Dobbs Matthew B, Rudzki J R, Purcell Derek B, Walton Tim, Porter Kristina R, Gurnett Christina A
Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2004 Jan;86(1):22-7. doi: 10.2106/00004623-200401000-00005.
The nonoperative technique for the treatment of idiopathic congenital talipes equinovarus (clubfoot) described by Ponseti is a popular method, but it requires two to four years of orthotic management. The purpose of this study was to examine the patient characteristics and demographic factors related to the family that are predictive of recurrent foot deformities in patients treated with this method.
The cases of fifty-one consecutive infants with eighty-six idiopathic clubfeet treated with use of the Ponseti method were examined retrospectively. The patient characteristics at the time of presentation, such as the severity of the initial clubfoot deformity, previous treatment, and the age at the initiation of treatment, were examined with use of univariate logistic regression analysis modeling recurrence. Demographic data on the family, including annual income, highest level of education attained by the parents, and marital status, as well as parental reports of compliance with the use of the prescribed orthosis, were studied in relation to the risk of recurrence.
The parents of twenty-one patients did not comply with the use of orthotics. Noncompliance was the factor most related to the risk of recurrence, with an odds ratio of 183 (p < 0.00001). Parental educational level (high-school education or less) also was a significant risk factor for recurrence (odds ratio = 10.7, p < 0.03). With the numbers available, no significant relationship was found between gender, race, parental marital status, source of medical insurance, or parental income and the risk of recurrence of the clubfoot deformity. In addition, the severity of the deformity, the age of the patient at the initiation of treatment, and previous treatment were not found to have a significant effect on the risk of recurrence.
Noncompliance and the educational level of the parents (high-school education or less) are significant risk factors for the recurrence of clubfoot deformity after correction with the Ponseti method. The identification of patients who are at risk for recurrence may allow intervention to improve the compliance of the parents with regard to the use of orthotics, and, as a result, improve outcome.
Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.
庞塞蒂描述的治疗特发性先天性马蹄内翻足（畸形足）的非手术技术是一种常用方法，但需要两到四年的支具治疗。本研究的目的是检查与家庭相关的患者特征和人口统计学因素，这些因素可预测采用该方法治疗的患者足部畸形复发情况。
回顾性研究连续51例采用庞塞蒂方法治疗86例特发性畸形足婴儿的病例。采用单因素逻辑回归分析模型对复发情况进行研究，分析就诊时的患者特征，如初始畸形足畸形的严重程度、既往治疗情况以及开始治疗时的年龄。研究家庭的人口统计学数据，包括年收入、父母所达到的最高教育水平、婚姻状况，以及父母关于是否遵守使用规定支具的报告与复发风险的关系。
21例患者的父母未遵守支具使用规定。不遵守规定是与复发风险最相关的因素，比值比为183（p < 0.00001）。父母的教育水平（高中及以下）也是复发的一个重要风险因素（比值比 = 10.7，p < 0.03）。就现有数据而言，未发现性别、种族、父母婚姻状况、医疗保险来源或父母收入与畸形足畸形复发风险之间存在显著关系。此外，畸形的严重程度、患者开始治疗时的年龄以及既往治疗情况对复发风险均无显著影响。
不遵守规定和父母的教育水平（高中及以下）是庞塞蒂方法矫正后畸形足畸形复发的重要风险因素。识别有复发风险的患者可能有助于进行干预，以提高父母对支具使用的依从性，从而改善治疗效果。
预后研究，II-1级（回顾性研究）。有关证据水平的完整描述，请参阅作者须知。
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