Factors Related to Early Recurrence of Idiopathic Clubfoot Post the Ponseti Method
Factors Related to Early Recurrence of Idiopathic Clubfoot Post the Ponseti Method
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DOI：
10.5704/moj.1911.005
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发表时间：
2019-11-01
影响因子：
0.7
通讯作者：
Sailohit, P.
中科院分区：
文献类型：
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作者：
Limpaphayom, N.;Sailohit, P.
简介：特发性马蹄内翻足或先天性马蹄内翻足 (CTEV) 在全球范围内采用潘塞蒂方法进行治疗；然而，畸形的复发是一个具有挑战性的问题。目的是回顾与 Ponseti 方法后 CTEV 早期复发相关的因素。材料和方法：2011-2016 年期间，对 34 名患有 52 CTEV 的婴儿进行了回顾，这些婴儿接受了 Ponseti 方法并至少随访了 6 个月。 22 名婴儿 (65%) 为男性，18 名婴儿 (53%) 患有双侧 CTEV。 CTEV 复发定义为畸形的四个组成部分中的至少一个再次出现。使用单变量逻辑回归分析评估复发与因素之间的关联，包括年龄、性别、双边性、家庭地理、主要护理人员类型、就诊时的严重程度、开始潘塞蒂方法的中心、足外展支架 (FAB) 的依从性、伸展运动的练习、FAB 类型和石膏并发症。结果：开始治疗时的中位年龄为 3.4（IQR；2.1-12.6）周。平均需要 6 次（范围：3-12）次铸模。 32/34 (94%) 的病例进行了腱切断术。平均随访时间为 2.3 +/- 1.1 年，复发发生在 14/52 英尺 (27%)。不遵守 FAB 方案始于平均年龄 11.2 +/- 6.5 个月，并显着增加断奶阶段的复发风险 [OR (95% CI)=8.4 (1.2-92.4)，p=0.03]。其他因素与复发无关。结论：治疗早期不遵守 FAB 与 CTEV 复发风险相关。医生应鼓励父母和/或监护人遵循该方案以降低复发风险。
Introduction: Idiopathic clubfoot or congenital talipes equinovarus (CTEV) is managed by the Ponseti method worldwide; however, the recurrence of the deformity is a challenging problem. The purpose was to review the factors associated with early recurrence of CTEV post the Ponseti method.Materials and Methods: During 2011-2016, 34 infants with 52 CTEV, who underwent the Ponseti method and a minimum follow-up period of six months, were reviewed. Twenty-two infants (65%) were male, and 18 infants (53%) had bilateral CTEV. Recurrence of CTEV was defined as a reappearance of at least one of the four components of the deformity. The association between recurrence and factors, including age, gender, bilaterality, family geography, type of principal caregiver, severity at presentation, centre where the Ponseti method was initiated, compliance to foot abduction brace (FAB), practice of stretching exercise, type of FAB, and complications of casting, were evaluated using univariate logistic regression analysis.Results: The median age at initiation of the treatment was 3.4 (IQR; 2.1-12.6) weeks. A median of six (range; 3-12) casts were required. Tenotomy was performed in 32/34 (94%) of cases. Recurrence occurred in 14/52 feet (27%) at an average follow-up period of 2.3 +/- 1.1 years. Noncompliance to FAB protocol began at an average age of 11.2 +/- 6.5 months, and significantly increased the risk of recurrence during the weaning phase [OR (95%CI)=8.4 (1.2-92.4), p=0.03]. Other factors were not associated with the recurrence.Conclusion: Non-compliance to FAB occurred early during the treatment and related to a risk of recurrence of CTEV. Physicians should encourage the parents and/or guardians to follow the protocol to decrease the risk of recurrence.