庞塞蒂方法治疗马蹄内翻足：石膏材料的比较

Treatment of clubfoot with the Ponseti method: a comparison of casting materials.

作者信息

Pittner Douglas E, Klingele Kevin E, Beebe Allan C

机构信息

Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA.

出版信息

J Pediatr Orthop. 2008 Mar;28(2):250-3. doi: 10.1097/BPO.0b013e318164f8e7.

DOI:10.1097/BPO.0b013e318164f8e7

PMID:18388724

Abstract

BACKGROUND

Popular initial treatment for congenital clubfoot includes the use of serial manipulations and casting as described by Ponseti et al. Plaster of Paris and semirigid fiberglass are 2 materials commonly used for casting. To our knowledge, no study to date has compared the clinical results of these 2 materials. The objective of this randomized prospective study was to compare the effectiveness of these materials in the initial management of clubfoot.

METHODS

All clubfeet presenting to the 2 senior authors' outpatient clinics over a 15-month period were offered enrollment. Patients were randomly assigned for treatment with either plaster or semirigid fiberglass casts. The severity of the clubfoot deformity was documented using the scoring system devised by Diméglio et al. Serial casts were applied according to the technique described by Ponseti et al. At the completion of nonsurgical treatment, the final clubfoot severity was documented.

RESULTS

A total of 42 clubfeet in 34 patients were enrolled in the study. After exclusion of 3 patients, 13 patients (16 feet) received fiberglass, and 18 patients (23 feet) received plaster casts. The mean baseline severity scores of the 2 groups were not significantly different. The mean final severity score was significantly higher in the feet treated with fiberglass than those treated with plaster (6.4 vs 4.1; P = 0.037). There was a trend toward higher scores for cast tolerance, durability, and parent satisfaction in the fiberglass group, but this did not reach significance.

CONCLUSIONS

This study supports the use of plaster casting with the Ponseti technique. The use of plaster casts resulted in a statistically lower Diméglio-Bensahel score at the completion of serial casting. There was a trend toward higher patient satisfaction in the fiberglass-treated group. Whether this difference has an effect on long-term outcomes and recurrence remains to be studied.

LEVEL OF EVIDENCE

Level II. Nonblinded randomized controlled prospective study.

摘要

背景

先天性马蹄内翻足常见的初始治疗方法包括采用庞塞蒂等人描述的系列手法复位和石膏固定。巴黎石膏和半刚性玻璃纤维是常用于石膏固定的两种材料。据我们所知，迄今为止尚无研究比较这两种材料的临床效果。这项随机前瞻性研究的目的是比较这些材料在马蹄内翻足初始治疗中的有效性。

方法

在15个月期间，所有到两位资深作者门诊就诊的马蹄内翻足患者均被邀请入组。患者被随机分配接受石膏或半刚性玻璃纤维石膏固定治疗。使用迪梅廖等人设计的评分系统记录马蹄内翻足畸形的严重程度。根据庞塞蒂等人描述的技术应用系列石膏。非手术治疗结束时，记录最终马蹄内翻足的严重程度。

结果

共有34例患者的42只马蹄内翻足纳入研究。排除3例患者后，13例患者（16只足）接受玻璃纤维石膏，18例患者（23只足）接受石膏固定。两组的平均基线严重程度评分无显著差异。接受玻璃纤维石膏治疗的足的平均最终严重程度评分显著高于接受石膏治疗的足（6.4对4.1；P = 0.037）。玻璃纤维组在石膏耐受性、耐用性和家长满意度方面有得分更高的趋势，但未达到显著水平。