三维重建整足数字模型指导个性化截骨治疗重度[足母]外翻畸形40例  

Personalized Osteotomy Guided by 3D Reconstruction of Foot Digital Model in the Treatment of Severe Great Avulsion Deformity 40 Cases

作　　者：李孝林 戴媛 刘岳 潘丰满 何川 张朝驹 LI Xiaolin;DAI Yuan;LIU Yue;PAN Fengman;HE Chuan;ZHANG Chaoju(Health Science Center,Yangtze University,Jingzhou 434000,Hubei China;Jingzhou Hospital of Traditional Chinese Medicine,Jingzhou 434000,Hubei China;Hubei University of Chinese Medicine,Wuhan 430065,China)

机构地区：[1]长江大学医学部,湖北荆州434000 [2]荆州市中医医院 [3]湖北中医药大学

出　　处：《中国中医骨伤科杂志》2023年第10期61-66,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：湖北省自然科学基金项目(2022CFB054);全国名老中医专家传承工作室建设项目(国中医药人教函〔2022〕75号)。

摘　　要：目的:总结三维重建整足数字模型指导个性化截骨治疗重度[足母]外翻的疗效。方法:符合纳入标准的40例共48足第一、二跖骨间角(IMA)≥15°的重度[足母]外翻患者,术前进行全足CT扫描,三维重建全足数字模型;观察、测量[足母]外翻角(HVA)、第一、二跖骨间角、第一跖骨长度等指标,于三维数字模型上根据所测畸形数据进行模拟截骨,明确每一例的截骨面和截骨角度,根据术前模拟情况进行术中个性化截骨;术后石膏托固定患足8周,去除外固定后指导患者功能锻炼,定期随访复查,最后一次复查时进行美国足踝外科协会(AOFAS)评分,测量[足母]外翻角、第一、二跖骨间角、第一跖骨长度、籽骨的位置。结果:40例患者平均随访22.7个月,48足中42足基本没有疼痛,6足偶有轻度疼痛,所有患者没有出现[足母]内翻及[足母]趾僵硬,行走功能正常,截骨均正常愈合;AOFAS评分从术前的(45.4±8.6)分增加到术后的(90.2±5.7)分,[足母]外翻角从术前的31.0°±4.32°减少到术后的7.5°±1.7°,第一、二跖骨间角从术前的18.7°±1.9°减少到术后的5.8°±1.2°;AOFAS评分、[足母]外翻角、第一、二跖骨间角术前术后比较,差异有统计学意义(P<0.05);第一跖骨长度从术前(5.98±0.35) cm到术后(5.89±0.37) cm,差异无统计学意义(P>0.05)。结论:三维重建整足数字模型、术前模拟截骨指导重度[足母]外翻畸形微创截骨矫形手术疗效确切、操作简单,在微创并精准化治疗上更有优势。Objective:To summarize the efficacy of personalized osteotomy guided by 3D reconstruction of foot digital model in the treatment of severe great hallus.Methods:For 40 patients meeting the inclusion criteria for this study,48 feet with severe great aventure with first and second intermetatarsal angle(IMA)≥15°were included in the study.Preoperative CT scan was performed to construct a 3D digital model of great foot to observe and measure hallux aventure angle(HVA),IMA and first metatarsal length.Simulated osteotomy was performed on the 3D digital model according to the measured deformity data,the osteotomy surface and osteotomy angle of each case were determined,and individualized intraoperative osteotomy was performed according to the preoperative simulation.The affected foot was immobilized in plaster support for 8 weeks after surgery,and the patient was instructed to perform functional exercise after removal of the immobilization.American Orthopedic Foot and Ankle Society(AOFAS)score,HVA,IMA,first metatarsal length,and sesamoid position were measured at the last review.Results:The 40 patients were followed up with an average of 22.7 months.Among the 48 feet,42 feet had basically no pain,while 6 feet even had mild pain.All patients had no great avulsion or great toe stiffness,normal walking function and normal healing of bone amputation.HVA decreased from 31.0°±4.32°preoperatively to 7.5°±1.7°postoperatively,IMA decreased from 18.7°±1.9°preoperatively to 5.8°±1.2°postoperatively.The difference of AOFAS score,HVA and IMA before and after surgery was statistically significant(P<0.05).The length of the first metatarsal bone ranged from(5.98±0.35)cm before surgery to(5.89±0.37)cm after surgery,with no statistically significant difference(P>0.05).Conclusion:3D reconstruction of foot digital model and preoperative simulation of bone amputation to guide minimally invasive orthopaedic surgery for severe hallux avulsion deformity are effective and easy to operate,and have more advantages in minimally inva

关 键 词：重度[足母]外翻 微创治疗 个性化截骨 数字骨科学 

分 类 号：R682.1[医药卫生—骨科学]