先天性马蹄内翻足Ponseti治疗初跟腱手术的预测

目的探讨先天性马蹄内翻足（CCF）患儿治疗前预测患儿行跟腱手术的可行性。方法96例CCF（148足）患儿,均依据Ponseti方法治疗,平均（5.7±1.3）次石膏矫正后,背屈活动≤15°或Pirani评分HS（后足评分）≥1,MS（中足评分）〈1的患足需行跟腱切断手术。石膏去除后需佩戴外展支具。结果经过系列石膏矫正后,148足中125足（84.5%）行跟腱切断术,23足（15.5%）未行跟腱手术。在治疗初有102足（68.9%）Pirani评分≥5分,其中93足（91.2%）经系列石膏矫正后行跟腱手术。手术组跟腱愈合佳,跖屈有力。结论在治疗初Pirani评分≥5分时91.2%患儿需要跟腱手术,CCF患儿初次来诊时,对患足行Pirani评分,即可预测其是否需行跟腱手术。在治疗初预先判断患儿是否需行跟腱手术则既有利于医师了解治疗进展,又能更好地与家长沟通配合治疗进程。

Ponseti method can predict the need for Achilles tenotomy in the treatment of congenital clubfoot

Objective To investigate the feasibility of prediction of the need for Achilles tenotomy by the Ponseti method for correction of clubfoot at the beginning of the treatment. Methods 96 patients （ 148 feet ） with congenital clubfoot who were consecutively treated. The treatment was consisted of weekly manipulations and serial long leg casting for an average of 5.7 ±1.3 times, as described by Ponseti., According to Pirani scoring systems, when the cast was removed, if dorsoflexion≤ 15° or the HS（ hindfoot sore）≥ 1 ,and MS（ mindfoot sore） 〈 1. Achilles tenotomy was performed. Results Tenotomies were performed in 125 of 148 feet （ 84. 5% ）. Of 102 feet with initial Pirani scores ≥5, 91.2% required tenotomy and 8.8% did not. Following removal of the last cast, there was no significant difference between those that did and did not receive tenotomy. Conclusions Children with clubfeet who have an initial score of≥5.0 by the Pirani system are very likely to need tenotomy. At the end of casting, feet are equally well corrected whether or not they need the tenotomy（91.2% ）. Predicting the need for tenotomy with the Ponseti method is advantageous for the doctor to know the progressing of the procedure and for communication with the parents on how to cooperate with the treatment.