Ozturk Anil Murat, Suer Onur, Coban Istemihan, Ozer Mehmet Asim, Govsa Figen
Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey.
Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey.
Indian J Orthop. 2020 Apr 23;54(Suppl 1):199-209. doi: 10.1007/s43465-020-00110-w. eCollection 2020 Sep.
Hallux valgus (HV) is the most common pathologic entity affecting the great toe. The goal of corrective surgery is to restore foot mechanics and provide pain relief. The purpose of the study was to create individual angle using life-size foot models with three-dimensional (3D) printing technology to design a section on HV osteotomy.
Ten female patients with a diagnosis of HV were included. Radiologic [HV angle and intermetatarsal (IM) angle] and clinical [American Orthopaedic Foot and Ankle Score (AOFAS)] assessment was done pre- and postoperatively. All the operations were planned together with 3D life-size models generated from computed tomography (CT) scans. Benefits of using the 3D life-size models were noted. The 3D model's perception was evaluated.
The mean AOFAS score, mean HV, and IM angles had improved significantly ( < 0.05). The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical planning. At the first tarsometatarsal joint, the HV models showed significantly greater dorsiflexion, inversion, and adduction of the first metatarsal relative to the medial cuneiform. At the first metatarsophalangeal joint, the HV models showed significantly greater eversion and abduction of the first proximal phalanx relative to the first metatarsal. It provided satisfactory results about operation time and blood loss. 3D model's perception was statistically significant ( < 0.05).
3D models help to transfer complex anatomical information to clinicians, which provide guidance in the preoperative planning stage, for intraoperative navigation. It helps to create a patient-specific angle section on osteotomy to correct IM angle better and improve postoperative foot function. The 3D personalized model allowed for a better perception of information when compared to the corresponding 3D reconstructed image provided.
拇外翻(HV)是影响大脚趾最常见的病理情况。矫正手术的目标是恢复足部力学并缓解疼痛。本研究的目的是使用三维(3D)打印技术制作真人大小的足部模型来创建个体角度,以设计拇外翻截骨术的方案。
纳入10例诊断为拇外翻的女性患者。术前和术后进行了影像学评估(拇外翻角度和跖间角)以及临床评估(美国矫形足踝协会评分,AOFAS)。所有手术均根据计算机断层扫描(CT)生成的3D真人大小模型共同制定计划。记录使用3D真人大小模型的益处。对3D模型的认知情况进行了评估。
平均AOFAS评分、平均拇外翻和跖间角均有显著改善(<0.05)。对3D模型的视觉和触觉检查能实现最佳的解剖学理解,能更快、更清晰地理解手术计划。在第一跗跖关节处,拇外翻模型显示第一跖骨相对于内侧楔骨有明显更大的背屈、内翻和内收。在第一跖趾关节处,拇外翻模型显示第一近端趾骨相对于第一跖骨有明显更大的外翻和外展。在手术时间和失血量方面取得了满意的结果。3D模型的认知具有统计学意义(<0.05)。
3D模型有助于将复杂的解剖信息传递给临床医生,在术前规划阶段为术中导航提供指导。它有助于创建针对患者的截骨角度方案,以更好地矫正跖间角并改善术后足部功能。与提供的相应3D重建图像相比,3D个性化模型能让人更好地理解信息。