| Objective(s):1.To investigate the application and clinical value of Mimics(Materialise’s Interactive Medical Image Control)and 3-matic software in measuring the metacarpophalangeal deviation angle(MCPDA)of patients with complex polydactyly deformities.2.To explore the advantages of digital 3D printing(Three-dimensional Printing)technology in preoperative evaluation and intraoperative use for polydactyly correction surgery,as well as its impact on postoperative efficacy.3.To implement personalized and precise treatment in polydactyly correction surgery through digital simulation and the creation of osteotomy guides using combined 3D printing technology,allowing for accurate bone cuts during surgery.Methods:1.A total of 24 patients with polydactyly deformities(2 cases of Wassel II type,6 cases of Wassel Ⅲ type,and 16 cases of Wassel IV type)who visited the orthopedic department of the 920th Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force between January 2022 and January 2023 were selected.Patients were divided into two groups according to the treatment method:①experim ental group,treated with digital 3D printing combined with osteotomy guide technology;② control group,treated with traditional surgery The eperimental group consisted of 10 patients,including 6 males and 4 females,aged between 3 and 26 years,with an average age of 10.8 years;the control group consisted of 14 patients,including 10 males and 4 females,aged between 3 and 27 years,with an average age of 14.6 years.All 10 patients in the experim ental group underwent hand CT and X-ray examinations,while the 14 patients in the control group only underwent hand X-ray examinations.2.CT data from the experimental group were imported into Mimics 21.0 software in DICOM(Digital Imaging and Communications in Medicine)format for processing,generating 3D models of hand bones and tendons and converting them into STL(Standard Template Library)format files.Next,the STL files were imported into 3-matic 11.0 software,and two-dimensional operation plane was generated through the software.Then,five orthopedic doctors marked the bisecting points of the metaphyseal-epiphys eal junctions at the distal and proximal ends of the first metacarpal bone within the obtained two-dimensional plane and connected them with a line to obtain the central axis of the first metacarpal.Similarly,the central axis of the proximal phalanx of the thumb was marked,and the lengths of the related line segments were measured and recorded Moreover,the angle between the central axis of the fist metacarpal and the central axis of the proximal phalanx of the thumb was measured,which corresponds to the metacarpophalangeal deviation angle.Each patient was measured by five orthopedic doctors using two methods,one using 3-matic software and the other using X-ray imaging,resulting in five sets of data(3D group and DR group).Finally,the obtained data were imported into SPSS(26.0)and MedCalc(v20.1.40)statistical software for repeatability and consistency analysis.3.Preoperative planning and surgical implementation:①Experimental group:Metacarpophalangeal deviation angle was measured through a digital platform,osteotomy plans were designed,and the presence of deformities in flexor and extensor tendons and other soft tissues was assessed.The osteotomy guide was designed using 3-matic software and manufactured using 3D printing technology for precise bone cuts during surgery;②Control group:The metacarpophalangeal deviation angle was measured through preoperative X-ray imaging,and the surgeon performed the osteotomy based on their experience.4_Postoperative follow-up and efficacy evaluation:The efficacy of treatment in patients with polydactyly deformities was assessed using TATA scores,ALURRA scores,and the Cambridge-Keeling method,summarizing the advantages of digital technology in the precise treatment of complex polydactyly deformities.It was demonstrated by comparing the preoperative simulation and actual intraoperative osteotomy data of 10 patients that digital technology can effectively improve the accuracy of osteotomies.Results:1.The 3-matic software was used in this study to measure the length of the bisector line segment at the metaphyseal-epiphyseal junction of the first metacarpal and proximal phalanx of the thumb,marking their central axes and angles.The intraclass correlation coefficient(ICC)value for the proximal and distal metaphyseal-epiphys eal junction of the first metacarpal was as high as 0.980 comparing the measurement results of five orthopedic doctors,while the ICC value for the proximal phalanx of the thumb was 0.906.Statistical analysis demonstrated that this measurement method has high repeatability(ICC value greater than 0.80).2.The results of measuring the metacarpophalangeal deviation angle using both the 3D and DR groups were compared and analyzed in the study