Kowalczyk Bartholomew, Lejman Tadeusz
The Paediatric Orthopaedic Department, University Children's Hospital of Krakow, Jagiellonian University, Wielicka St. 265, 30-663, Kraków, Poland,
J Child Orthop. 2008 Oct;2(5):365-71. doi: 10.1007/s11832-008-0122-0. Epub 2008 Aug 22.
This study presents our experience with the Ponseti method of manipulation and casting followed by Achilles tenotomy (AT) in children with arthrogryposis multiplex congenita (AMC).
Five children (ten feet) were followed for at least 24 months after the AT and are the cohort for this study. Their mean age at follow-up was 38.4 months (26 to 48 months), and the average follow-up period was 35.8 months (24-44 months). Treatment was begun within the first months of life. The AT to correct rigid equinus was performed at a mean of 14.4 weeks of life, after 7-10 cast changes (mean 8.4). Clinical criteria by Niki et al. and standard standing AP and lateral radiographs were analyzed for final evaluation. Efficacy of Ponseti casting and AT tenotomy was assessed according to the amount and continuance of the achieved correction.
Seven feet had clinically satisfactory results. Among the three unsatisfactory feet, there were two (one child) with rocker-bottom pseudocorrections after repeated bilateral AT and one recurrent clubfoot (one child). Six feet required soft tissue releases at 3, 12 and 21 months after the AT due to recurrence of moderate equinus and adductus. Three feet (two children) underwent repeat AT at 10 and 15 months after the primary procedure. The mean interval between initial AT and redo surgical procedures was 11.8 months (range 3-21 months). Two feet (20%) remained without significant deformity after AT.
Clubfoot in AMC responds initially to the Ponseti method of casting, and deformity may be corrected or diminished. In some children, more extensive surgical treatment can be avoided and in others, delayed. Despite the need for additional surgical intervention, the Ponseti method of casting and AT does seem to be an alternative for initial treatment in children with AMC.
本研究介绍了我们对患有先天性多发性关节挛缩症（AMC）的儿童采用庞塞蒂手法复位及石膏固定，随后进行跟腱切断术（AT）的经验。
五名儿童（共十只脚）在跟腱切断术后至少随访了24个月，构成了本研究的队列。他们随访时的平均年龄为38.4个月（26至48个月），平均随访期为35.8个月（24 - 44个月）。治疗在出生后的头几个月内开始。平均在出生后14.4周、经过7 - 10次石膏更换（平均8.4次）后进行跟腱切断术以纠正僵硬性马蹄足。分析了尼基等人的临床标准以及标准站立位前后位和侧位X线片以进行最终评估。根据所实现的矫正量和持续性评估庞塞蒂石膏固定法和跟腱切断术的疗效。
七只脚临床效果满意。在三只效果不满意的脚中，有两只（一名儿童）在反复双侧跟腱切断术后出现摇椅底假性矫正，还有一只复发性马蹄内翻足（一名儿童）。六只脚因中度马蹄足和内收复发，在跟腱切断术后3个月、12个月和21个月需要进行软组织松解。三只脚（两名儿童）在初次手术后第10个月和15个月接受了再次跟腱切断术。初次跟腱切断术与再次手术之间的平均间隔为11.8个月（范围3 - 21个月）。两只脚（20%）在跟腱切断术后无明显畸形。
AMC中的马蹄内翻足最初对庞塞蒂石膏固定法有反应，畸形可能得到矫正或减轻。在一些儿童中，可以避免或推迟更广泛的手术治疗。尽管需要额外的手术干预，但庞塞蒂石膏固定法和跟腱切断术似乎确实是AMC儿童初始治疗的一种选择。
