Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007, USA.
J Bone Joint Surg Am. 2010 Apr;92(4):882-9. doi: 10.2106/JBJS.I.00819.
In the late 1990s, renewed interest emerged in less invasive treatment options, most notably the Ponseti method, to correct idiopathic clubfoot deformity. Recently, reports from several centers have demonstrated that such minimally invasive techniques may be used reliably to correct this complex deformity. The present study sought to determine whether the rate of extensive surgical releases to treat idiopathic clubfoot in the United States has decreased.
We used data from the Centers for Disease Control and Prevention and the Nationwide Inpatient Sample to determine the number of live births, the number of patients diagnosed with clubfoot, and the number of extensive surgical releases that were performed each year from 1996 to 2006. The trends over time were evaluated with use of regression analysis, and changes in frequency were analyzed with use of time series analysis. The percentage of clubfeet that were treated with surgery in each year was calculated by dividing the number of surgical release procedures by the number of clubfoot diagnoses.
Between 1996 and 2006, the estimated number of patients under six months of age diagnosed with clubfoot remained fairly constant, averaging 2140 infants per year. The linear equation estimated a slight decrease of approximately thirty-one infants with clubfoot per year (R(2) = 0.51, p < 0.05). In contrast, in the same decade, the estimated number of surgical releases performed in patients less than twelve months of age decreased substantially, from 1641 releases in 1996 to 230 releases in 2006. The linear equation estimated a decrease of approximately 157 surgical releases per year (R(2) = 0.83, p < 0.05). The trend analysis indicated that the percentage of clubfeet treated with surgical release generally decreased over time at a rate of 6.7% per year, decreasing from just over 70% in 1996 to just over 10% in 2006 (R(2) = 0.81, p < 0.05).
In the United States between 1996 and 2006, the rate of extensive surgery to treat idiopathic clubfoot in patients less than twelve months old decreased substantially. This trend is likely due to an increased use of less invasive techniques, such as the Ponseti method, which a growing body of evidence has shown to be a viable treatment option for clubfoot.
20 世纪 90 年代末，人们对微创治疗选择，尤其是潘塞提（Ponseti）方法，产生了新的兴趣，以期矫正特发性马蹄内翻足畸形。最近，来自多个中心的报告表明，这种微创技术可以可靠地矫正这种复杂的畸形。本研究旨在确定美国治疗特发性马蹄内翻足的广泛手术松解率是否有所下降。
我们利用疾病控制和预防中心及全国住院患者样本的数据，确定了每年的活产儿数量、被诊断为马蹄内翻足的患者数量以及每年实施的广泛手术松解数量。我们采用回归分析评估了随时间的变化趋势，并采用时间序列分析评估了频率的变化。每年的手术治疗率通过手术松解例数除以马蹄内翻足诊断例数计算得出。
1996 年至 2006 年间，6 个月以下被诊断为马蹄内翻足的患儿数量基本保持稳定，平均每年 2140 例。线性方程估计，每年约有 31 例马蹄内翻足患儿被确诊（R²=0.51，p＜0.05）。相比之下，在同一十年间，12 个月以下患儿接受的手术松解数量大幅减少，从 1996 年的 1641 例减少至 2006 年的 230 例。线性方程估计，每年减少约 157 例手术松解（R²=0.83，p＜0.05）。趋势分析表明，接受手术松解治疗的马蹄内翻足比例总体上随时间呈每年 6.7%的速度下降，从 1996 年的略高于 70%降至 2006 年的略高于 10%（R²=0.81，p＜0.05）。
1996 年至 2006 年间，美国 12 个月以下患儿接受广泛手术治疗特发性马蹄内翻足的比例大幅下降。这一趋势可能是由于越来越多地采用微创技术，如潘塞提方法，越来越多的证据表明该方法是治疗马蹄内翻足的可行选择。
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