Objective: To explore the effectiveness and advantage of three-dimensional (3D) printed navigation templates assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus.
Methods: Between April 2013 and February 2015, 28 patients (28 feet) with moderate and severe hallux valgus who underwent Ludloff osteotomy were randomly divided into 2 groups ( n=14). In group A, the patients were treated with Ludloff osteotomy assissted with a 3D printed navigation template. In group B, the patients were treated with traditional Ludloff osteotomy. There was no significant difference in gender, age, affected side, and clinical classification between 2 groups ( P>0.05). The operation time and intraoperative blood loss were recorded. The ankle function of the foot at preoperation, immediate after operation, and last follow-up were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) score. Besides, the X-ray film were taken to assess the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the first metatarsal length shortening.
Results: All patients were followed up 18-40 months (mean, 26.4 months). The operation time and intraoperative blood loss in group A were significantly less than those in group B ( P<0.05). The HVA, IMA, and AOFAS scores in groups A and B at immediate after operaton and last follow-up were sinificantly improved when compared with preoperative values ( P<0.05); but no significant difference was found between at immediate after operation and at last follow-up ( P>0.05). No significant difference was found in HVA and IMA between group A and group B at difference time points ( P>0.05). There were significant differences in AOFAS score and the first metatarsal length shortening at immediate after operation and at last follow-up between 2 groups ( P<0.05). Except 1 case of metastatic metatarsalgia in group B, there was no other operative complications in both groups.
Conclusion: 3D printed navigation template assisted Ludloff osteotomy can provide accurate preoperative planning and intraoperative osteotomy. It is an ideal method for moderate and severe hallux valgus.
目的: 探讨 3D 打印导航模板辅助 Ludloff 截骨矫形术治疗中重度ﾙ外翻的疗效及优势。.
方法: 将 2013 年 4 月—2015 年 2 月拟行 Ludloff 截骨矫形术治疗且符合选择标准的 28 例（28 足）中重度ﾙ外翻患者纳入研究，随机分为两组（ n=14）：A 组为采用 3D 打印导航模板辅助截骨手术，B 组为传统截骨手术。两组患者性别、年龄、患足侧别和ﾙ外翻分度等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。记录两组手术时间、术中出血量；术前、术后即刻及末次随访时，采用美国矫形足踝协会（AOFAS）评分评价患足功能；根据 X 线片测量ﾙ外翻角（hallux valgus angle，HVA）、跖骨间角（intermetatarsal angle，IMA）以及第 1 跖骨长度短缩程度。.
结果: 患者均获随访，随访时间 18～40 个月，平均 26.4 个月。A 组手术时间和术中出血量均显著少于 B 组，差异有统计学意义（ P<0.05）。A、B 组术后即刻及末次随访的 HVA、IMA 和 AOFAS 评分均较术前显著改善，差异有统计学意义（ P<0.05）；术后即刻与末次随访时比较，差异无统计学意义（ P>0.05）。A、B 组间术前、术后即刻及末次随访时的 HVA、IMA 比较，差异无统计学意义（ P>0.05）。术后即刻及末次随访时，A、B 组间 AOFAS 评分及第 1 跖骨长度短缩比较，差异有统计学意义（ P<0.05）。术后除 B 组 1 例发生转移性跖骨痛外，A、B 组均无相关并发症发生。.
结论: 采用 3D 打印导航模板辅助 Ludloff 截骨矫形术，可以达到术前准确制定手术计划、术中实施精准截骨的目的，是治疗中重度ﾙ外翻的有效方法之一。.
Keywords: Hallux valgus; Ludloff osteotomy; navigation template; three-dimensional printing.