Spiegel David A, Shrestha Om P, Sitoula Prakash, Rajbhandary Tarun, Bijukachhe Binod, Banskota Ashok K
Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Clin Orthop Relat Res. 2009 May;467(5):1164-70. doi: 10.1007/s11999-008-0600-1. Epub 2008 Nov 6.
Although the Ponseti method has been effective in patients up to 2 years old, limited information is available on the use of this method in older patients. We retrospectively reviewed the records of 171 patients (260 feet) to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 1 and 6 years. A mean of seven casts was required, and there were no differences in the number of casts between the different age groups. Two hundred fifty (95%) of the 260 feet were treated surgically for residual equinus after a plateau in casting, and procedures included percutaneous tendo-Achilles release (n = 205 [79%]), open tendo-Achilles lengthening (n = 8 [3%]), posterior release (n = 21 [8%]), and extensive soft tissue release (posteromedial release, n = 16 [6%]). The mean dorsiflexion after removal of the last cast was 12.5 degrees for the entire group and was greater in 1 year olds compared with 3 year olds. Although all patients achieved a plantigrade foot, the importance of the mild loss of passive dorsiflexion remains to be determined. An extensive soft tissue release was avoided in 94% of patients using the Ponseti method. We intend a followup study to ascertain whether the correction is maintained.
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
尽管庞塞蒂方法对2岁以下的患者有效，但关于该方法在年龄较大患者中的应用信息有限。我们回顾性分析了171例患者（260只脚）的记录，以确定在1至6岁未治疗的特发性马蹄内翻足患者中，使用庞塞蒂方法能否实现畸形的初始矫正（足底负重位足）。平均需要七次石膏固定，不同年龄组之间的石膏固定次数没有差异。在石膏固定达到平台期后，260只脚中有250只（95%）因残留马蹄畸形接受了手术治疗，手术包括经皮跟腱松解术（n = 205 [79%]）、开放性跟腱延长术（n = 8 [3%]）、后路松解术（n = 21 [8%]）和广泛软组织松解术（后内侧松解术，n = 16 [6%]）。整个组在拆除最后一次石膏后的平均背屈角度为12.5度，1岁儿童的背屈角度大于3岁儿童。尽管所有患者都实现了足底负重位足，但被动背屈轻度丧失的重要性仍有待确定。使用庞塞蒂方法的患者中有94%避免了广泛软组织松解术。我们打算进行一项随访研究，以确定矫正效果是否能维持。
III级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
