3D打印截骨导板辅助Scarf截骨治疗中重度拇外翻畸形

doi:10.3877/cma.j.issn.1674-134X.2025.03.016

目的

探讨3D打印截骨导板辅助Scarf截骨治疗中重度拇外翻畸形的临床研究及疗效分析。

方法

选取2018年10月至2023年12月联勤保障部队第九四〇医院关节外科收治的24例（30足）中重度拇外翻畸形患者，分为3D打印截骨导板辅助下Scarf截骨组（观察组）和常规Scarf截骨组（对照组）。对照组12例（15足），年龄44～49岁，术前拇外翻角（HVA）30°～45°、跖骨间角（IMA）11°～23°；观察组12例（15足），年龄43～49岁，术前HVA 30°～46°、IMA 11°～25°。比较两组患者手术时间、术中出血量、住院时间、术后并发症、术后1周VAS疼痛评分、美国足踝外科学会（AOFAS）足踝功能评分，以及术后即刻和末次随访的IMA、HVA、远端跖骨关节面角（DMAA）、第1跖骨相对长度（RLFM）。手术前后多个时点组内定量资料比较采用重复测量方差分析，两组间计量资料比较采用t检验，计数资料采用卡方检验。

结果

两组手术切口均Ⅰ期愈合，且均无术后并发症；两组患者在随访时间（t=0.820）、术中失血量（t=1.430）、住院时间（t=0.990）、术后1周VAS评分（t=1.099）等比较差异无统计学意义（P>0.05）；观察组的手术时间较对照组明显减少，组间比较差异有统计学意义（t=-1.430，P<0.001）；观察组及对照组术后即刻及末次随访的HVA、IMA、DMAA、AOFAS与术前的组内比较，差异有统计学意义（观察组F=225.1、54.93、139.3、1103，对照组F=165.5、33.65、88.3、818.5，均为P<0.001）比较观察组、对照组两组间的术后即刻、末次随访的HVA、IMA、DMAA及AOFAS，差异有统计学意义（t=-2.733、-2.662、-3.138、2.083，-2.890、-3.081、-2.727、4.108，均为P<0.05）；比较观察组、对照组两组间的术后即刻和末次随访的RLFM，差异无统计学意义（t=-0.419、-0.455，均为P>0.05）。

结论

应用3D打印截骨导板辅助Scarf截骨治疗中重度拇外翻，术中截骨更加精准，力线恢复更佳，足部功能恢复更好。

关键词: 拇外翻, 打印，三维, 截骨术

Objective

To explore the clinical study and efficacy of three dimentional (3D) printed osteotomy plate combined with Scarf osteotomy in the treatment of moderate to severe hallux valgus deformity.

Methods

Twenty-four patients (30 feet) with moderate to severe valgus admitted to the Department of Joint Surgery, 940th Hospital of the Joint Logistics Support Force from October 2018 to December 2023 were divided into two groups: the observation group adopted Scarf osteotomy assisted by 3D printing osteotomy guide plate and the control group adopted conventional Scarf osteotomy, 12 patients with 15 feet in each group. In the observation group, the patients were from 43 to 49 years old, the preoperative hallux valgus angle (HVA) was 30° to 46°, and intermetatarsal angle (IMA) was 11° to 25°. In the control group, the patients were from 44 to 49 years old, the preoperative HVA was 30° to 45°, and IMA was11° to 23°. The following parameters were compared: operative time, intraoperative blood loss, hospital stay, postoperative complications, visual analog scale (VAS) pain score at one week after surgery, American Orthopaedic Foot & Ankle Society (AOFAS) functional scores, and radiographic parameters immediate after surgery and at final follow-up, including HVA, IMA, distal metatarsal articular angle (DMAA), relative length of the first metatarsal (RLFM). Statistical analysis included repeated-measures ANOVA for multi-timepoint quantitative data, t tests for continuous variables, and chi square test for categorical variables.

Results

All the incisions were healed by first intention without complications. No significant differences were observed between groups in follow-up duration (t=0.820), intraoperative blood loss (t=1.430), length of hospital stay (t=0.990), or VAS scores one week after surgery (t=1.099) (all P>0.05). The observation group exhibited significantly shorter operative time than the control group (t=-1.430, P<0.001). The immediate data of HVA, IMA, DMAA, and AOFAS after surgery and the data at final follow-up compared to the data before surgery in both the observation and control groups showed statistically significant differences (observation group: F=225.1, 54.93, 139.3, 1103, control group: F=165.5, 33.65, 88.3, 818.5, all P<0.001). Between-group comparisons of the HVA, IMA, DMAA, and AOFAS scores immediately postoperatively and at final follow-up revealed statistically significant differences (observation vs. control group: t=-2.733, -2.662, -3.138, 2.083, -2.890, -3.081, -2.727, 4.108, all P<0.05). No statistically significant difference was observed in RLFM between the two groups at immediate time point after surgery or at final follow-up (t=-0.419, -0.455, both P>0.05).

