3D打印个体化截骨导板辅助治疗Rozansky Ⅲ、Ⅳ型痛性跟距骨桥

3D printed individualized osteotomy template for treatment of painful talocalcaneal coalition of Rozansky typesⅢ-Ⅳ

目的探讨3D打印个体化截骨导板在RozanskyⅢ、Ⅳ型痛性跟距骨桥治疗中的应用价值。方法回顾性分析2016年1月至2018年8月武汉市第四医院足踝外科采用3D打印截骨导板辅助治疗的14例痛性跟距骨桥患者资料。男8例,女6例;年龄19~42岁(平均30.2岁)。获得全足CT扫描,以健侧为模板镜像标识切除骨桥部分并设计出3D定位截骨导板,在截骨导板引导下切除跟距骨桥病灶。记录末次随访时疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分及并发症发生情况。结果14例患者术后获平均21.6个月(12~33个月)随访。末次随访时VAS评分(2.3±0.7)分、AOFAS踝-后足评分(86.5±4.5)分均较术前(7.0±1.9)分、(37.1±6.0)分显著改善,差异有统计学意义(P<0.05)。随访期间未出现跟距骨桥复发或创伤性关节炎。结论3D打印个体化截骨导板技术可以对跟距骨桥实行精确定位、完整切除,为跟距骨桥的手术治疗提供一个新的技术辅助手段。

Objective To explore the effectiveness of 3D printed individualized osteotomy template for the treatment of painful talocalcaneal coalition of Rozansky typesⅢ-Ⅳ.Methods From January 2016 to August 2018,a 3D printed individualized osteotomy template was used in 14 patients with painful talocalcaneal coalition at Department of Foot and Ankle Surgery,Wuhan Fourth Hospital.They were 8 males and 6 females,aged from 19 to 42 years(mean,30.2 years).CT scan of full bilateral feet was conducted.The bone bridge to be resected was marked and an individualized template designed taking the CT scans of the healthy foot as mirror images.The 3D individualized templates were used to assist resection of talocalcaneal coalitions.Scores of visual analogue scale(VAS)and American Orthopaedic Foot and Ankle Society(AOFAS)and complications were recorded at the final follow-up.Results The 14 patients obtained an average follow-up of 21.6 months.Their VAS and AOFAS ankle and hindfoot scores(2.3±0.7 and 86.5±4.5)at the final follow-up were significantly improved compared with their preoperative values(7.0±1.9 and 37.1±6.0)(P<0.05).Their follow-up X-ray films showed no recurrence of talocalcaneal coalition or traumatic arthritis.Conclusion A 3D printed individualized osteotomy template is an effective assistance in the treatment of talocalcaneal coalition because it can lead to accurate location of the talocalcaneal bridge and full osteotomy.