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三维打印导航模板辅助Ludloff截骨术治疗中重度拇外翻的临床研究

[Clinical study of three-dimensional printed navigation template assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus].

作者信息

Xu Yan, Liu Shuai, Hu Jun, Zhang Huikang, Yao Qingqiang, Wang Liming

机构信息

Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210006,

Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210006, P.R.China;Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Jiangsu, 221009, P.R.China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Jul 15;32(7):906-911. doi: 10.7507/1002-1892.201801163.

Abstract

OBJECTIVE

To explore the effectiveness and advantage of three-dimensional (3D) printed navigation templates assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus.

METHODS

Between April 2013 and February 2015, 28 patients (28 feet) with moderate and severe hallux valgus who underwent Ludloff osteotomy were randomly divided into 2 groups ( =14). In group A, the patients were treated with Ludloff osteotomy assissted with a 3D printed navigation template. In group B, the patients were treated with traditional Ludloff osteotomy. There was no significant difference in gender, age, affected side, and clinical classification between 2 groups ( >0.05). The operation time and intraoperative blood loss were recorded. The ankle function of the foot at preoperation, immediate after operation, and last follow-up were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) score. Besides, the X-ray film were taken to assess the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the first metatarsal length shortening.

RESULTS

All patients were followed up 18-40 months (mean, 26.4 months). The operation time and intraoperative blood loss in group A were significantly less than those in group B ( <0.05). The HVA, IMA, and AOFAS scores in groups A and B at immediate after operaton and last follow-up were sinificantly improved when compared with preoperative values ( <0.05); but no significant difference was found between at immediate after operation and at last follow-up ( >0.05). No significant difference was found in HVA and IMA between group A and group B at difference time points ( >0.05). There were significant differences in AOFAS score and the first metatarsal length shortening at immediate after operation and at last follow-up between 2 groups ( <0.05). Except 1 case of metastatic metatarsalgia in group B, there was no other operative complications in both groups.

CONCLUSION

3D printed navigation template assisted Ludloff osteotomy can provide accurate preoperative planning and intraoperative osteotomy. It is an ideal method for moderate and severe hallux valgus.

摘要

目的

探讨三维(3D)打印导航模板辅助卢德洛夫截骨术治疗中重度拇外翻的有效性及优势。

方法

2013年4月至2015年2月,28例(28足)接受卢德洛夫截骨术治疗的中重度拇外翻患者被随机分为2组(每组14例)。A组患者采用3D打印导航模板辅助卢德洛夫截骨术治疗,B组患者采用传统卢德洛夫截骨术治疗。两组患者在性别、年龄、患侧及临床分型方面差异无统计学意义(P>0.05)。记录手术时间及术中出血量。采用美国矫形足踝协会(AOFAS)评分评估术前、术后即刻及末次随访时患足的踝关节功能。此外,拍摄X线片评估拇外翻角(HVA)、跖间角(IMA)及第一跖骨长度缩短情况。

结果

所有患者均获随访18~40个月(平均26.4个月)。A组手术时间及术中出血量显著少于B组(P<0.05)。A、B两组术后即刻及末次随访时的HVA、IMA及AOFAS评分与术前相比均显著改善(P<0.05);但术后即刻与末次随访时比较差异无统计学意义(P>0.05)。不同时间点A组与B组的HVA及IMA比较差异无统计学意义(P>0.05)。两组术后即刻及末次随访时的AOFAS评分及第一跖骨长度缩短情况比较差异有统计学意义(P<0.05)。除B组1例发生转移性跖痛症外,两组均无其他手术并发症。

结论

3D打印导航模板辅助卢德洛夫截骨术可提供准确的术前规划及术中截骨,是治疗中重度拇外翻的理想方法。

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