Lintz François, Pozzessere Enrico, Grün Wolfram, Acker Antoine, Huánuco Casas Erik Jesús, Ferkel Eric, de Cesar Netto Cesar
Clinique de l'Union, Department of Foot and Ankle Surgery, Ramsay Healthcare, Saint Jean, France.
Foot and Ankle Division of Orthpaedics, Duke University School of Medicine, Durham, NC, USA.
Foot Ankle Orthop. 2025 Mar 18;10(1):24730114251325854. doi: 10.1177/24730114251325854. eCollection 2025 Jan.
Recent literature highlights the importance of treating hallux valgus (HV) as a 3-dimensional (3D) deformity. Although 3D printing may enhance visualization of the multiplanar aspects of HV, its influence on surgical planning remains unclear. This study assessed changes in surgical plans when surgeons sequentially reviewed 2D radiographs, 3D weightbearing computed tomography (WBCT), and 3D-printed models, hypothesizing that 3D printing would have the greatest impact.
A single HV case (a 40-year-old woman, intermetatarsal angle [IMA] 21 degrees, HV angle [HVA] 47 degrees) was evaluated by 30 surgeons in a masked, stepwise manner. Surgical plans were recorded at each stage. Surgeons rated the influence of WBCT and 3D printing using a 5-point Likert scale. A follow-up survey examined the effect of these technologies on correction amplitudes.
The participants were mostly early career surgeons (median age 35.5 years, 2 years in practice). WBCT was accessible to 43.3% and used in 30% of HV cases, whereas 3D printing was accessible to 23.3% and used in 6.6%. Changes in the treatment algorithm occurred in 30% of cases after WBCT and in 43.3% after 3D printing. Significant differences ( < .05) were observed for the Lapicotton procedure between radiography and WBCT, and between WBCT and 3D printing. Surgeons performing <50 HV cases annually or with >70% Foot and Ankle specialization were more influenced by WBCT. Follow-up data (n = 23) indicated that WBCT and 3D printing influenced correction amplitudes, particularly for pronation and distal metatarsal articular angle (DMAA), more than for the IMA.
Both WBCT and 3D printing influenced surgical planning, mostly explained by changes in first ray tarsometatarsal procedures. The rotational components (pronation and DMAA) were perceived as the most significantly affected. Future studies should explore cost-effectiveness, patient outcomes, and the utility of combining WBCT and 3D printing in other deformities requiring multiplanar corrections. Level IV, cross-sectional survey.
近期文献强调了将拇外翻（HV）视为三维（3D）畸形进行治疗的重要性。尽管3D打印可能会增强对HV多平面特征的可视化，但它对手术规划的影响仍不明确。本研究评估了外科医生依次查看二维X线片、三维负重计算机断层扫描（WBCT）和3D打印模型时手术方案的变化，假设3D打印的影响最大。
30名外科医生以盲法、逐步方式评估了一个单一的HV病例（一名40岁女性，跖间角[IMA]21度，HV角[HVA]47度）。在每个阶段记录手术方案。外科医生使用5点李克特量表对WBCT和3D打印的影响进行评分。一项随访调查考察了这些技术对矫正幅度的影响。
参与者大多是早期执业外科医生（中位年龄35.5岁，执业2年）。43.3%的人可以使用WBCT，其中30%的HV病例使用了WBCT；而23.3%的人可以使用3D打印，其中6.6%的病例使用了3D打印。30%的病例在查看WBCT后、43.3%的病例在查看3D打印模型后治疗方案发生了变化。在Lapicotton手术中，X线片与WBCT之间以及WBCT与3D打印之间观察到显著差异（P<0.05）。每年进行少于50例HV手术或足踝专科化程度超过70%的外科医生受WBCT的影响更大。随访数据（n = 23）表明，WBCT和3D打印对矫正幅度有影响，特别是对旋前和跖骨头远端关节角（DMAA）的影响大于对IMA的影响。
WBCT和3D打印都影响了手术规划，这主要可以通过第一跖跗关节手术的变化来解释。旋转成分（旋前和DMAA）被认为受影响最为显著。未来研究应探索成本效益、患者预后以及在其他需要多平面矫正的畸形中联合使用WBCT和3D打印的效用。四级，横断面调查。
