3D打印改良Reverdin截骨模板治疗拇外翻畸形的初步应用

Computer-aided modification of Reverdin osteotomy template for hallux valgus

目的利用三维重建和3D打印技术为改良Reverdin截骨术治疗拇外翻畸形手术方案的制定和实施提供一种精确截骨的方法°方法对2015年6月至2016年6月我们收治的11例（16足）拇外翻患者在负重位行X线检查和足部连续螺旋CT扫描，测量平均拇外翻角为33．50°±6．80°，第一跖骨间角为12．20°± 2．90°，跖骨远端关节角为15．20°±2．60°°将原始Dieom格式数据导入Ma-terialise Mimics Innovation Suite 16．0软件，三维重建足部模型，将足部三维重建模型以.stl格式保存，导入Imageware 12．0软件，根据Reverdin截骨方式设计最佳截骨线及角度，然后建立与截骨范围解剖学形态一致的截骨模板，3D打印模板实体，手术时将建立的截骨模板与第一跖骨头贴合，沿截骨模板进行截骨，克氏针固定。术后观察拇外翻角度改善、截骨愈合及负重行走情况。结果16足截骨角度满意，术后经6～12个月随访，拇外翻角度为7．3l°±0．33°（5°~ 11°），平均校正度为21．92°±4．8°（13°~ 240），截骨处骨愈合好，负重行走无痛。结论通过计算机辅助技术设计的改良Reverdin截骨模板为四外翻畸形矫正术提供一种个性化、精确截骨的方法，增大了截骨后截骨端接触面积，截骨处骨愈合好。

Objective To provide a method to modify accurately the Reverdin osteotomy template for hallux valgus using 3D reconstruction and printing. Methods From June 2015 to June 2016, 11 patients （16 feet） with hallux valgus at our departments underwent weight-bearing X-ray examination and continuous spiral CT scanning of the feet. The outer turning angle of hallux averaged 33.50° ± 6. 80°, the first inter-metatarsal angle 12.20° ± 2. 90° and the distal metatarsal articular angle 15.20° ± 2.60°. Their imaging Di-com data were imported into Materialise Mimics Innovation Suite vl 6. 0 software for generation of 3D models of the pelvis which were then stored in stereolithography format and imported into Imageware 12 software. After optimal templates were reversely rebuilt to have the best angles and range for Reverdin osteotomy in the 3D models, they were manufactured by a rapid prototyping machine. The osteotomy templates were used in surgery to guide the osteotomy of hallux valgus. Correction of hallux valgus, bone union at the osteotomy sites and weight -bearing walk were observed postoperatively. Results Accurate angles of osteotomy were con-firmed by postoperative radiography in all the 16 feet. Follow-ups for 6 to 12 months showed in the 16 feet a mean outer turning angle of hallux of 7.31° ± 0. 33° （from 5° to 11°） and a mean correction of 21.92° ± 4. 8° （from 13° to 24°）. Bone union was fine at the osteotomy sites and no pain was reported during weight-bearing walk, Conclusion 3D reconstruction and printing can produce a patient-specific template for accurate Reverdin osteotomy for hallux valgus, leading to increased contact area and fine union of the osteotomy ends.