| Objective(s): To explore the clinical application and efficacy of 3D printed personalized osteotomy guide assisted Scarf osteotomy in the treatment of moderate and severe hallux valgus.Methods: Selected 14 patients(23 feet)with moderate or severe hallux valgus from the Department of Orthopedics and Minimally Invasive Spine Surgery of Caomette Hospital,Kunming First People’s Hospital,from September 2020 to June2022,there were 13 females and 1 male,including 9 bipedal cases and 5 single-legged cases,with an average age of(55.86±11.45)years old,after the patients in the group were hospitalized,thin-slice CT scans of the all feet were completed,and the CT data were collected and copied,and then imported into Mimics21.0 software for 3D reconstruction of the feet model,according to 1:1 model was established,according to the degree of deformity and the degree of osteophyte hyperplasia of each patient,according to the target parameters of deformity correction required by the preoperative design,use software such as 3-matic and Magics to make personalized and precise osteotomy guide plates required during the operation,after exporting the guide plate data in STL format,use photosensitive resin as the raw material to use the photocuring 3D printer to complete the guide plate production,after plasma disinfection,it was used as a spare during the operation.During the operation,all patients were treated with the 3D printed personalized osteotomy guide plate to assist the Scarf osteotomy operation plan,compared the improvement of HVA,IMA,DMAA angle before operation and after 1 month,3 months,6 months and 12 months,follow-up surveys were conducted and patients were asked to fill in the American Orthopedic Foot and Ankle Society(AOFAS)scoring system and VAS pain score to evaluate the improvement of foot and ankle function before surgery and6 months and 12 months after surgery.Results: All 14 patients were followed up for 9 to 14 months(average 12months)after operation,among them,1 patient had a fracture at the osteotomy end of the right first metatarsal bone,and the fracture healed after 3 months of conservative treatment,the remaining 13 patients had no metatarsalgia,displacement of osteotomy block,loosening and fracture of internal fixation,osteotomy end nonunion or delayed union,hallux varus and other complications,obtained satisfactory results.Foot X-ray HVA in preoperative weight-bearing position(34.48 ° ±8.71 °),HVA 12 months postoperatively(12.74 ° ±1.48 °);Preoperative IMA(12.65 ° ±2.77 °),Postoperative IMA(6.87°±1.89°);Preoperative DMAA(14.78°±5.49°),postoperative DMAA(9.78°±3.99°).HVA,IMA,and DMAA at 12 months after operation were significantly reduced compared with those before operation,and the difference was statistically significant(P < 0.05),preoperative AOFAS score(49.57±7.39)points,postoperative AOFAS score(88.96±3.52)points;preoperative VAS pain score(3.26±0.45)points,postoperative VAS pain score(0.96±0.21)points,the postoperative AOFAS score was significantly higher than that before operation,and the postoperative VAS pain score was significantly lower than that before operation,and the differences were statistically significant.(P<0.05).Conclusion(s): Using 3D printed personalized osteotomy guide to assist Scarf osteotomy in the treatment of moderate or severe hallux valgus can provide patients with digital,personalized and precise treatment plans,the accuracy of osteotomy is improved,so as to obtain good deformity correction,pain relief,improvement of feet function,and satisfactory surgical effect. |
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