3D打印导板辅助跖骨截骨矫正轻中度母外翻△

3D printed guide-assisted transverse metatarsal osteotomy for mild to moderate hallux valgus

摘要:

[目的]评价 3D 打印导板辅助经皮微创跖骨横行截骨（percutaneous minimally invasive metatarsal transverse osteotomy, PMIMTO） 治疗轻中度母外翻的疗效。[方法] 回顾性分析 2022 年 6 月—2023 年 4 月采用 3D 打印导板辅助 PMIMTO 治疗的 21 例轻中度母外翻患者的临床资料。采用美国矫形足踝外科学会（American Orthopedic Foot and Ankle Society, AOFAS）前足评分、视觉模拟评分 （visual analogue scale, VAS） 对患者的疗效和功能进行评价。行影像检查，测量母外翻角 （hallux valgus an- gle, HVA）、第 1、2 跖骨间角 （intermetatarsal angle, IMA），记录手术时长和第 1 跖骨短缩程度。[结果] 所有患者手术顺利， 伤口均Ⅰ期愈合，未出现并发症。平均随访时间（15.1±2.2）个月。随术前、术后 3 个月和末次随访的时间推移，AOFAS 前足评分 [(59.7±3.6), (86.7±1.6), (89.8±4.3), P＜0.001] 和疼痛 VAS 评分 [(6.1±1.3), (2.1±0.7), (0.7±0.6), P＜0.001] 显著改善。至末次随访时，所有患者均未出现跖骨头坏死、骨不连、畸形复发等并发症。影像方面，与术前相比，术后 3 个月和末次随访时 HVA [(32.2±5.0)°, (11.9±1.1)°, (11.2±2.6)°, P＜0.001] 和 IMA [(12.6±1.6)°, (9.0±0.6)°, (8.1±1.4)°, P＜0.001] 均显著改善。[结论]3D 打印置钉导板可以有效提高 PMIMTO 的安全性与有效性，缩短手术时间，是一种安全、有效的方法。

Abstract:

[Objective] To evaluate the clinical efficacy of 3D-printed guide- assisted percutaneous minimally invasive metatarsal transverse osteotomy (PMIMTO) in the treatment of mild to moderate hallux valgus deformity. [Methods] A retrospective research was conducted on 21 patients (22 feet) who received the 3D-printed guide-assisted PMIMTO for mild to moderate hallux valgus deformity between June 2022 and April 2023. The therapeutic consequence and function of the patients were evaluated by using the forefoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and the visual analogue scale (VAS) for pain. As imaging taken, the hallux valgus angle (HVA) and the intermetatarsal angle (IMA) between the first and second metatarsals were measured, as well as the extents of the first metatarsal shortened were recorded. [Results] All the patinets had PMIMTO performed smoothly, with wounds healed in the first stage and no complications. The average follow-up time was of (15.1±2.2) months. With time elapsed preoperatively, 3 months postoperatively and the the last follow-up, AOFAS forefoot score [(59.7±3.6), (86.7±1.6), (89.8±4.3), P＜0.001] and pain VAS score [(6.1±1.3), (2.1±0.7), (0.7±0.6), P＜0.001] were significantly improved. At the last follow-up, no complications such as metatarsal head necrosis, nonunion of bones, or recurrence of deformity occurred in anyone of the patients. In terms of imaging, the HVA [(32.2±5.0)°, (11.9±1.1)°, (11.2±2.6)°, P＜0.001] and IMA [(12.6±1.6)°, (9.0±0.6)°, (8.1±1.4)°, P＜0.001] were significantly improved 3 months postoperatively and at the latest follow-up compared with those before the operation. [Conclusion] This 3D-printed guide does effectively improve the safety and effectiveness of PMIM-TO and shorten the operation time, is a safe and effective method.