Wang Chenggong, Yu Dengjie, Xu Can, Li Mingqing, Zhong Da, Wang Long, Liu Hua, Li Yusheng
Department of Orthopedics, Xiangya Hospital Central South University No. 87 Xiangya Road, Changsha 410008, Hunan, China.
Department of Foot and Ankle Surgery, Xiangya Hospital Central South University No. 87 Xiangya Road, Changsha 410008, Hunan, China.
Am J Transl Res. 2021 Jun 15;13(6):6087-6097. eCollection 2021.
Over the past seven years, our team has designed a simulated operation combined with patient-specific instrumentation (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it in the clinic. This study aimed to evaluate the differences between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application, and postoperative curative effect.
We retrospectively analyzed SMOT data collected from our hospital between October 2014 and December 2018. Patients (n = 28) were enrolled and divided into CO (n = 17) and SO-PSI (n = 11) groups; mean follow-up time was 33.4 (range, 13 to 59) months. We statistically analyzed and compared perioperative data, accuracy of preoperative planning, intraoperative application, difference between pre- and post-operative radiologic ankle angles, changes in American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of ankle motion, and Takakura stage after surgery.
All ankle alignments and positions were recovered for both groups. Compared with the CO group, the SO-PSI group had a shorter mean operating time and postoperative hospital stay, a decreased number of fluoroscopy examinations, lower albumin reduction, longer preoperative planning time and preoperative hospital stay, and increased hospitalization expenses. In the SO-PSI group, comparison of ankle angles at preoperative planning and postoperatively revealed good correlation, while this was not the case in the CO group. Mean tibial ankle center discrepancy for the SO-PSI group was 1.86 ± 1.06 mm. On follow-up, all radiologic parameters for the two groups improved significantly; however, the improvement of the tibial anterior surface angle and tibiotalar tilt angle for the SO-PSI group were more obvious than those for the CO group. AOFAS score, VAS score, ankle range of motion, and Takakura stage improved after surgery in both groups; however, the improvements in the SO-PSI group were greater than those in the CO group overall.
SO-PSI technology can facilitate accurate and rapid preoperative planning for SMOT. In general, compared with conventional technology, SO-PSI has advantages for preoperative planning, intraoperative application, and postoperative curative effect.
在过去七年中，我们团队设计了一种结合患者特异性器械的模拟手术（SO-PSI）辅助的外踝上截骨术（SMOT）方法，并将其应用于临床。本研究旨在评估SO-PSI技术与传统手术（CO）技术在SMOT的术前规划、术中应用及术后疗效方面的差异。
我们回顾性分析了2014年10月至2018年12月期间从我院收集的SMOT数据。纳入患者（n = 28）并分为CO组（n = 17）和SO-PSI组（n = 11）；平均随访时间为33.4（范围13至59）个月。我们对围手术期数据、术前规划准确性、术中应用、术前与术后踝关节放射学角度差异、美国矫形足踝协会（AOFAS）评分变化、视觉模拟量表（VAS）评分、踝关节活动范围及术后Takakura分期进行了统计学分析和比较。
两组患者的踝关节对线和位置均恢复。与CO组相比，SO-PSI组的平均手术时间和术后住院时间较短，透视检查次数减少，白蛋白降低幅度较小，术前规划时间和术前住院时间较长，住院费用增加。在SO-PSI组中，术前规划与术后踝关节角度比较显示出良好的相关性，而CO组则不然。SO-PSI组的平均胫骨踝关节中心差异为1.86±1.06 mm。随访时，两组的所有放射学参数均有显著改善；然而，SO-PSI组的胫骨前表面角和胫距倾斜角的改善比CO组更明显。两组术后AOFAS评分、VAS评分、踝关节活动范围及Takakura分期均有改善；然而，总体而言，SO-PSI组的改善大于CO组。
SO-PSI技术有助于SMOT的准确、快速术前规划。总体而言，与传统技术相比，SO-PSI在术前规划、术中应用及术后疗效方面具有优势。
