Siddiqui Noman A, Lamm Bradley M
Chief of Podiatry, Northwest Hospital, and Medical Director, Diabetic Limb Preservation, LifeBridge Health, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
Chief, Diabetic Limb Preservation, LifeBridge Health, Head of Foot and Ankle Surgery, and Director, Foot and Ankle Deformity Correction Fellowship, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
J Foot Ankle Surg. 2014 Nov-Dec;53(6):700-5. doi: 10.1053/j.jfas.2014.04.011. Epub 2014 Jun 6.
Preoperative planning is commonly performed for many foot and ankle procedures. The purpose of the present study was to prospectively determine the preoperative digital planning accuracy of predicting the calcaneal graft size used during the "Evans" calcaneal osteotomy. Preoperative digital deformity correction planning, using a standard planning method (TraumaCad(®) software), was performed on 10 feet scheduled to undergo an Evans procedure. Of the 10 patients, 6 were female and 4 were male, with an average age of 43 ± 22 years. Digital planning was used to predict the Evans graft size. The surgeon was unaware of the predicted graft size, which was then compared with the actual graft size inserted during the procedure. In addition, the pre- and postoperative radiographic angles were recorded and compared (anteroposterior view, talo-first metatarsal angle, calcaneocuboid abduction; lateral view, calcaneal inclination angle; and axial view, tibial-calcaneal angle). The average preoperative talo-first metatarsal angle, calcaneocuboid angle, calcaneal inclination angle, and tibial-calcaneal angle measured 21° ± 9.6°, 28.3° ± 9.0°, 13.8° ± 5.7°, and 15.3° ± 8.2°, respectively. The preoperative tibial-calcaneal position was 2.8 ± 1.2 mm. The radiographic weightbearing angles measured at an average follow-up of 7.4 (range 6 to 12) months improved to 6.3° ± 7.4° (p = .0015), 12.3° ± 6.1° (p < .001), 21.3° ± 7.7° (p = .0122), and 2.2° ± 3.6° (p = .0019) for the talo-first metatarsal, calcaneocuboid abduction, calcaneal inclination, and tibial-calcaneal angles, respectively. The final tibial-calcaneal position measured 1.4 ± 0.7 mm (p < .001). The preoperative Evans graft measurement (11.8 ± 2.6 mm) compared with the actual graft (12.2 ± 1.3 mm) placed was within 0.4 ± 1.8 mm (p = .51). Preoperative digital planning for Evans calcaneal osteotomy has been shown to be a valuable tool for predicting the surgical graft size for accurate pedal realignment.
许多足踝手术通常都要进行术前规划。本研究的目的是前瞻性地确定在“伊文斯”跟骨截骨术中预测所用跟骨移植物大小的术前数字化规划准确性。对10例计划接受伊文斯手术的足部进行术前数字化畸形矫正规划，采用标准规划方法（TraumaCad®软件）。10例患者中，女性6例，男性4例，平均年龄43±22岁。采用数字化规划预测伊文斯移植物大小。手术医生不知道预测的移植物大小，然后将其与手术中植入的实际移植物大小进行比较。此外，记录并比较术前和术后的X线角度（前后位，距骨-第一跖骨角、跟骰关节外展角；侧位，跟骨倾斜角；轴位，胫跟角）。术前平均距骨-第一跖骨角、跟骰关节角、跟骨倾斜角和胫跟角分别为21°±9.6°、28.3°±9.0°、13.8°±5.7°和15.3°±8.2°。术前胫跟位置为2.8±1.2mm。平均随访7.4（6至12）个月时测量的负重X线角度，距骨-第一跖骨角、跟骰关节外展角、跟骨倾斜角和胫跟角分别改善至6.3°±7.4°（p = 0.0015）、12.3°±6.1°（p < 0.001）、21.3°±7.7°（p = 0.0122）和2.2°±3.6°（p = 0.0019）。最终胫跟位置测量为1.4±0.7mm（p < 0.001）。术前伊文斯移植物测量值（11.8±2.6mm）与实际植入的移植物（12.2±1.3mm）相比，相差0.4±1.8mm（p = 0.51）。已证明伊文斯跟骨截骨术的术前数字化规划是预测手术移植物大小以实现准确足部复位的有价值工具。
