The Ponseti method in the treatment of children with idiopathic clubfoot presenting between five and ten years of age
The Ponseti method in the treatment of children with idiopathic clubfoot presenting between five and ten years of age
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DOI：
10.1302/0301-620x.95b12.32173
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发表时间：
2013-12-01
影响因子：
4.6
通讯作者：
Spiegel, D. A.
中科院分区：
文献类型：
--
作者：
Banskota, B.;Banskota, A. K.;Spiegel, D. A.
我们的目标是评估Ponseti方法在治疗五至十岁儿童特发性马蹄内翻足时的使用情况，并进行微小的调整。对36名平均年龄为7.4岁（5至10岁）的儿童（55足）进行了回顾性分析，并辅以步态的数字图像和视频记录。男19例，女17例。平均随访31.5个月（24 ~ 40）。平均石膏数量为9.5（6 - 11），所有儿童均需要手术，包括经皮肌腱切开术或开放性肌腱延长术（49%）、后路松解术（34.5%）、后内侧软组织松解术（14.5%）或软组织松解术联合截骨术（2%）。踝关节平均背屈9 °（0 ° ~ 15 °）。前足对线为中性的28只脚（51%）或内收（< 10度）的20只脚（36%），> 10度的7只脚（13%）。26只足（47%）的后足对线为中性或轻度外翻，19只足（35%）为轻度内翻（< 10度），10只足（18%）为内翻（> 10度）。38只脚（86%）出现脚跟-脚趾步态，12只（28%）表现出外侧边缘负重（共有44只脚，步态视频可用于分析）。在9只脚（16%，6名儿童）中发现了明显的复发。27名患儿的家长（75%）对手术完全满意，46只足（84%）实现了跖行行走，没有进行广泛的软组织松解或骨性手术，尽管矫正不足是常见的，需要长期随访来评估结果。
Our goal was to evaluate the use of Ponseti's method, with minor adaptations, in the treatment of idiopathic clubfeet presenting in children between five and ten years of age. A retrospective review was performed in 36 children (55 feet) with a mean age of 7.4 years (5 to 10), supplemented by digital images and video recordings of gait. There were 19 males and 17 females. The mean follow-up was 31.5 months (24 to 40). The mean number of casts was 9.5 (6 to 11), and all children required surgery, including a percutaneous tenotomy or open tendo Achillis lengthening (49%), posterior release (34.5%), posterior medial soft-tissue release (14.5%), or soft-tissue release combined with an osteotomy (2%). The mean dorsiflexion of the ankle was 9 degrees (0 degrees to 15 degrees). Forefoot alignment was neutral in 28 feet (51%) or adducted (< 10 degrees) in 20 feet (36%), > 10 degrees in seven feet (13%). Hindfoot alignment was neutral or mild valgus in 26 feet (47%), mild varus (< 10 degrees) in 19 feet (35%), and varus (> 10 degrees) in ten feet (18%). Heel-toe gait was present in 38 feet (86%), and 12 (28%) exhibited weight-bearing on the lateral border (out of a total of 44 feet with gait videos available for analysis). Overt relapse was identified in nine feet (16%, six children). The parents of 27 children (75%) were completely satisfied.A plantigrade foot was achieved in 46 feet (84%) without an extensive soft-tissue release or bony procedure, although under-correction was common, and longer-term follow-up will be required to assess the outcome.