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[三维打印技术在拇外翻截骨 Chevron 形术中设计个体化角状截骨面的应用]

[Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy].

作者信息

Zhang Yu-Hang, Bi Da-Wei, Chen Yi-Min, Zu Gang, Ma Hai-Tao

机构信息

The Second Department of Orthopedics, the First People's Hospital of Xiaoshan District, Hangzhou 311200, Zhejiang, China;

出版信息

Zhongguo Gu Shang. 2018 Mar 25;31(3):203-207. doi: 10.3969/j.issn.1003-0034.2018.03.002.

Abstract

OBJECTIVE

To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy.

METHODS

From May 2013 to May 2016, 47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A, there were 25 patients (33 feet), including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old, average weight IMA was (13.58±1.15) degree, AOFAS score was 59.00±5.86, and treated individual 3D printing technology to design operation scheme. While in group B, there were 22 patients (33 feet), including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old, average weight IMA was(13.51±1.14) degree, AOFAS score was 60.67±5.85, and treated with osteotomy according to surgical experience. Operation time, blood loss, hospital stays, VAS score at 1 week after operation, wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups, AOFAS score system was used to evaluate ankle function after surgery.

RESULTS

There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time, blood loss, hospital stays and VAS score at 1 week after operation(<0.05); IMA in group A was (5.21±0.88)°, (6.42±0.85)° in group B, and had significant differences between two groups (=5.68, <0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01(=4.14, <0.05). Fourteen feet in group A obtained excellent results and 19 feet good, while 5 feet in group B obtained excellent results and 27 feet good.

CONCLUSIONS

Compared with traditional osteotomy group, three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy could better correct IMA, improve postoperative foot function, and it is a kind of individualized and digital method to design operation.

摘要

目的

探讨三维打印技术在拇外翻截骨术中设计个性化契形截骨角度的临床应用。

方法

2013年5月至2016年5月,将47例(66足)轻中度拇外翻患者按术前不同设计行契形截骨术,分为计算机截骨组(A组)和传统截骨组(B组)。A组25例(33足),男4例(5足),女21例(28足),平均年龄(47.88±6.08)岁,平均负重下第1、2跖骨间夹角(IMA)为(13.58±1.15)°,美国足踝外科协会(AOFAS)评分为59.00±5.86,采用个体化3D打印技术设计手术方案;B组22例(33足),男3例(3足),女19例(28足),平均年龄(48.16±6.16)岁,平均负重下IMA为(13.51±1.14)°,AOFAS评分为60.67±5.85,按手术经验行截骨术。比较两组手术时间、出血量、住院时间、术后1周视觉模拟评分法(VAS)评分、伤口愈合情况及术后负重下IMA改善情况,采用AOFAS评分系统评价术后踝关节功能。

结果

A组随访时间为(12.41±2.32)个月,B组为(11.73±2.76)个月,两组差异无统计学意义。B组有1例患者被排除。其余患者术后伤口一期愈合良好。两组手术时间、出血量、住院时间及术后1周VAS评分差异无统计学意义(P>0.05);A组术后IMA为(5.21±0.88)°,B组为(6.42±0.85)°,两组比较差异有统计学意义(P=5.68,P<0.05)。A组AOFAS评分为(88.15±5.19)分,B组为(82.90±5.01)分,两组比较差异有统计学意义(P=4.14,P<0.05)。A组优14足,良19足;B组优5足,良27足。

结论

与传统截骨组比较,三维打印技术设计拇外翻契形截骨个性化角度能更好地矫正IMA,改善术后足部功能,是一种个体化、数字化的手术设计方法。

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