The results showed that there was no statistically significant difference between the two groups in terms of metacarpophalangeal deviation angle measurement,with P values greater than 0.05 in both cases.At the same time,a consistency test was conducted on the results of the two measur ement methods used by the five orthopedic doctors,finding that the ICC values of the data obtained by both methods were greater than 0.80,indicating strong consistency.A Bland-Altman analysis was performed on the two methods,and it was found that all 10 measurement points were within the limits of agreement,with an average level of 3.3(-14.1,20.7).In summary,there is good consistency between the measurement results of the 3-matic software and the X-ray measurements,and no significant difference between the two measurement methods.3.There were 24 patients in this study,10 in the experimental group and 14 in the control group.The surgical process went smoothly for both groups,with no significant differences in osteotomy time and blood loss during surgery.No infections occurred in the experimental group after surgery,while one patient in the control group experienced paronychia and subsequent nail bed infection,which was controlled after nail removal.It was found using independent sample t-tests and chi-square tests that the experimental group had higher average levels of interphalangeal and metacarpnphalangeal joint range of motion,finger circumference,length,and nail size compared to the control group,with statistically significant differences(P<0.05).The experimental group also had a lower average level of interphalangeal joint deviation angle and proportion of nail deformity compare d to the control group,with statistically significant differences(P<0.05).Comparisons of interphalangeal and metacarpophalangeal joint stability,M etacarpophalang eal Deviation Angle,ALURRA scores,and TATA scores between the two groups showed no statistically significant differences(P>0.05).4.There was no statistically significant difference between the actual metacarpal osteotomy thickness during surgery and the osteotomy thickness during surgical modeling and rehearsal in the experim ental group(P>0.05).Bland-Altman scatter plot analysis showed that the 10 measurement points of the prosthesis osteotomy thickness and the actual osteotomy thickness during surgery were all within the consistency boundaries,with a proportion of 90%and a mean level of-0.2(-0.9,2.5)This suggests that the prosthesis osteotomy thickness and the actual osteotomy thickness during surgery have good consistency.Conclusion(s):1.Using medical digital software and X-ray film to measure the metacarpophalangeal mutual deviation Angle can obtain accurate and reliable measurement results.X-ray method is simple,but it requires high posture,which is not suitable for some special polydactyly.Medical digital software can eliminate this trouble,reduce the risk of measurement error,make up for the shortcomings of X-ray method,and lay the foundation for digital applications Mimics and 3-matic software was used to reconstruct the 3D skeletal model of the polydactyly of the hand.With the help of digital system technology,it was helpful to measure the deviation Angle of the metacarpophalangeal joint accurately.Through statistical analysis,it is believed that this method has high stability and reliability,and can provide accurate data for the preoperative design of 3D printing osteotomy guide plate.2.Using digital technology for the treatment of complex polydactyly allows for more accurate preoperative assessment of the patient’s condition and the design of personalized surgical plans.In addition,during surgery,digital technology helps doctors perform more precise osteotomy,reducing surgical difficulty and risk,and enhancing the success rate of the surgery.Experimental data show that the application of digital technology achieves more satisfactory aesthetic and functional results,while also increasing the value of CT data usage and improving data accuracy.In conclusion.digital technology combined with 3D printing is a very effective means of treating polydactyly,offering better treatment outcomes for patients.3 The application of digital technology combined with 3D printing technology has certain advantages in osteotomy correction of polydactyly,improving surgical accuracy and treatment outcomes There is no significant difference between the actual intraoperative osteotomy thickness and the preoperative rehearsal osteotomy thickness,indicating that this method is feasible and highly accurate.Furthermore,3D printed osteotomy guide plates can effectively assist surgical procedures,making intraoperative operations more precise.Therefore,the use of 3D printed osteotomy guide plates in complex polydactyly surgery is highly recommended. |
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