皮下跟腱切断术在Ponseti方法治疗先天性马蹄内翻足中的作用

[目的]介绍皮下跟腱切断术的手术指征、方法,阐明皮下跟腱切断术在Ponseti方法治疗先天性马蹄内翻足中的重要性。[方法]本院自2000年1月~2005年12月,采用Ponseti方法治疗先天性马蹄内翻足236例,男196例,女40例,共330足,年龄3 d~13个月。选择连续矫形石膏后,足不能背屈>15°,不能保持外展70°位置的病例为施行皮下跟腱切断术指征。308足具备手术指征接受手术治疗,22足未行皮下跟腱切断术而直接佩戴矫形支具。[结果]佩戴支具后定期随访,平均随访期2.1年,随访率97.88%。所有行手术的跟腱无1例不连接,外观连续,扪之有弹性,已行走者步态正常,跟腱有力。随访中,未手术组4足出现马蹄复发,行皮下跟腱切断术;手术组31足出现不同程度的马蹄,内收畸形复发,再行皮下或切开跟腱延长术及肌腱转移术。所有接受手术者无1例出现“摇椅足”畸形。[结论]皮下跟腱切断术是Ponseti方法治疗先天性马蹄内翻足中非常重要的环节,是完全矫正马蹄畸形的关键,它对于恢复跟骨的解剖位置,维持足正常的形态具有重要意义。严格把握手术指征,仔细操作,正确配合矫形石膏和外展支具使用,有助于取得Ponseti方法治疗的成功。     

先天性马蹄内翻足经Ponseti方法治疗后复发的影响因素分析

[目的]探讨先天性马蹄内翻足(congenital talipes equinovarus,CTEV)经Ponseti方法治疗后畸形复发的相关影响因素。[方法]2002年3月～2007年11月本院应用Ponseti方法治疗先天性马蹄内翻足患儿378例544足,回顾性分析资料完整,随访时间超过5年的119例173足,男90例,女29例;初治年龄1 d～14个月,平均(3.55±3.22)个月,按照复发与否分为复发组和非复发组,其中复发组43例57足,非复发组76例116足。单因素分析比较两组间患儿性别、初治年龄、侧别、跟腱切断与否、初始Pirani评分、初始石膏纠正次数、支具依从性的差别,以复发与否作为应变量将上述变量行Logistic多因素回归分析,探讨这些因素与复发的相关性。[结果]单因素分析显示两组间支具依从性(x2=74.12,P=0.000)、初始Pirani评分(t=3.24,P=0.001)及初始石膏纠正次数(t=2.26,P=0.025)有差别,性别、初治年龄、侧别、跟腱切断差异无统计学意义;Logistic多因素回归分析显示支具依从性(OR=112.60,P=0.000)、初始Pirani评分(OR=5.02,P=0.000)是影响复发的独立因素。[结论]患足的复发与支具不顺从、初始Pirani评分高有关,进一步提高支具依从性是控制复发的关键,对于初始Pirani评分高者需要制定更加密切的随访计划,以便及时发现和矫正复发的畸形。     

Ponseti方法治疗小儿先天性马蹄内翻足的护理

[摘要]目的：探讨Ponseti方法治疗小儿先天性马蹄内翻足的护理方法及效果,减少由马蹄内翻畸形足引起的残疾,提高生活质量。方法：对我科2007～2010年68例先天性马蹄内翻足患儿采用Ponseti方法治疗期间的临床护理资料进行回顾性分析。结果：随访68例94足畸形患儿均获得满意的矫正,活动功能良好,未出现护理并发症。     

应用Ponseti方法治疗大龄儿先天性马蹄内翻足

1 先天性马蹄内翻足治疗方法的历史回顾 先天性马蹄内翻足(congenital talipes equinovarus或congenital clubfoot)是一种常见的出生缺陷和儿童骨关节畸形,由足内翻、踝跖屈、前足内收3种主要畸形因素组成,是骨科领域内常见的、需要特别治疗的先天性畸形[1].据世界卫生组织(WHO)有关资料显示,全球每年有近20万的新生儿患有马蹄内翻足,其中80%在亚洲等发展中国家.中国是最大的发展中国家,也是出生缺陷的高发国家之一,估计每年约有7万的新生儿患有先天性马蹄内翻足[1].     

