Ng Bobby Kin-Wah, Lam Tsz-Ping, Cheng Jack Chun-Yiu
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
J Pediatr Orthop B. 2010 Mar;19(2):164-70. doi: 10.1097/BPB.0b013e328333ab2e.
Conservative clubfoot treatment requires weekly cast changes. We questioned whether a method using synthetic fiberglass instead of the traditional plaster material and with the infant lying comfortably on a special foam-casting platform could be satisfactorily used. A retrospective cohort review on idiopathic clubfoot treated with this particular method was carried out. The severity of clubfoot at presentation was assessed with the classification of Dimeglio et al. The outcome of treatment was assessed with the same scoring system at the latest follow-up. The need of secondary open surgical releases was noted. The parent's acceptability of this method was evaluated with a self-designed questionnaire. The existence of a learning curve was explored by comparing the outcomes of 22 feet during two time periods: those treated before 31 December 2003 (group 1) and those treated after 1 January 2004 (group 2). The mean Dimeglio Scores improved from 17.5 to 4.1 for group 1 and from 15.0 to 3.2 for group 2. Nine of 10 feet in group 2 had tenotomy of the tendo Achilles and none needed open surgical release whereas 10 out of 12 feet in group 1 required open releases. A learning curve did exist for this method. No major complication was noted with the technique. Parent acceptability was high for this method, which was effective in the management of severe idiopathic clubfoot.
保守治疗马蹄内翻足需要每周更换石膏。我们质疑一种使用合成玻璃纤维而非传统石膏材料且让婴儿舒适地躺在特殊泡沫铸造平台上的方法是否能令人满意地使用。对采用这种特殊方法治疗的特发性马蹄内翻足进行了回顾性队列研究。采用迪梅吉奥等人的分类方法评估就诊时马蹄内翻足的严重程度。在最近一次随访时，使用相同的评分系统评估治疗结果。记录二次开放性手术松解的必要性。通过自行设计的问卷评估家长对该方法的接受度。通过比较2003年12月31日前治疗的22只足（第1组）和2004年1月1日后治疗的22只足（第2组）两个时间段的治疗结果，探索学习曲线的存在情况。第1组的平均迪梅吉奥评分从17.5提高到4.1，第2组从15.0提高到3.2。第2组10只足中有9只进行了跟腱切断术，无一需要开放性手术松解，而第1组12只足中有10只需要开放性松解。这种方法确实存在学习曲线。该技术未发现重大并发症。家长对该方法的接受度很高，该方法在严重特发性马蹄内翻足治疗中有效。