Conclusion

The 3D-printed osteotomy guide-assisted Scarf osteotomy improves surgical precision, enhances alignment correction, and optimizes functional recovery in moderate-to-severe hallux valgus.

Key words: Hallux valgus, Printing, three-dimensional, Osteotomy

表1 术前一般资料

Table 1 General data before surgery

组别Groups	例数/足数Case /foot number	性别Gender（例）		年龄[岁，（±s）]Age (year)	身体质量指数[kg/m²，（±s）]Body mass index	病程[年，（±s）]Disease duration (year)
组别Groups	例数/足数Case /foot number	男Male	女Female	年龄[岁，（±s）]Age (year)	身体质量指数[kg/m²，（±s）]Body mass index	病程[年，（±s）]Disease duration (year)
观察组Observation group	12/15	3	9	46.7±1.6	23.3±3.7	55.6±14.0
对照组Control group	12/15	4	8	46.5±1.8	23.4±3.7	56.8±16.7
统计值Statistical values		χ²=0.202		t=0.236	t=-0.056	t=-0.229
P值		>0.05		>0.05	>0.05	>0.05

表1 术前一般资料

Table 1 General data before surgery

组别Groups	例数/足数Case /foot number	性别Gender（例）		年龄[岁，（±s）]Age (year)	身体质量指数[kg/m²，（±s）]Body mass index	病程[年，（±s）]Disease duration (year)
组别Groups	例数/足数Case /foot number	男Male	女Female	年龄[岁，（±s）]Age (year)	身体质量指数[kg/m²，（±s）]Body mass index	病程[年，（±s）]Disease duration (year)
观察组Observation group	12/15	3	9	46.7±1.6	23.3±3.7	55.6±14.0
对照组Control group	12/15	4	8	46.5±1.8	23.4±3.7	56.8±16.7
统计值Statistical values		χ²=0.202		t=0.236	t=-0.056	t=-0.229
P值		>0.05		>0.05	>0.05	>0.05

表2 手术相关资料（

±s）

Table 2 Data relevant to the operation

组别Groups	例数/足数Case /foot number	随访时间（个月）Follow-up time (month)	手术时间（min）Surgical duration	术中出血量（ml）Intraoperative blood loss	住院时间（d）Length of hospital stay	VAS评分VAS score
观察组Observation group	12/15	12.7±2.4	40.1±2.7	14.3±2.0	6.3±1.1	2.3±1.1
对照组Control group	12/15	11.7±3.0	54.8±3.8	15.3±1.9	6.7±1.1	2.7±1.2
t值		0.820	-12.179	-1.430	-0.990	-1.099
P值		>0.05	<0.001	>0.05	>0.05	>0.05

表2 手术相关资料（

±s）

Table 2 Data relevant to the operation

组别Groups	例数/足数Case /foot number	随访时间（个月）Follow-up time (month)	手术时间（min）Surgical duration	术中出血量（ml）Intraoperative blood loss	住院时间（d）Length of hospital stay	VAS评分VAS score
观察组Observation group	12/15	12.7±2.4	40.1±2.7	14.3±2.0	6.3±1.1	2.3±1.1
对照组Control group	12/15	11.7±3.0	54.8±3.8	15.3±1.9	6.7±1.1	2.7±1.2
t值		0.820	-12.179	-1.430	-0.990	-1.099
P值		>0.05	<0.001	>0.05	>0.05	>0.05

表3 两组患者HVA比较[°，（

±s）]

Table 3 Comparison of HVA between two groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	36.9±4.5	10.7±1.8	12.1±1.7	225.1	<0.001
对照组Control group	12/15	36.7±4.9	12.5±1.8	13.7±1.4	165.5	<0.001
t值		0.118	-2.733	-2.890
P值		>0.05	0.011	0.007

表3 两组患者HVA比较[°，（

±s）]

Table 3 Comparison of HVA between two groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	36.9±4.5	10.7±1.8	12.1±1.7	225.1	<0.001
对照组Control group	12/15	36.7±4.9	12.5±1.8	13.7±1.4	165.5	<0.001
t值		0.118	-2.733	-2.890
P值		>0.05	0.011	0.007

表4 两组患者IMA比较[°，（

±s）]

Table 4 Comparison of IMA between two groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	15.9±3.5	5.9±1.3	6.1±1.0	54.93	<0.001
对照组Control group	12/15	16.5±4.2	7.1±1.2	7.2±1.2	33.65	<0.001
t值		-0.374	-2.662	-3.081
P值		>0.05	0.013	0.005