Ponseti方法治疗小儿先天性马蹄内翻足的护理

目的：探讨Ponseti方法治疗小儿先天性马蹄内翻足的护理方法及效果,矫正马蹄内翻畸形,减少并发症,提高生活质量,减少残疾。方法：对我科2006～2009年68例先天性马蹄内翻足患儿采用Ponseti方法治疗期间的临床护理资料进行回顾性分析。结果：随访68例94足畸形患儿均获得满意的矫正,活动功能良好,未出现护理并发症。结论：对用Ponseti治疗的患儿进行科学的护理和良好的康复训练,方法简单,伤害低,有效减少和避免了治疗过程中并发症的发生,对小儿先天性马蹄内翻足的康复起着积极的作用。     

改良Ponseti方法治疗先天性马蹄内翻足疗效

[目的]评价改良Ponseti方法治疗先天性马蹄内翻足疗效.[方法]在Ponseti方法(连续石膏矫形加经皮跟腱切断加足外展矫形支具)的基础上稍加改良,并应用于治疗先天性马蹄内翻足76例116足,男52例80足,女24例36足;年龄5 d～4岁.[结果]本组病例76例均得到随访,平均随访25.5个月,最长46个月,按Dimeglio评分分级方法,76例116足中73例112足(96.5%)畸形矫正满意.[结论]改良Ponseti方法对4岁以内的婴幼儿先天性马蹄内翻足均可取得满意的效果.     

先天性马蹄内翻足的手术治疗

目的 提高先天性马蹄内翻足的治疗效果,减少其并发症和复发率。方法 采用后路松解、胫前肌外移、Ｅｖａｎｓ和Ｉｉｚａｒｏｖ等手术治疗５个月￣１４岁儿童先天性马蹄内翻足３１５２例（４８４足）,按Ｇａｒｃｅａｕ疗效评定标准对疗效进行评价。     

Ponseti法治疗先天性马蹄内翻足疗效分析

[目的]评价采用Ponseti法治疗1岁以内先天性马蹄内翻足的疗效。[方法]2005年4月~2008年10月,本院骨科共收治先天性马蹄内翻足病例125例138足,男98例106足,女27例32足,年龄7 d~12个月。按年龄分为新生儿期(7~28 d)、小婴儿期(29 d~6个月)、婴儿期(6~12个月)三组,均按D im eglio评分系统进行评分,应用Ponseti法(手法矫正+石膏固定+经皮跟腱切断+足外展支具)治疗。[结果]病例随访13~42个月,平均25.3个月。按D im eglio评分系统评价疗效,120例132足矫形效果满意,5例6足残余部分畸形行手术治疗。各年龄组治疗优良率无显著差异(P0.05)。[结论]Ponseti法治疗先天性马蹄内翻足疗效确切,是一种很好的保守治疗方法。对于1岁以内先天性马蹄足均可取得优良效果。     

Ilizarov技术联合Ponseti方法治疗儿童僵硬性马蹄内翻足的临床研究

目的 探讨Ilizarov技术联合Ponseti方法治疗大龄儿童僵硬性马蹄内翻足畸形的临床疗效.方法 回顾性分析2012年7月至2016年7月玉林桂南医院收治的36例(49足)儿童僵硬性马蹄内翻足病例的临床资料,术前均行负重位踝关节正侧位X线检查,根据安装Ilizarov外固定架治疗前是否进行Ponseti石膏矫正分为...     

先天性马蹄内翻足两种非手术治疗方法比较

先天性马蹄内翻足是临床常见的出生缺陷,目前主流的非手术治疗方法包括Ponseti方法和Bensahel功能疗法.该文通过文献回顾,就Ponseti方法和Bensahel功能疗法治疗先天性马蹄内翻足相关病理学认识、治疗原理和方法、随访结果、步态分析等作一综述,以明确两者的优缺点,讨论哪种方法更适合我国现阶段治疗.     

Treatment of congenital clubfoot with the Ponseti method

AIM: The primary therapy for congenital clubfoot is non-surgical involving manipulation and serial casting. With traditional casting, relatively large numbers of feet require extensive surgery to achieve full correction. The purpose of this study was to evaluate the efficacy of the Ponseti method. METHODS: Between 1.1.2004 und 31.12.2005, 29 patients with 41 clubfeet were treated with the Ponseti method. Only patients without any prior treatment were included. Classification followed Pirani's score. The number of casts to full correction, tenotomies, number of posteromedial releases, dorsi-, plantarflexion and hindfoot position were documented. The follow-up time was 1-9 months, the average follow-up time was 9.1 months. RESULTS: 39 clubfeet were successfully treated with the Ponseti method. The average Pirani score was 4.9. Percutaneous tenotomies were necessary in 34 of the clubfeet. Average dorsiflexion was 19 degrees and plantarflexion 42 degrees . After failed Ponseti treatment 2 feet were treated with a posteromedial release. CONCLUSION: With the Ponseti method the need for extensive corrective surgery is greatly reduced. We recommend the Ponseti method as standard therapy in clubfoot management.     

