3D打印辅助改良Chevron截骨手术治疗拇外翻的应用

Clinical study of 3D-printing used to assistmodified Chevron osteotomy for hallux valgus

目的探讨3D打印辅助改良Chevron截骨手术治疗轻中度拇外翻的应用效果。方法回顾性分析解放军联勤保障部队第九○八医院2017年1月-2020年1月接受改良Chevron截骨治疗轻中度拇外翻患者(23足)的临床资料,根据选择治疗方式不同分为3D打印组(13足)和传统组(10足)。3D打印组采用3D打印辅助改良Chevron截骨手术,患者术前行CT扫描患足,设计截骨,打印足模型及截骨模板,术前模拟及术中辅助截骨。传统组采用传统徒手改良Chevron截骨。统计分析2组患者一般资料、手术时间、术中透视次数、术前及术后第一、二跖骨间夹角(IMA),术前及术后拇外翻角(HVA)、术前及末次随访时足踝外科功能评分(AOFAS)。结果2组手术时间及术后HVA比较差异无统计学意义(P>0.05)。3D打印组术中透视次数(2.46±0.66)少于传统组(3.10±0.74),3D打印组术后IMA(6.38±1.45)°矫正优于传统组(7.70±1.60)°,比较差异有统计学意义(P<0.05)。末次随访时2组足部功能AOFAS评分、优良率比较差异无统计学意义(P>0.05)。结论3D打印辅助及传统改良Chevron截骨手术治疗轻中度拇外翻均取得了良好的临床效果,但是3D打印辅助可以减少术中辐射暴露及获得更好的矫正效果。

Objective To explore clinical application of 3D-printing used to assist modified Chevron osteotomy for moderate hallux valgus.Methods We retrospectively analyzed the data of 23 feet with moderate hallux valgus who underwent modified Chevron osteotomy in the 908th Hospital of the Chinese People′s Liberation Army Joint Logistics Support Force between May 2017 to May 2021.They were divided into two groups according to surgical procedures as 3D-printing group(13 feet)and traditional group(10 feet).Patients in 3D-printinggroup were treated 3D-printing technology to design individual navigation templates used to assist osteotomy.While patients in traditionalgroup were treated with osteotomy according to surgical experience.The general information,operation time,number of intraoperative fluoroscopy,improvement of postoperative intermetatarsal angle and hallux valgus angle were compared between two groups.AOFAS score system was used to evaluate ankle function after surgery.Results There were no significant differences in general data.The operative time and post-operation HVA of two groups were no significant(P>0.05).The number of intraoperative fluoroscopy in 3D-printinggroup(2.46±0.66)was less than that in traditionalgroup(3.10±0.74).Postoperative IMA correction was better in 3D-printinggroup(6.38±1.45)°than that in traditionalgroup(7.70±1.60)°(P<0.05).The post-operative AOFAS score and good rate were no significant differences between the two groups(P>0.05).Conclusion Both 3D-printing technology and traditional modified Chevron osteotomy have achieved good clinical results in the treatment of mild and moderate hallux valgus,but 3D-printing couldreduce intraoperative radiation exposure and achieve better correction effect.