Kampa Rebecca, Binks Katherine, Dunkley Mia, Coates Christopher
Department of Orthopaedics, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK,
J Child Orthop. 2008 Dec;2(6):463-7. doi: 10.1007/s11832-008-0134-9. Epub 2008 Sep 26.
Idiopathic congenital talipes equinovarus (CTEV) is a relatively common complex deformity of the foot that can be successfully managed by the Ponseti method. The purpose of this study was to see if the latter can be effectively administered by non-medical specialists outside a specialist or teaching hospital setting.
Retrospective review of 24 children (39 feet) with idiopathic congenital talipes equinovarus managed by a physiotherapist-led service in a district general hospital.
The median Pirani score at presentation was 4.5 (mean 4.2, range 1.5-6). The median Pirani score for feet requiring tenotomy was 6 (4.5-6), whereas feet not requiring tenotomy had a median Pirani score of 2.5 (1.5-5). A total of 18 feet (46%) underwent an Achilles tenotomy. Foot correction was achieved with an average of 3.4 (2-6) cast changes in the non-tenotomy group, and an average of 7.5 (5-13) in the tenotomy group. Successful initial correction of the deformity was achieved in 37 (95%) of the feet studied. One patient (2 feet, 5%) failed local conservative management, requiring tertiary referral. Two children (2 feet) have relapsed, requiring further serial casting. No children required open surgical release. Follow-up was for a mean of 31 months (17-50).
Early results suggest that a combined consultant/physiotherapist-delivered Ponseti service can be effectively and successfully administered in a district general hospital.
特发性先天性马蹄内翻足（CTEV）是一种相对常见的足部复杂畸形，可通过庞塞蒂方法成功治疗。本研究的目的是探讨在专科或教学医院以外的环境中，非医学专家能否有效实施该方法。
对一家地区综合医院由物理治疗师主导的服务治疗的24例（39足）特发性先天性马蹄内翻足患儿进行回顾性研究。
就诊时皮拉尼评分中位数为4.5（平均4.2，范围1.5 - 6）。需要跟腱切断术的足部皮拉尼评分中位数为6（4.5 - 6），而不需要跟腱切断术的足部皮拉尼评分中位数为2.5（1.5 - 5）。共有18足（46%）接受了跟腱切断术。非跟腱切断术组平均更换3.4次（2 - 6次）石膏实现足部矫正，跟腱切断术组平均更换7.5次（5 - 13次）。在研究的37足（95%）中成功实现了畸形的初始矫正。1例患者（2足，5%）局部保守治疗失败，需要三级转诊。2例儿童（2足）复发，需要进一步连续打石膏。没有儿童需要进行开放手术松解。随访平均31个月（17 - 50个月）。
早期结果表明，由顾问医生/物理治疗师联合提供的庞塞蒂服务可在地区综合医院有效且成功地实施。
