改良Ponseti方法治疗早期先天性马蹄内翻足的神经电生理研究

目的改良Ponseti方法治疗早期先天性马蹄内翻足（CCF）的神经电生理研究。方法应用改良Ponseti方法治疗年龄7天～12个月先天性马蹄内翻足25例31足，应用Nicolet公司VikingIV肌电图诱发电位仪对每期石膏矫形后的CCF患儿进行检测。检测包括双下肢胫神经、腓总神经、腓肠神经及H反射。分析比较运动神经传导速度（MCV）、感觉波（SCV）、传导波幅的变化情况。依据Dimeglio法分型和Pirani评分判定疗效。随访时间为12—36个月，平均15个月。结果31足在石膏矫形前神经电生理异常的有23足f74．19％）。神经电图检测显示21个病足结果异常（67．74哟，H反射异常15足（48．39%。第1～Ⅲ期石膏矫形后的神经电生理变化不明显，第4期石膏矫形后改变明显。28足神经电生理检测达到或接近正常后停止石膏矫形，带足部支具巩固治疗，3足神经电生理检测未接近正常，停止石膏矫形后3个月复发。再行石膏矫形后治愈。结论神经电生理检测可以直接、客观地判断改良Ponseti方法治疗早期先天性马蹄内翻足的治愈标准及预后。

Neuroelectrophysiological research of modified Ponseti method in treatment of early stage congenital clubfoot

Objective Neuroelectrophysiological research of modified Ponseti methodin treatment of congenital clubfoot （CCF） at early stage. Methods Twenty five patients （31 feet） with congenital clubfoot, ages ranged from 7 days to 12 months old, were treated by modified Ponseti method. Viking IV myoeleetrieity evoked potential equipment of Nicolet Company were used to detect the tibial nerve of the lower limbs, the peroneal nerve, sural nerve and H-reflex on CCF patients. The motor nerve conduction velocity （MCV）, sensory nerve conduction velocity （SCV） and conduction amplitude were analyzed. The therapeautic efficacy were assessed according to Dimeglio methods and Pirani scores. The follow-up study lasted for 12-36 months, averaged 15 months. Results There were 23 feet （74.19%） with neuroelectrophysiological abnormalities in all 31 feet before plaster ortho- pedic. The electroneurogram showed 21 feet （67.74%） with abnormal results, 15 feet （48.39%） with H-reflex abnormalities. There was no significantly neuroeleetrophysiologieal change after I - Ⅲ stage plaster orthopedic, while there was significantly neuroelectrophysiological change after IV stage plaster orthopedic. The plaster orthopedic was stopped and the foot brace consolidation therapy was applied in 28 feet when the neuroelectrophysiolog- ical testing was near normal. 3 feet were not close to normal in the neuroelectrophysiological testing and recurred 3 months after the plaster orthopedic. It was cured after plaster orthopedic again. Conclusion Neurophysiological detection can directly and objectively judge the cure standards and prognosis of early stage CCF treated with Modified Ponseti method.