Janicki Joseph A, Narayanan Unni G, Harvey Barbara, Roy Anvesh, Ramseier Leonhard E, Wright James G
Orthopaedic Surgery, Children's Memorial Hospital, Chicago, IL 60614-3394, USA.
J Pediatr Orthop. 2009 Jun;29(4):393-7. doi: 10.1097/BPO.0b013e3181a6bf77.
Clubfeet are associated with many neuromuscular and congenital conditions. Nonidiopathic clubfeet are typically thought to be resistant to nonoperative management. The Ponseti method has revolutionized the treatment of patients with idiopathic clubfeet. The purpose of this study was to describe the use of the Ponseti method in the treatment of patients whose clubfeet are associated with a neuromuscular diagnosis or a syndrome.
All patients with clubfeet who were treated at the Hospital for Sick Children, Toronto, from 2001 to 2005 were reviewed. Patients were included only if a neuromuscular condition or a syndrome associated with clubfeet could be identified and if the primary treatment was at our institution. Twenty-three patients with 40 nonidiopathic clubfeet and 171 patients with 249 idiopathic clubfeet have been treated with a minimum follow-up time of 1 year. The outcomes evaluated included the number of casts, the percentage of patients requiring percutaneous Achilles tendon lengthening (tenotomy of the Achilles tendon [TAT]), rate of recurrences, rate of failures, and the need for additional secondary procedures.
The mean age at presentation for nonidiopathic clubfeet was 11 weeks. The mean follow-up time was 33 months, and the mean number of casts was 6.4; a percutaneous TAT was necessary in 27 (68%) of 40 feet. Failure of the Ponseti casting occurred in 4 (10%) of the 40 feet. Recurrence requiring additional treatment occurred in 16 (44%) of 36 feet. Additional procedures included second percutaneous TAT, limited posterior/plantar release, or complete posteromedial release totaling 11 (28%) of 40. When compared with idiopathic clubfeet, nonidiopathic clubfeet required more casts and had a higher rate of failures, recurrences, and additional procedures than idiopathic clubfeet.
Although not as successful as for idiopathic clubfeet, when the Ponseti technique is applied to nonidiopathic clubfeet, correction can be achieved and maintained in most patients.
Prognostic level 2.
马蹄内翻足与许多神经肌肉及先天性疾病相关。非特发性马蹄内翻足通常被认为对非手术治疗有抵抗性。庞塞蒂方法彻底改变了特发性马蹄内翻足患者的治疗方式。本研究的目的是描述庞塞蒂方法在治疗与神经肌肉诊断或综合征相关的马蹄内翻足患者中的应用。
回顾了2001年至2005年在多伦多病童医院接受治疗的所有马蹄内翻足患者。仅纳入那些能确定与马蹄内翻足相关的神经肌肉疾病或综合征且主要治疗在我们机构进行的患者。23例患有40只非特发性马蹄内翻足的患者和171例患有249只特发性马蹄内翻足的患者接受了治疗，最短随访时间为1年。评估的结果包括石膏固定次数、需要经皮跟腱延长术（跟腱切断术[TAT]）的患者百分比、复发率、失败率以及额外二次手术的需求。
非特发性马蹄内翻足患者就诊时的平均年龄为11周。平均随访时间为33个月，平均石膏固定次数为6.4次；40只足中的27只（68%）需要进行经皮TAT。40只足中有4只（10%）庞塞蒂石膏固定法失败。36只足中有16只（44%）复发需要进一步治疗。额外的手术包括第二次经皮TAT、有限的后侧/足底松解或完全的后内侧松解，共40只足中的11只（28%）。与特发性马蹄内翻足相比，非特发性马蹄内翻足需要更多的石膏固定，且失败率、复发率和额外手术率均高于特发性马蹄内翻足。
尽管不像治疗特发性马蹄内翻足那样成功，但当将庞塞蒂技术应用于非特发性马蹄内翻足时，大多数患者仍可实现并维持矫正。
预后水平2。
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