Lovell Matthew E, Morcuende Jose A
The Ponseti Center for Clubfoot Treatment, Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa 52242, USA.
Iowa Orthop J. 2007;27:82-4.
Following correction with the Ponseti method some idiopathic clubfeet still will relapse even after six years of age. A better understanding of the cause for these late relapses will greatly help in the management of this condition. We evaluated a consecutive case-series from 1948 through December 1984 including 209 patients (321 clubfeet). Patients were treated following the Ponseti method. Initial number of casts, age at relapse, neurological evaluation, and final treatment for the late-relapses were recorded. There were 12 patients (6%) having a relapse after the seventh birthday. In 4 of these patients (6 clubfeet) a neuromuscular disease was diagnosed, representing 33% of the late relapses. These patients were initially treated with an average of 4 casts (range: 2-6) with 2 requiring an Achilles tenotomy. Patients used the brace for an average of 4 years. The average age at the relapse prior to the suspicion of neuromuscular disease was 9 years (range: 8-11 years). Two patients had family history of neuromuscular disease (myotonic dystrophy and multiple core disease). In the other two cases (Charcot-Marie-Tooth Disease type IA and myasthenia gravis) neuromuscular disease was not suspected. All four patients required an anterior tibialis transfer, three had a plantar fasciotomy, and two had peroneus longus to brevis transfers. One patient required a subsequent posterior tibialis transfer and another patient a triple arthrodesis (myotonic dystrophy). In conclusion, late relapses in patients with idiopathic clubfoot may represent the onset of a previously undiagnosed neuromuscular disease, and should be thoroughly evaluated.
采用庞塞蒂方法矫正后，一些特发性马蹄内翻足即使在6岁以后仍会复发。更好地了解这些晚期复发的原因将极大地有助于这种疾病的治疗。我们评估了1948年至1984年12月的一组连续病例，包括209例患者（321只马蹄内翻足）。患者均按照庞塞蒂方法进行治疗。记录了最初石膏固定的次数、复发时的年龄、神经学评估以及晚期复发的最终治疗情况。有12例患者（6%）在7岁生日后复发。在其中4例患者（6只马蹄内翻足）中诊断出神经肌肉疾病，占晚期复发患者的33%。这些患者最初平均使用4次石膏（范围：2 - 6次），其中2例需要跟腱切断术。患者平均佩戴支具4年。在怀疑患有神经肌肉疾病之前复发的平均年龄为9岁（范围：8 - 11岁）。2例患者有神经肌肉疾病家族史（强直性肌营养不良和多核病）。在另外2例（1A型夏科 - 马里 - 图斯病和重症肌无力）中未怀疑有神经肌肉疾病。所有4例患者均需要进行胫前肌转移术，3例进行足底筋膜切开术，2例进行腓骨长肌转至腓骨短肌手术。1例患者随后需要进行胫后肌转移术，另1例患者需要进行三关节融合术（强直性肌营养不良）。总之，特发性马蹄内翻足患者的晚期复发可能代表先前未被诊断出的神经肌肉疾病的发作，应进行全面评估。
