5足),女21例(28足),平均年龄(47.88±6.08)岁,负重位跖骨间角(IMA)(13.58±1.15)°,术前AOFAS评分59.00±5.86,术前采用个性化3D打印技术设计操作方案,进行个体化截骨治疗;B组22例(33足),男3例(3足),女19例(30足),平均年龄(48.16±6.16)岁,负重位IMA(13.51±1.14)°,术前AOFAS评分60.67±5.85,术前仅参考负重位X线,根据手术经验截骨治疗。比较两组患者的手术时间、术中出血量、住院时间、术后1周VAS疼痛评分、创口愈合情况及术后负重位IMA的改善情况,并采用足踝外科评分系统(AOFAS)对术后足踝部功能进行评估。结果:A组随访时间为(12.41±2.32)个月与B组为(11.73±2.76)个月比较差异有统计学意义。B组1例术后失访排除,所有病例术后创口Ⅰ期愈合,两组患者手术时间、术中出血量、住院时间及术后1周VAS疼痛评分比较差异无统计学意义(P0.05);A组术后IMA为(5.21±0.88)°,B组IMA为(6.42±0.85)°,两组比较差异有统计学意义(t=5.68,P0.05)。A组AOFAS评分为88.15±5.19与B组为82.90±5.01比较差异有统计学意义;A组优14足,良19足;B组优5足,良27足;两组比较差异有统计学意义(P0.05)。结论:应用3D打印技术制定的个体化截骨方案治疗轻中度拇外翻,较传统经验制定手术方案能更好地纠正患者的IMA,改善术后足部功能,是一种个体化数字化的手术方案。

Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy

Objective: To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy. Methods: From May 2013 to May 2016,47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A,there were 25 patients (33 feet),including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old,average weight IMA was (13.58±1.15) degree,AOFAS score was 59.00±5.86,and treated individual 3D printing technology to design operation scheme. While in group B,there were 22 patients (33 feet),including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old,average weight IMA was(13.51±1.14) degree,AOFAS score was 60.67±5.85,and treated with osteotomy according to surgical experience. Operation time,blood loss,hospital stays,VAS score at 1 week after operation,wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups,AOFAS score system was used to evaluate ankle function after surgery. Results: There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time,blood loss,hospital stays and VAS score at 1 week after operation(P<0.05); IMA in group A was (5.21±0.88) °, (6.42±0.85)° in group B, and had significant differences between two groups (t=5.68,P<0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01(t=4.14,P<0.05). Fourteen feet in group A obtained excellent results and 19 feet good,while 5 feet in group B obtained excellent results and 27 feet good. Conclusion: Compared with traditional osteotomy group,three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy could better correct IMA,improve postoperative foot function,and it is a kind of individualized and digital method to design operation.