先天性马蹄内翻足经皮跟腱切断手术时机的选择

目的应用Ponseti方法早期治疗先天性马蹄内翻足（先天性马蹄内翻足）,探讨经皮跟腱切断手术时机的选择。方法60例（91足）先天性马蹄内翻足患儿,随机分为A、B两组,每组30例,治疗初评分≥4分（僵硬型）。A组患足矫形外展至70°、背屈〈15°、同时HS〉1、MS〈1和距骨被覆盖;B组患足矫形至前足内收纠正但无法背屈,同时HS〉1、MS≤1,行跟腱切断术;以Pirani评分标准比较两组治疗结果。结果患儿均得到随访,时间6～30（15±5）个月。A、B两组手术前石膏矫形次数分别为（5.1±0.91）次、（2.42±0.56）次（P〈0.05）,治疗时间分别为（36.8±4.98）d、（19.3±5.09）d（P〈0.01）,差异有统计学意义。两组跟腱均获得愈合,跖屈有力,术后患足背屈活动度差异无统计学意义（P〉0.05）。结论在Ponseti方法矫正僵硬型马蹄足过程中,畸形愈严重跟腱挛缩愈严重,早期行经皮跟腱切断手术可明显减少石膏矫形次数、缩短疗程,不影响疗效。     

Reliability of radiographic measures in infants with clubfoot treated with the Ponseti method

PurposeThe aim of this study was two-fold: (1) to determine if radiographic measures can be reliably made in infants being treated with the Ponseti method and (2) to document radiographic changes before and after Achilles tenotomy.MethodsA retrospective radiographic and chart review was performed on children with clubfoot treated by the Ponseti method at a single institution over a 10-year period. Five independent reviewers measured a series of angles from a lateral forced dorsiflexion radiograph taken prior to and following Achilles tenotomy. These measures were taken in triplicate to determine the intra- and inter-reader reliability of dorsiflexion, tibio-calcaneal, talo-calcaneal, and talo-first metatarsal angles.ResultsThirty-six subjects (56 feet) were treated with the Ponseti method and met the inclusion criteria. The median (range) age of patients at the time of tenotomy was 52 (34–147) days. The intra-reader reliability [intra-rater correlation coefficient (ICC)] for each of the measured angles pre- and post-tenotomy ranged from 0.933 to 0.995 and 0.864 to 0.995, respectively. Similarly, the inter-reader reliabilities (ICC) ranged from 0.727 for the pre-tenotomy (talo-calcaneal) to 0.950 for the post-tenotomy (talo-first metatarsal) angles. The mean differences between pre- and post-tenotomy radiographs were: dorsiflexion increase of 17°, tibio-calcaneal angle increase of 19°, talo-calcaneal angle increase of 9°, and talo-first metatarsal angle increase of 10° (p-value ≤0.001 for all measurements except the talo-first metatarsal angle, with a p-value of 0.001).ConclusionsReliable radiographic measures can be made from lateral dorsiflexion radiographs of clubfeet treated with the Ponseti method before and after Achilles tenotomy.     

