Iltar Serkan, Uysal Mehmet, Alemdaroğlu Kadir Bahadir, Aydoğan Nevres Hürriyet, Kara Talip, Atlihan Doğan
Ankara Training and Research Hospital, Department of Second Orthopaedics, Ankara, Turkey.
J Foot Ankle Surg. 2010 Sep-Oct;49(5):426-31. doi: 10.1053/j.jfas.2010.06.010.
The Ponseti method has become accepted worldwide as the treatment of choice for nonoperative management of clubfoot. However, there has been no research on whether casting should begin in the newborn period (< or = 30 days old) or later (> 30 days but < 1 year old) or on whether the length of the foot at the beginning of casting is predictive of the outcome of therapy. Therefore, we conducted an investigation to compare outcomes in patients started on casting therapy in the newborn period or later. Outcomes were based on Pirani and Diméglio scores. The study population was comprised of 40 clubfeet in 29 consecutive infants with no associated neuromuscular disease, who underwent Ponseti treatment. The median follow-up was 34 months (range, 20-47 months). Casting began in the newborn period on 26 feet of 18 patients (newborn group), and after 1 month of age on 14 feet of 11 patients (older infant group). Final Diméglio scores were significantly worse for the patients whose casts were applied in the newborn period, compared with those who had the first cast applied at a time >30 days postpartum (P = .04). Infants with feet > or =8 cm in length at the start of cast treatment had better final Diméglio scores than those with feet <8 cm. Our findings suggest that casting according to the Ponseti method should begin in infants older than 1 month of age, or with an involved foot > or =8 cm in length.
庞塞蒂方法已被全球公认为治疗先天性马蹄内翻足非手术治疗的首选方法。然而，对于是否应在新生儿期（≤30天）或更晚（>30天但<1岁）开始石膏固定治疗，以及石膏固定开始时足部的长度是否能预测治疗结果，尚无相关研究。因此，我们进行了一项调查，以比较在新生儿期或更晚开始石膏固定治疗的患者的治疗结果。治疗结果基于皮拉尼和迪梅廖评分。研究人群包括29例连续的无相关神经肌肉疾病的婴儿的40只马蹄内翻足，这些婴儿均接受了庞塞蒂治疗。中位随访时间为34个月（范围20 - 47个月）。18例患者的26只足在新生儿期开始石膏固定（新生儿组），11例患者的14只足在1月龄后开始石膏固定（较大婴儿组）。与产后>30天首次进行石膏固定的患者相比，在新生儿期进行石膏固定的患者最终迪梅廖评分明显更差（P = 0.04）。石膏固定治疗开始时足部长度≥8 cm的婴儿最终迪梅廖评分优于足部<8 cm的婴儿。我们的研究结果表明，按照庞塞蒂方法进行石膏固定应在1月龄以上的婴儿中开始，或者受累足部长度≥8 cm时开始。