表4 两组患者IMA比较[°，（

±s）]

Table 4 Comparison of IMA between two groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	15.9±3.5	5.9±1.3	6.1±1.0	54.93	<0.001
对照组Control group	12/15	16.5±4.2	7.1±1.2	7.2±1.2	33.65	<0.001
t值		-0.374	-2.662	-3.081
P值		>0.05	0.013	0.005

表5 两组患者DMAA比较[°，（

±s）]

Table 5 Comparison of DMAA between two groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	15.1±2.1	6.3±1.2	7.3±1.2	139.3	<0.001
对照组Control group	12/15	16.1±2.2	7.7±1.3	8.9±1.9	88.3	<0.001
t值		-1.174	-3.138	-2.727
P值		>0.05	0.004	0.011

表5 两组患者DMAA比较[°，（

±s）]

Table 5 Comparison of DMAA between two groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	15.1±2.1	6.3±1.2	7.3±1.2	139.3	<0.001
对照组Control group	12/15	16.1±2.2	7.7±1.3	8.9±1.9	88.3	<0.001
t值		-1.174	-3.138	-2.727
P值		>0.05	0.004	0.011

表6 两组患者RLFM比较[mm，（

±s）]

Table 6 Comparison of RLFM Between Groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	52.5±2.1	53.0±1.7	53.1±1.4	0.530	0.59
对照组Control group	12/15	52.9±2.3	53.3±1.8	53.3±1.8	0.171	0.84
t值		-0.570	-0.419	-0.455
P值		>0.05	>0.05	>0.05

表6 两组患者RLFM比较[mm，（

±s）]

Table 6 Comparison of RLFM Between Groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	52.5±2.1	53.0±1.7	53.1±1.4	0.530	0.59
对照组Control group	12/15	52.9±2.3	53.3±1.8	53.3±1.8	0.171	0.84
t值		-0.570	-0.419	-0.455
P值		>0.05	>0.05	>0.05

表7 两组患者AOFAS比较[分，（

±s）]

Table 7 Comparison of AOFAS Between Groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	43.9±2.9	82.2±3.0	86.0±2.1	1103	<0.001
对照组Control group	12/15	45.3±3.1	79.8±3.3	83.0±1.9	818.5	<0.001
t值		-1.272	2.083	4.108
P值		0.214	0.047	<0.001

表7 两组患者AOFAS比较[分，（

±s）]

Table 7 Comparison of AOFAS Between Groups

组别Groups	例数/足数Case / foot number	术前Before operation	术后即刻Immediate after operation	末次随访Final follow-up	F值	P值
观察组Observation group	12/15	43.9±2.9	82.2±3.0	86.0±2.1	1103	<0.001
对照组Control group	12/15	45.3±3.1	79.8±3.3	83.0±1.9	818.5	<0.001
t值		-1.272	2.083	4.108
P值		0.214	0.047	<0.001

图1 行3D打印截骨导板辅助Scarf截骨术前后左足正位X线影像。图A为术前影像，示左足拇外翻畸形，HVA 41°、IMA14°；图B为术后1月复查截骨X线，示左足IMA及HVA明显改善；图C为术后随访1年X线，示左足截骨断端愈合。

Figure 1 Anteroposterior X-ray images of left foot before and after Scarf osteotomy assisted by 3D printed osteotomy guide plate of typical case one. A is X-ray image before surgery, showing valgus deformity of the left foot, with HVA 41°and IMA 14°; B is X-ray image at one month follow-up after surgery, showing that IMA and HVA were significantly improved; C is X-ray image at one year follow-up, showing that the broken end of osteotomy healed

图2 常规Scarf截骨术前后右足正位X线影像。图A为术前患足正侧位X线示右足拇外翻畸形，HVA 31°、IMA11°；图B为术后1月复查截骨X线示：右足IMA及HVA改善；图C为术后随访1年X线示：右足拇外翻截骨矫形术后截骨断端愈合，内固定取出

Figure 2 Anteroposterior X-ray images of right foot before and after conventional Scarf osteotomy. A is X-ray image before surgery, showing valgus deformity of the right foot, with HVA31°, IMA11°; B is X-ray image at one month follow-up after surgery, showing that IMA and HVA of right foot were improved ; C is X-ray image at one year follow-up, showing that the broken end of osteotomy healed, and internal fixation was removed

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Three dimentional printing osteotomy guide plate combined Scarf osteotomy in treatment of moderate to severe hallux valgus deformity

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Three dimentional printing osteotomy guide plate combined Scarf osteotomy in treatment of moderate to severe hallux valgus deformity