David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
J Am Acad Orthop Surg. 2010 Aug;18(8):486-93. doi: 10.5435/00124635-201008000-00005.
The Ponseti method for the management of idiopathic clubfoot has recently experienced a rise in popularity, with several centers reporting excellent outcomes. The challenge in achieving a successful outcome with this method lies not in correcting deformity but in preventing relapse. The most common cause of relapse is failure to adhere to the prescribed postcorrective bracing regimen. Socioeconomic status, cultural factors, and physician-parent communication may influence parental compliance with bracing. New, more user-friendly braces have been introduced in the hope of improving the rate of compliance. Strategies that may be helpful in promoting adherence include educating the family at the outset about the importance of bracing, encouraging calls and visits to discuss problems, providing clear written instructions, avoiding or promptly addressing skin problems, and refraining from criticism of the family when noncompliance is evident. A strong physician-family partnership and consideration of underlying cognitive, socioeconomic, and cultural issues may lead to improved adherence to postcorrective bracing protocols and better patient outcomes.
潘塞提(Ponseti)方法最近在治疗特发性马蹄内翻足方面越来越受欢迎,有几个中心报告了出色的结果。使用这种方法取得成功的挑战不在于矫正畸形,而在于预防复发。复发的最常见原因是未能遵守规定的矫正后支具治疗方案。社会经济地位、文化因素和医患沟通可能会影响父母对支具的依从性。为了提高依从性的比率,已经引入了新的、更便于使用的支具。可能有助于促进依从性的策略包括:在开始时向家庭讲解支具的重要性,鼓励家庭打电话或上门讨论问题,提供清晰的书面说明,避免或及时处理皮肤问题,以及在出现不依从时避免批评家庭。建立强大的医患合作关系,并考虑潜在的认知、社会经济和文化问题,可能会提高对矫正后支具治疗方案的依从性,并改善患者的结果。