mimics术前设计3D打印模型在拇外翻Cheveron术中的应用

目的探讨以mimics软件为基础,设计个体化截骨角辅助拇外翻Chevron截骨矫形手术。方法2019年1月至2021年6月Chevron截骨治疗的轻中度拇外翻患者60例,根据术前设计方案不同,分为计算机截骨组(A组)和经验截骨组(B组):其中A组30例30足,男5足,女25足,年龄(58.73±8.37)岁,负重位拇跖骨间角(IMA)(14.80°±3.10°),AOFAS评分(59.00±4.19)分,术前应用3D打印截骨导板设计操作方案,进行个体化截骨治疗;B组30例30足,男6足,女24足,年龄(58.53±6.16)岁,负重位IMA(14.97°±3.21°),AOFAS评分(59.90±9.39)分,术前仅参考负重位X线,根据手术经验截骨治疗。比较两组术后负重位IMA、拇外翻角度(HVA)的改善情况、术后随访填写足踝外科评分(AOFAS),对术后足踝部功能进行评估。结果60例患者随访8~12个月;术后负重位X线:A组IMA(4.13°±1.48°),B组IMA(5.27°±1.76°),A组HVA(10.20°±1.37°),B组HVA(11.10°±1.94°)。组间比较差异有统计学意义(P<0.05)。术后随访AOFAS评分:A组(83.57±5.34)分,B组(79.67±4.12)分,组间比较差异有统计学意义(P<0.05)。结论3D打印技术是一种个体化,数字化的手术方案制定方法。应用3D打印技术制定的个体化截骨方案治疗轻中度拇外翻,较传统经验制定手术方案能更好纠正患者IMA角,改善术后足部功能。

Objective To explore the design of personalized osteotomy angle-assisted Chevron osteotomy for hallux valgus based on mimics software.Methods A total of 60 patients with mild to moderate hallux valgus who underwent Chevron osteotomy from January 2019 to June 2021 were divided into a computer osteotomy group(group A)and an empirical osteotomy group(group B)according to different preoperative design plans:30 patients(30 feet)in group A,including 5 male feet and 25 female feet,aged(58.73±8.37)years,with an intermetatarsal angle(IMA)of(14.80°±3.10°)in the weight-bearing position and an AOFAS score of(59.00±4.19).A 3D printed osteotomy guide was used to design the operation plan before surgery for personalized osteotomy treatment.The group B included 30 patients(6 males and 24 females)with an age of(58.53±6.16)years.The weight-bearing IMA was(14.97°±3.21°)and the AOFAS score was(59.90±9.39).Only the weight-bearing X-ray was used before surgery,and osteotomy was performed according to surgical experience.The improvement of the weight-bearing IMA and hallux valgus angle(HVA)after surgery was compared between the two groups.The AOFAS score was filled in during the postoperative follow-up to evaluate the postoperative foot and ankle function.Results The 60 patients were followed up for 8-12 months.The weight-bearing X-ray after surgery showed that the IMA of group A was(4.13°±1.48°),the IMA of group B was(5.27°±1.76°),the HVA of group A was(10.20°±1.37°),and the HVA of group B was(11.10°±1.94°).The differences between the two groups were statistically significant(P<0.05).The AOFAS scores of group A and group B were(83.57±5.34)and(79.67±4.12)respectively,and the difference between the two groups was statistically significant(P<0.05).Conclusion 3D printing technology is an individualized and digital method for surgical planning.The individualized osteotomy plan formulated by 3D printing technology for the treatment of mild to moderate hallux valgus can better correct the IMA angle of patients and improve the postoperative foot function compared with the traditional experience-based surgical plan.