Ponseti方法治疗先天性马蹄内翻足的疗效及双踝角测量

目的讨论采用Ponseti方法早期保守治疗先天性马蹄内翻足及应用双踝角(FBM)测量对治疗前后效果进行评估。方法2004-04～2007-07采用Ponseti方法治疗先天性马蹄内翻足63例,58例为单纯性马蹄内翻足,5例伴发多关节挛缩畸形;男46例,女17例;单侧44例,双侧19例,共82足;年龄7d至6个月。治疗前测量正常足印44足,FBM角平均86.7°,马蹄内翻足患者足印82足,Ⅰ类24足FBM角平均73.5°;Ⅱ类42足FBM角平均65.7°;Ⅲ类16足FBM角平均54.9°。结果所有患者平均随访期12.7个月,最长26个月。58例单纯性马蹄内翻足患者外观畸形纠正,关节功能良好,测量FBM角平均85.1°;5例多关节挛缩马蹄足残留少量内收畸形,测量FBM角平均75.3°,需再行软组织松解术。结论Ponseti方法保守治疗先天性马蹄内翻足可获得令人满意的疗效;双踝角测量对于婴幼儿马蹄内翻足治疗前后的评估和治疗方法的选择具有实际使用意义。

Treatment of congenital clubfoot by using Ponseti method and evaluating the therapeutic effects with foot binalleolar angel

Objective To explore the results of Ponseti method as an early conservative treatment for infants congenital clubfoot and evaluate curative effects with foot binalleolar angel measurement. Method Sixty-three infants(males 46 and females 17,aged from 7 days to 6 months)were managend with Ponseti method in the hospital from April, 2004 to July, 2007. The unilateral deformation occurred in 44 infants and bilateral deformation in 19 patients and 5 patients were associated with multiple joint contractures. The anteromedial angle between the long axis of foot and binalleolar plane was measured as FBM angle; 44 healthy feet of the infants were measured as FBM angle average 86.7°. FBM angle of another 82 feet of the patients were measured for comparison and evaluation. For the talipes equinovarus feet, the preoperative FBM angles were: average 73.5° in grade 1 (24feet); 65.7° in grade 2 (42feet) and 54.9° in grade 3 (16feet). Result All the infants were followed up for average 12.7 months(the longest, up to 26 months). The patients of simple equinus deformity were recovered normal appearances and ankle function with the FBM angle 85.1° averaged; 5 patients with multiple joint contractares need extra soft tissue release for mild ankle adduction the FBM angle 75.3° averaged. Conclusions The satisfactory results can be gained using Ponseti method to treat patients with congenital clubfoot. The FBM angle measurement has significant importance in the treatment method selection of talipes equinovarus and the result evaluation of pre-and postoperative treatment.