Ponseti法矫正不同月龄先天性马蹄内翻足疗效分析

[目的]探讨采用Ponseti法矫正不同月龄先天性马蹄内翻足的疗效。[方法]将2010年1月～2015年1月于本院采用Ponseti法矫正先天性马蹄内翻足的患儿共528例704足纳入本研究。根据年龄不同分为三组:新生儿期95例148足,小婴儿期262例342足,婴儿期169例214足。采用Ponseti法进行治疗,主要包括手法矫正、石膏固定、经皮跟腱切断和足外展支具固定。术后随访,治疗前后采用Dmieglio评分系统进行评分及分型。[结果]各月龄组均随Dmieglio分型等级增加,石膏固定次数显著增多,差异有统计学意义(P0.05)。但各Dmieglio分型等级,不同月龄组患儿的患足石膏固定次数差异无统计学意义(P0.05)。各月龄分组患儿治疗前Dmieglio评分随分型等级增加而增加,组间比较差异均有统计学意义(P0.05);各月龄分组患儿末次随访时Dmieglio评分随分型等级增加而增加,组间比较差异均有统计学意义(P0.05);各月龄分组中,与治疗前相比,各Dmieglio分型患儿末次随访时Dmieglio评分均有所降低,差异均有统计学意义(P0.05)。相同时间点,各Dmieglio分型患儿在不同月龄分组间差异均无统计学意义(P0.05)。528例704足中,507例673足疗效满意,其中新生儿期组优良率为96.08%、小婴儿期组为95.45%、婴儿期组为95.57%,三组间临床结果优良率的差异无统计学意义(P0.05)。[结论]对于1岁以内的先天性马蹄内翻足幼儿,Ponseti法保守治疗的矫形效果确切,疗效与Dmieglio分型相关。     

Midterm results of the Ponseti method in the treatment of congenital clubfoot

Purpose

The Ponseti method has become the gold standard for clubfoot treatment. Although promising short-term results have been published, only a few studies report results at the end of the bracing period. We aimed to evaluate the functional midterm results, rate of recurrence and need for subsequent surgery.

Methods

Patients from our prospective database of clubfeet treated with the Ponseti method with a minimum age of three years were identified. Exclusion criteria were syndrome or neurogenic association, address in a foreign country, presentation after six weeks of age, more than three casts applied elsewhere and correction with less than three casts. A total of 125 patients met the inclusion criteria. The Pediatric Outcomes Data Collection Instrument (PODCI), the disease-specific instrument (DSI) questionnaire and an invitation for a clinical examination were sent out. For patients not presenting for evaluation, data from the last follow-up were extracted.

Results

Seventy questionnaires (56 %) of patients with a mean age of 5.7 years (3.3–8.9 years) were returned. The DSI score (n = 65) was 85.3 (± 13.01 SD) and the PODCI score (n = 59) was 95.5 (± 6.3 SD). A total of 113 of 125 patients (90.4 %) with 182 clubfeet were examined in the study or seen in follow-up. During a mean follow-up of 5.2 years (range 3–8.5 years) a repeat tenotomy was performed in 4 % of cases, a percutaneous Achilles tendon lengthening in 3 %, a tibialis anterior tendon transfer in 13 % and open joint surgery in 5 %. The mean dorsiflexion with knee extended was 15.9° (range 0–32°; SD ±5.5) with 16 feet (9 %) presenting less than 10°.

Conclusions

The functional scores indicate that the Ponseti method results in mostly pain-free feet not limiting age-appropriate activity. In this consecutive case series open joint surgery could be avoided in 95 % of cases with a good functional and anatomic outcome.     

Early results of treatment for congenital clubfoot using the Ponseti method

The purpose of this study was to evaluate the early results of the Ponseti method in reducing extensive corrective surgery rates for congenital idiopathic clubfoot in patients treated in Children's Orthopaedic Clinic and Rehabilitation Department Medical University of Lublin between the years 2007-2011. Thirty-five patients with 47 idiopathic clubfeet were followed prospectively while being managed with the Ponseti method. Clubfoot severity was graded with use of the Dimeglio system. The initial correction was achieved, and early results were measured by using Pirani scoring method.     

Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method.

Little information exists about the degree of efficacy of the several nonoperative treatments, such as manipulation and casting, used in correcting the pathology of the virgin clubfoot deformity. The steps in the correction of the displacements and anomalies of the skeletal components have never been visualized. The method reported to have the best long-term results is that of Ponseti. A magnetic resonance imaging protocol was devised to image the described chondroosseous abnormalities of the virgin clubfoot deformity and to illustrate the changes that occur with the Ponseti method of treatment. Scans were performed at the beginning of, in the middle of, and at the end of treatment. Images obtained with this protocol largely agree with postmortem studies of clubfeet. All of the major chondroosseous pathology could be visualized in vivo. With Ponseti treatment, all the abnormalities seen on the initial scans either improved markedly or corrected completely. Treatment resulted in correction not only of the abnormal relationships of the tarsal bones, but also of the abnormal shapes of the individual tarsal osteochondral anlages, probably because of the changes in growth resulting from the changes in mechanical loading of fast-growing tissues.