Starship Children's Health, Auckland, New Zealand.
J Bone Joint Surg Am. 2010 Feb;92(2):270-8. doi: 10.2106/JBJS.H.01560.
Current trends in the treatment of idiopathic clubfoot have shifted from extensive surgical release to more conservative techniques. The purpose of the present study was to prospectively compare the results of the Ponseti method with those of surgical releases for the correction of clubfoot deformity.
We prospectively compared patients who had idiopathic clubfoot deformities that were treated at a single institution either with the Ponseti method or with below-the-knee casting followed by surgical release. The clinical records of the patients with a minimum duration of follow-up of two years were reviewed. All scheduled and completed operative interventions and associated complications were recorded.
Fifty-five patients with eighty-six clubfeet were treated; forty feet were included in the group that was treated with the Ponseti method, and forty-six feet were included in the group that was treated with below-the-knee casts followed by surgery (with three of these feet requiring casting only). There was no difference between the groups in terms of sex, ethnicity, age at the time of first casting, pretreatment Pirani score (average, 5.2 in both groups), or family history. The average number of casts was six in the Ponseti group and thirteen in the surgical group. Of the feet that were treated with below-the-knee casts, forty-three underwent surgery, with forty-two undergoing major surgery (posterior release [eleven] or posteromedial release [thirty-one]). In the Ponseti group, fourteen feet required fifteen operative interventions for recurrences, with only one foot requiring revision surgery. Four of these fifteen were major (necessitating posterior [one] or posteromedial release [three]) while eleven were minor. Thirteen feet in the surgical group required fourteen surgical revisions. Two postoperative complications were seen in each group.
While both cohorts had a relatively high recurrence rate, the Ponseti cohort was managed with significantly less operative intervention and required less revision surgery. The Ponseti method has now been adopted as the primary treatment for clubfoot at our institution.
目前特发性马蹄内翻足的治疗趋势已从广泛的手术松解转向更保守的技术。本研究的目的是前瞻性比较潘塞提（Ponseti）方法与手术松解治疗马蹄内翻足畸形的结果。
我们前瞻性比较了在一家机构接受治疗的特发性马蹄内翻足畸形患者，这些患者分别接受潘塞提方法或膝下石膏固定后手术松解治疗。回顾了至少随访两年的患者的临床记录。记录了所有计划和完成的手术干预措施及其相关并发症。
55 名患者的 86 只足患有马蹄内翻足畸形，其中 40 只足接受潘塞提方法治疗，46 只足接受膝下石膏固定后手术治疗（其中 3 只仅接受石膏固定）。两组在性别、种族、首次石膏固定时的年龄、治疗前皮拉尼评分（两组平均为 5.2）或家族史方面无差异。潘塞提组的平均石膏固定次数为 6 次，手术组为 13 次。接受膝下石膏固定的 46 只足中有 43 只接受了手术，其中 42 只接受了主要手术（后外侧松解术[11 只]或后内侧松解术[31 只]）。在潘塞提组中，14 只足需要 15 次手术干预以防止复发，只有 1 只足需要进行翻修手术。其中 15 次中有 4 次是主要手术（需要进行后外侧松解术[1 次]或后内侧松解术[3 次]），11 次是次要手术。手术组中有 13 只足需要 14 次手术修正。两组各有 2 例术后并发症。
虽然两组的复发率都相对较高，但潘塞提组的手术干预次数明显较少，需要的手术修正次数也较少。潘塞提方法现已被我们机构作为马蹄内翻足的主要治疗方法。
