| Objective:To establish a computer-assisted method for the measurement of the relative angle of hallux valgus and compare it with the conventional X-ray measurement to explore its application value in diagnosis and treatment of hallux valgus.Develop a scoring table for the treatment of hallux valgus diagnosis and treatment and conduct preliminary verification to discuss its reference value in diagnosis and treatment of hallux valgus.Methods:1.The data of 30 cases(36 feet)of hallux valgus were analyzed prospectively.Based on the full weight-bearing position CT image application Mimics,we reconstructed the three-dimensional model of the hallux valgus.Using the software fitting function,the analysis of the proximal phalanx axis was finished automatically.We also reconstructed the actual articular surface of the distal metatarsal bone,and corrected it with the proximal phalanx and the three-dimensional model of the first metatarsal.The usage of the above mentioned anatomic parameters were the fundamental of accurate HVA,IMA,DMAA measurement.Four testers used the method and measured 30 cases of hallux valgus by X-line measuring,and the results were followed with statistical and Bland-Altman analysis.2.Based on the evidence-based principle,preliminary draft the items of the hallux valgus diagnosis and treatment plan score table and supplement the items according to the current clinical common score table;adopt Delphi method(Delphi)through 17 experts Two rounds of consultations,screening of preliminary drafting indicators;weighted analysis of screening indicators using Analytic Hierarchy Process(AHP);8 expert panel discussions on grading,quantifying,scoring parallel validity and validity of the indicators;correlation based on hallux valgus Symptoms,improve the hallux valgus diagnosis and treatment plan score table,preliminary verification of the hallux valgus score table.Results:The reliability of the four measurement doctors using the conventional X-ray and CT modeling reconstruction methods were respectively analyzed,the ICC coefficients were 0.89 and 0.91.The consistency of four measurement doctors was reliable(ICC>0.80).For the measurement of HVA,IMA,DMAA,there was no significant difference between the measurement doctors by using two methods of measurement in four subjects(ICC>0.80).The mean value of HVA measured by conventional X ray measurement method was(29.10±10.04°),and the mean value of HVA measured by CT modeling method was(30.02±10.62°).The results were not statistically different(P>0.05).The mean value of IMA measured by conventional X ray measurement method was(13.98 ± 4.38°),and the mean value of IMA measured by CT modeling method was(13.83 ±4.29°).The results were not statistically different(P>0.05).The mean value of DMAA measured by conventional X ray measurement method was(13.98 ±4.38°),and the mean value of DMAA measured by CT modeling method was(13.83 ± 4.29°).The results were statistically different(P<0.05).The Bland-Altman results showed that there was no difference in the consistency of the two measurement methods for IMA and HVA while the measurement results of DMAA were quite different.2.Forming the "Evaluation Form of Hallux Outpatient Treatment Plan":This scale uses the percentage system method to include three dimensions:pain,functional morphology,and imaging examination to supplement the hallux valgus complications.18 points in functional form:walking distance accounted for 3 points,divided into unlimited(0 points),1km-2km(1 minute),500m-lkm(2 points),0-500m(3 points);appearance of 6 points,According to the position of the big toe and other toes,it is divided into no pressure(0 points),no compression occurs(3 points),overlap(6 points);wear shoes take 6 points,and reference AOFAS is divided into any style Shoes(0 points),comfortable or extra cushioned shoes(3 points),custom shoes or foot braces,(6 points).As the pain was referenced to AOFAS,Mayo’s forefoot scoring system was divided into no,mild:occasional and mild,moderate:obvious,daily pain,severe:almost all the time no pain in the four levels,while the reference weight is divided into 12 points,do not correspond to 0,4,8,12 points.The image is divided into 70 points and is divided into IMA<9°(0 points),9°<IMA<15°(25 minutes),150<IMA≤20°(40 minutes),IMA>20°(55 points),and severely.Arthritis,joint relaxation(70 points);complications include DMAA,toe deformity(except the big toe),hallux deformity,sesamoid rotation in 4 aspects.The preliminary validation of the score scale was performed on 9 patients with hallux valgus from January 2018 to March 2018.The results showed that 9 cases were all consistent with the expert’s choice of treatment plan.Conclusions:1.The measurement of hallux valgus HVA,IMA,DMAA by Mimics software based on foot weight-bearing CT images can accurately generate the side lines of the above mentioned three angles.Thus,the angle measurement can be realized accurately and the error caused by conventional X-ray measurement method can be reduced,so as to reconstruct the distal articular surface of the first metatarsal bone.Then,for the measurement of DMAA,the accuracy and reliability were superior to the conventional X-ray measurement method.Therefore,it is believed that this method can make up for the shortcomings of the conventional X-ray measurement method and reduce the measurement error.It is a feasible,reliable and accurate measurement method,which provides a reliable basis for precise individualized treatment of hallux valgus,and has certain clinical value.2.The content of the "Earthopulmonary Diagnosis and Treatment Plan Scoring Table" is well-developed and follows the evidence-based concept.A comprehensive and systematic assessment of the clinical symptoms and impact examination of patients with hallux valgus can provide a reference basis for the development of the treatment plan and has clinical guidance value. |
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