Boehm Stephanie, Limpaphayom Noppachart, Alaee Farhang, Sinclair Marc F, Dobbs Matthew B
Department of Orthopaedic Surgery, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2008 Jul;90(7):1501-7. doi: 10.2106/JBJS.G.00563.
Clubfoot occurs in approximately one in 1000 live births and is one of the most common congenital birth defects. Although there have been several reports of successful treatment of idiopathic clubfoot with the Ponseti method, the use of this method for the treatment of other forms of clubfoot has not been reported. The purpose of the present study was to evaluate the early results of the Ponseti method when used for the treatment of clubfoot associated with distal arthrogryposis.
Twelve consecutive infants (twenty-four feet) with clubfoot deformity associated with distal arthrogryposis were managed with the Ponseti method and were retrospectively reviewed at a minimum of two years. The severity of the foot deformity was classified according to the grading system of Diméglio et al. The number of casts required to achieve correction was compared with published data for the treatment of idiopathic clubfoot. Recurrent clubfoot deformities or complications during treatment were recorded.
Twenty-two clubfeet in eleven patients were classified as Diméglio grade IV, and two clubfeet in one patient were classified as Diméglio grade II. Initial correction was achieved in all clubfeet with a mean of 6.9 +/- 2.1 casts (95% confidence interval, 5.6 to 8.3 casts), which was significantly greater than the mean of 4.5 +/- 1.2 casts (95% confidence interval, 4.3 to 4.7 casts) needed in a cohort of 219 idiopathic clubfeet that were treated during the same time period by the senior author with use of the Ponseti method (p = 0.002). Six feet in three patients had a relapse after initial successful treatment. All relapses were related to noncompliance with prescribed brace wear. Four relapsed clubfeet in two patients were successfully treated with repeat casting and/or tenotomy; the remaining two relapsed clubfeet in one patient were treated with extensive soft-tissue-release operations.
Our early-term results support the use of the Ponseti method for the initial treatment of distal arthrogrypotic clubfoot deformity. Longer follow-up will be necessary to assess the risk of recurrence and the potential need for corrective clubfoot surgery in this patient population, which historically has been difficult to treat nonoperatively.
马蹄内翻足在大约每1000例活产婴儿中出现1例，是最常见的先天性出生缺陷之一。尽管已有几篇关于使用庞塞蒂方法成功治疗特发性马蹄内翻足的报道，但该方法用于治疗其他形式马蹄内翻足的情况尚未见报道。本研究的目的是评估庞塞蒂方法用于治疗与远端关节弯曲综合征相关的马蹄内翻足的早期效果。
对12例连续的患有与远端关节弯曲综合征相关马蹄内翻足畸形的婴儿（24只脚）采用庞塞蒂方法进行治疗，并进行至少两年的回顾性研究。根据迪梅廖等人的分级系统对足部畸形的严重程度进行分类。将实现矫正所需的石膏次数与已发表的特发性马蹄内翻足治疗数据进行比较。记录治疗期间复发性马蹄内翻足畸形或并发症。
11例患者的22只马蹄内翻足被分类为迪梅廖IV级，1例患者的2只马蹄内翻足被分类为迪梅廖II级。所有马蹄内翻足均实现了初始矫正，平均使用6.9±2.1次石膏（95%置信区间，5.6至8.3次石膏），这显著高于同期由资深作者使用庞塞蒂方法治疗的219例特发性马蹄内翻足队列所需的平均4.5±1.2次石膏（95%置信区间，4.3至4.7次石膏）（p = 0.002）。3例患者的6只脚在初始成功治疗后出现复发。所有复发均与未遵医嘱佩戴支具有关。2例患者的4只复发性马蹄内翻足通过重复石膏固定和/或腱切断术成功治疗；1例患者的其余2只复发性马蹄内翻足接受了广泛的软组织松解手术。
我们的早期结果支持使用庞塞蒂方法对远端关节弯曲性马蹄内翻足畸形进行初始治疗。需要更长时间的随访来评估该患者群体中复发的风险以及矫正马蹄内翻足手术的潜在需求，该群体历来难以通过非手术方法治疗。
