Desai Sameer, Aroojis Alaric, Mehta Rujuta
Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
J Pediatr Orthop. 2008 Jan-Feb;28(1):53-9. doi: 10.1097/bpo.0b013e31815a60a6.
The Ponseti method of manipulation is widely used in the treatment of clubfoot. Monitoring of correction is usually based on clinical judgment, and there is a need for an objective method of evaluation. The small bones of the newborn foot are essentially cartilaginous and can be visualized well on sonography as against radiographs.
A prospective study was conducted on 32 clubfeet (26 subjects; age range, 12 days to 3 months) using ultrasound. Sonography was performed using the coronal medial projection at the start of treatment, when midfoot Pirani score was zero (foot fully abducted), and at the end of treatment. The medial malleolus to navicular distance and the talo-cuneiform angle were measured with foot position at rest and during the simulated Ponseti maneuver. The normal feet in unilateral cases served as controls.
With the Ponseti method of manipulation, there was a significant increase in the medial malleolus to navicular distance and improvement in the talo-cuneiform angle at the end of treatment, when compared with the pretreatment values (P < 0.001). All feet were clinically well corrected. However, 5 feet (15%) showed a "spurious correction," which was only detected on ultrasound. This was identified by the fact that the navicular was not fully reduced over the head of the talus, and there was a break in the naviculo-cuneiform joint. It was difficult to predict which feet were likely to develop a spurious correction, although the 5 feet in our study were stiffer, more severely deformed, and showed less correction on initial manipulation as compared with the feet that corrected well.
Clubfoot correction during serial manipulation can be monitored using sonography. An accurate realignment of the talo-navicular joint can be demonstrated, and presence of spurious correction can be detected early.
庞塞蒂手法在治疗马蹄内翻足中被广泛应用。矫正情况的监测通常基于临床判断，因此需要一种客观的评估方法。新生儿足部的小骨头基本为软骨性，相较于X线片，超声能更好地显示这些骨头。
对32例马蹄内翻足（26名受试者；年龄范围为12天至3个月）进行了一项前瞻性超声研究。在治疗开始时、中足皮拉尼评分等于零（足部完全外展）时以及治疗结束时，采用冠状面内侧投影进行超声检查。在足部休息和模拟庞塞蒂手法操作期间，测量内踝至舟骨的距离以及距骨 - 楔骨角。单侧病例中的正常足作为对照。
采用庞塞蒂手法操作，与治疗前值相比，治疗结束时内踝至舟骨的距离显著增加，距骨 - 楔骨角有所改善（P < 0.001）。所有足部临床矫正效果良好。然而，5只足（15%）显示出“假性矫正”，这仅在超声检查中被发现。其表现为舟骨未完全复位至距骨头上方，且舟楔关节处存在间隙。尽管本研究中的5只足相较于矫正良好的足更僵硬、畸形更严重且初始手法操作时矫正程度更小，但很难预测哪些足可能会出现假性矫正。
连续手法操作治疗马蹄内翻足期间可通过超声监测矫正情况。可以显示距舟关节的准确复位，并能早期检测到假性矫正的存在。
