Ludloff截骨术治疗踇外翻的三维数字模型研究

目的　建立母外翻足三维数字模型，通过模拟Ludloff截骨手术，比较术前术后各项参数的变化，预测术后疗效及并发症，为临床进行母外翻Ludloff截骨术提供一定的理论支持，尽可能降低手术风险，增加手术安全性，提高疗效。 方法　回顾性调查11例（13足）在本院足踝外科治疗的母外翻患者，模拟手术前后对三维重建模型进行母外翻角（HVA）、第1~2跖间角（IMAI~II）、第1跖骨长度、第2跖骨相对长度、第1~5跖间角（IMAI~V）等数值测量记录，并行统计学分析。 结果 模拟截骨术前后HVA分别为（35.62±6.54）°，（11.43±3.24）°；IMAI~II分别为（16.43±2.41）°，（9.12±3.18）°；第1跖骨长度分别为（63.58±4.17）mm，（59.87±3.83）mm；第2跖骨相对长度分别为（93.74±6.02）°，（86.85±5.36）°；IMAI~V分别为（29.68±3.65）°，（19.45±2.46）°。模拟手术前后上述对应指标改变有统计学意义（P<0.05）。 结论　应用三维数字模型技术对母外翻患者进行模拟Ludloff截骨术及测量相关参数，是一种可以评估Ludloff截骨效果的数字化技术，为制定手术方案提供依据。

Three-dimensional digital model of Ludloff osteotomy for treating hallux valgus

Objective To set up a 3 D digital model of hallux valgus and provide theoretical support for Ludloff osteotomy in patients with hallux valgus to reduce the operation risk, increase the operation safety and improve the curative effect by simulating Ludloff osteotomy, comparing the changes of preoperative and postoperative parameters, predicting the postoperative curative effect and complications Methods 11 cases of patients(13 feet)with hallux valgus who treated at department of foot and ankle surgery, Guangzhou orthopaedic hospital from January 2016 to January 2017 were retrospectively collected. A3D digital model of the foot was set up based on CT data. 3D construction model was simulated to measure and statistically analyze the preoperative and postoperative the hallux valgus angel( HVA), the intermetatarsal angel from the first to the second metatarsal(IMAI~Ⅱ), the length of the first metatarsal, the relative length of the second metatarsal and the intermetatarsal angel from the first to the fifth metatarsal(IMAI^V). Results Preoperative and postoperative simulating osteotomy of HVA, IMAI~Ⅱ,length of the first metatarsal, the relative length of the second metatarsal, IMAI^Vwere(35.62±6.54) °and(35.62±6.54) °,(16.43±2.41)°and(9.12±3.18)°,(63.58±4.17)mm and(59.87 ± 3.83)mm,(93.74 ± 6.02)° and(86.85 ± 5.36)°,(29.68 ± 3.65)° and(19.45 ± 2.46)°respectively. There were statistical significance of the above corresponding indicator changes of before and after simulating osteotomy(P<0.05). Conclusions Using 3 D digital model technique to simulate Ludloff osteotomy and measure the parameters is a feasible way to evaluate the effect of Ludloff osteotomy and provide reference for formulating the operative plan.