METHOD FOR SURGICAL MANAGEMENT OF PATIENTS WITH ANTERIOR FOOT DEFORMATION

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of anterior foot deformation by osteotomy. Method involves taking a patient's footprint, measuring significant parameters of foot bone correction, developing an operating methodology and implementing an osteotomy. Image is obtained by computed tomography, then it is converted in 3D dicom format program to the stl format and a three-dimensional model of the patient's foot is made. Significant bone foot correction parameters are measured on a model. As significant parameters, angle between proximal phalanx of first finger and first metatarsal bone is measured; angle between first and second metatarsal bones; angle of inclination of articular surface of head of first metatarsal bone relative to its axis; angle between articular surface of first metatarsal bone and longitudinal axis of second metatarsal bone and angle of inclination of proximal articular surface of proximal phalanx of first finger to axis of proximal phalanx of first finger is compared with norm. Based on the obtained parametric data 3D program, an osteotomy plane is performed and an osteotomy of the medial exostosis of the first metatarsal bone is performed. Similarly, 3D program involves L-shaped osteotomy – transverse cut in proximal part of metatarsal bone with direction of sawing 60° relative to longitudinal axis of first metatarsal bone and at angle of 90° to longitudinal axis of second metatarsal bone. That is followed by a distal incision parallel to the proximal canal and, after complete virtual separation of the proximal fragment, displacing laterally, virtual orientation pin is used to fix osteotomized fragments. Patterns according to figure 7 are created and printed on 3D printer, where 1 is a resection template; 2 is a template for L-shaped osteotomy; 3 is template for movement and fixation of osteotomized fragments, wherein the surface of the patterns applied on the first metatarsal bone should correspond to the surface of the first metatarsal bone. Besides, the templates are provided with guide cuts and holes for cutting tools and orienting pins, which enable to apply an osteotomy in a sequential application on the first metatarsal bone, as well as displacement and fixation of osteotomized bone fragments to a predetermined position. When creating templates, the osteotomy vector and level, the direction of the pins and the level of movement are considered.;EFFECT: method provides accurate and reliable osteotomy by creating templates.;1 cl, 13 dwg