Gerlach David J, Gurnett Christina A, Limpaphayom Noppachart, Alaee Farhang, Zhang Zhongli, Porter Kristina, Kirchhofer Melissa, Smyth Matthew D, Dobbs Matthew B
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis Shriners Hospital for Children, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2009 Jun;91(6):1350-9. doi: 10.2106/JBJS.H.00837.
Myelomeningocele is a common birth defect that is often accompanied by clubfoot deformity. Treatment of clubfoot associated with myelomeningocele traditionally has consisted of extensive soft-tissue release operations, which are associated with many complications. The purpose of the present study was to evaluate the early results of the Ponseti method for the treatment of clubfoot associated with myelomeningocele.
Sixteen consecutive patients with myelomeningocele (twenty-eight clubfeet) and twenty consecutive patients with idiopathic clubfeet (thirty-five clubfeet) were followed prospectively while being managed with the Ponseti method. The average duration of follow-up was thirty-four months for the myelomeningocele group and thirty-seven months for the idiopathic group. Clubfoot severity was graded at the time of presentation with use of the Diméglio system. The initial correction that was achieved, casting and/or bracing difficulties, recurrences, and subsequent treatments were evaluated and compared between the two cohorts by means of appropriate statistical analysis.
Eleven (39%) of the twenty-eight clubfeet in the myelomeningocele group were graded as Diméglio grade IV, compared with only four (11%) of the thirty-five clubfeet in the idiopathic group (p = 0.014). Initial correction was achieved in thirty-five clubfeet (100%) in the idiopathic group and in twenty-seven clubfeet (96.4%) in the myelomeningocele group (p = 0.16). Relapse of deformity was detected in 68% of the feet in the myelomeningocele group, compared with 26% of the feet in the idiopathic group (p = 0.001). Relapses were treated successfully without the need for extensive soft-tissue release surgery for all but four of the clubfeet in the myelomeningocele group and for all but one of the clubfeet in the idiopathic group (p = 0.16).
Our data support the use of the Ponseti method for the initial treatment of clubfoot deformity associated with myelomeningocele, although attention to detail is crucial in order to avoid complications. Longer follow-up will be necessary to assess the risk of late recurrence and the potential need for more extensive clubfoot corrective surgery in this patient population.
脊髓脊膜膨出是一种常见的出生缺陷，常伴有马蹄内翻足畸形。传统上，与脊髓脊膜膨出相关的马蹄内翻足治疗包括广泛的软组织松解手术，该手术伴有许多并发症。本研究的目的是评估庞塞蒂方法治疗与脊髓脊膜膨出相关的马蹄内翻足的早期效果。
对连续16例脊髓脊膜膨出患者（28只马蹄内翻足）和连续20例特发性马蹄内翻足患者（35只马蹄内翻足）采用庞塞蒂方法进行前瞻性随访管理。脊髓脊膜膨出组的平均随访时间为34个月，特发性组为37个月。在就诊时使用迪梅廖系统对马蹄内翻足严重程度进行分级。通过适当的统计分析对两组患者的初始矫正情况、石膏固定和/或支具佩戴困难情况、复发情况及后续治疗进行评估和比较。
脊髓脊膜膨出组28只马蹄内翻足中有11只（39%）被评为迪梅廖IV级，而特发性组35只马蹄内翻足中只有4只（11%）被评为该级别（p = 0.014）。特发性组35只马蹄内翻足（100%）和脊髓脊膜膨出组27只马蹄内翻足（96.4%）实现了初始矫正（p = 0.16）。脊髓脊膜膨出组68%的马蹄内翻足出现畸形复发，而特发性组为26%（p = 0.001）。除脊髓脊膜膨出组的4只马蹄内翻足和特发性组的1只马蹄内翻足外，其余复发均成功治疗，无需进行广泛的软组织松解手术（p = 0.16）。
我们的数据支持使用庞塞蒂方法对与脊髓脊膜膨出相关的马蹄内翻足畸形进行初始治疗，尽管为避免并发症，注重细节至关重要。需要更长时间的随访来评估该患者群体中晚期复发的风险以及更广泛的马蹄内翻足矫正手术的潜在需求。
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