Yagmurlu Mehmet Firat, Ermis Mehmet Nurullah, Akdeniz Huseyin Emre, Kesin Erkin, Karakas Eyup Selahattin
Department of Orthopedics and Traumatology, Baltalimani Bone Diseases Hospital, Istanbul, Turkey.
Pediatr Int. 2011 Feb;53(1):85-9. doi: 10.1111/j.1442-200X.2010.03201.x.
With an incidence of 1-2 per 1000 live births, clubfoot is one of the commonest congenital deformities. Deformity has four components: equinus, hindfoot varus, forefoot adductus, and cavus. The Ponseti method for the treatment of clubfoot has been shown to be effective in children up to one year of age. Even with this effective method, late-presenting cases are still challenging. The aim of this study is to evaluate the corrective effect of the Ponseti method on different components of clubfoot after walking age and to find how the patient's age relates to this correction.
From 2003 to 2005 we treated 31 feet of 27 patients with clubfoot with a mean age of 21 months (12-72 months) with the Ponseti method. Average follow up was 42 months. All of the patients were evaluated before and after treatment for Dimeglio scores. Patients in the first group, aged less than 20 months, were compared with those in the second group, who were older than 20 months. The corrections for each component of the deformity were analyzed separately.
All deformities showed significant correction. Improvements for each separate component were found to be statistically significant. Patients older than 20 months improved less for the components of varus, medial rotation of calcaneopedal block and adductus compared to younger patients.
The Ponseti method is effective in correcting deformities of clubfoot, even after walking age, but affectivity may decrease with age.
先天性马蹄内翻足是最常见的先天性畸形之一，发病率为每1000例活产中有1 - 2例。畸形有四个组成部分：马蹄足、后足内翻、前足内收和高弓足。已证明庞塞蒂方法治疗1岁以内儿童的马蹄内翻足有效。即便有这种有效方法，就诊较晚的病例治疗仍具挑战性。本研究的目的是评估庞塞蒂方法对学步期后马蹄内翻足不同组成部分的矫正效果，并探究患者年龄与这种矫正效果的关系。
2003年至2005年，我们用庞塞蒂方法治疗了27例患者的31只马蹄内翻足，平均年龄21个月（12 - 72个月），平均随访42个月。所有患者在治疗前后均接受迪梅廖评分评估。将第一组年龄小于20个月的患者与第二组年龄大于20个月的患者进行比较。分别分析畸形各组成部分的矫正情况。
所有畸形均有显著矫正。各单独组成部分的改善在统计学上有显著意义。与年轻患者相比，年龄大于20个月的患者在内翻、跟骨 - 距骨块内旋和内收等组成部分的改善较小。
庞塞蒂方法即使在学步期后也能有效矫正马蹄内翻足畸形，但效果可能随年龄增长而降低。
