3D打印导航模板辅助Ludloff截骨矫形术治疗中重度外翻

Clinical study of three-dimensional printed navigation template assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus

目的探讨3D打印导航模板辅助Ludloff截骨矫形术治疗中重度外翻的疗效及优势。方法将2013年4月—2015年2月拟行Ludloff截骨矫形术治疗且符合选择标准的28例(28足)中重度外翻患者纳入研究,随机分为两组(n=14):A组为采用3D打印导航模板辅助截骨手术,B组为传统截骨手术。两组患者性别、年龄、患足侧别和外翻分度等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、术中出血量;术前、术后即刻及末次随访时,采用美国矫形足踝协会(AOFAS)评分评价患足功能;根据X线片测量外翻角(hallux valgus angle,HVA)、跖骨间角(intermetatarsal angle,IMA)以及第1跖骨长度短缩程度。结果患者均获随访,随访时间18～40个月,平均26.4个月。A组手术时间和术中出血量均显著少于B组,差异有统计学意义(P<0.05)。A、B组术后即刻及末次随访的HVA、IMA和AOFAS评分均较术前显著改善,差异有统计学意义(P<0.05);术后即刻与末次随访时比较,差异无统计学意义(P>0.05)。A、B组间术前、术后即刻及末次随访时的HVA、IMA比较,差异无统计学意义(P>0.05)。术后即刻及末次随访时,A、B组间AOFAS评分及第1跖骨长度短缩比较,差异有统计学意义(P<0.05)。术后除B组1例发生转移性跖骨痛外,A、B组均无相关并发症发生。结论采用3D打印导航模板辅助Ludloff截骨矫形术,可以达到术前准确制定手术计划、术中实施精准截骨的目的,是治疗中重度外翻的有效方法之一。

Objective To explore the effectiveness and advantage of three-dimensional（3 D） printed navigation templates assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus. Methods Between April 2013 and February 2015, 28 patients（28 feet） with moderate and severe hallux valgus who underwent Ludloff osteotomy were randomly divided into 2 groups（n=14）. In group A, the patients were treated with Ludloff osteotomy assissted with a 3 D printed navigation template. In group B, the patients were treated with traditional Ludloff osteotomy. There was no significant difference in gender, age, affected side, and clinical classification between 2 groups（P〈0.05）. The operation time and intraoperative blood loss were recorded. The ankle function of the foot at preoperation, immediate after operation, and last follow-up were assessed by the American Orthopedic Foot and Ankle Society（AOFAS） score. Besides,the X-ray film were taken to assess the hallux valgus angle（HVA）, intermetatarsal angle（IMA）, and the first metatarsal length shortening. Results All patients were followed up 18-40 months（mean, 26.4 months）. The operation time and intraoperative blood loss in group A were significantly less than those in group B（P〈0.05）. The HVA, IMA, and AOFAS scores in groups A and B at immediate after operaton and last follow-up were sinificantly improved when compared with preoperative values（P〈0.05）; but no significant difference was found between at immediate after operation and at last follow-up（P〉0.05）. No significant difference was found in HVA and IMA between group A and group B at difference time points（P〉0.05）. There were significant differences in AOFAS score and the first metatarsal length shortening at immediate after operation and at last follow-up between 2 groups（P〈0.05）. Except 1 case of metastatic metatarsalgia in group B, there was no other operative complications in both groups. Conclusion 3 D printed navigation template assisted Ludloff osteotomy can provide accurate preoperative planning and intraoperative osteotomy. It is an ideal method for moderate and severe hallux valgus.