Terrazas-Lafargue Gaston, Morcuende Jose A
The Ponseti Clubfoot Treatment Center, University of Iowa, Iowa City, Iowa, USA.
Iowa Orthop J. 2007;27:24-7.
Clubfoot correction by the Ponseti method is highly successful with an average of 5 casts in the majority of patients. However, early experience with the technique demonstrated that many cases required more than 5 casts for correction. The purpose of this study was to evaluate the effects of timing of cast removal before subsequent manipulation and casting in the correction of club-foot using the Ponseti method. We reviewed 90 patients (129 clubfeet) treated between December 2000 and June 2006. Two groups were evaluated. Group A: 44 patients (63 clubfeet) had their cast removed by the parents the night before the visit. Group B: 46 patients (66 feet) had their cast removed in the clinic just before the new casts were applied. Overall, full correction was obtained in 128 (99%) clubfeet, with only 1 clubfoot requiring surgical release. Group A required an average of 10 casts (range: 4 to 22), compared to 5 casts (range: 4 to 10) in Group B (p = 0.001). Average time for correction was 13 weeks in Group A and 6 weeks in Group B (p = 0.001). There were 20 relapses (22%), 12 (27%) in Group A and 8 (17%) in Group B (p = 0.42). In conclusion, removing the cast just before the new cast is applied significantly decreases the number of casts required for correction and shortens the length of treatment.
采用庞塞蒂方法进行马蹄内翻足矫正成功率很高，大多数患者平均需5次石膏固定。然而，该技术早期经验表明，许多病例矫正需要超过5次石膏固定。本研究目的是评估在采用庞塞蒂方法矫正马蹄内翻足时，后续手法操作和石膏固定前拆除石膏的时机的影响。我们回顾了2000年12月至2006年6月期间治疗的90例患者（129只马蹄内翻足）。评估了两组。A组：44例患者（63只马蹄内翻足）在就诊前一晚由家长拆除石膏。B组：46例患者（66只足）在诊所刚要应用新石膏前拆除石膏。总体而言，128只（99%）马蹄内翻足获得完全矫正，仅1只马蹄内翻足需要手术松解。A组平均需要10次石膏固定（范围：4至22次），而B组为5次石膏固定（范围：4至10次）（p = 0.001）。A组平均矫正时间为13周，B组为6周（p = 0.001）。有20例复发（22%），A组12例（27%），B组8例（17%）（p = 0.42）。总之，在应用新石膏前拆除石膏可显著减少矫正所需石膏固定次数并缩短治疗时间。
