Adegbehingbe O O, Oginni L M, Ogundele O J, Ariyibi A L, Abiola P O, Ojo O D
Obafemi Awolowo University, Faculty of Clinical Sciences, Department of Orthopaedic Surgery & Traumatology, Ile Ife Osun State, Nigeria.
Iowa Orthop J. 2010;30:7-14.
Congenital clubfoot treatment continues to be controversial particularly in a resource-constrained country. Comparative evaluation of clubfoot surgery with Ponseti methods has not been reported in West Africa.
To determine the effects of Ponseti techniques on clubfoot surgery frequency and patterns in Nigeria.
This was a prospective hospital-based intention-to-treat comparative study of clubfoot managed with Ponseti methods (PCG) and extensive soft tissue surgery (NPCG). The first step was a nonselective double-blind randomization of clubfoot patients into two groups using Excel software in a university teaching hospital setting. The control group was the NPCG patients. The patients' parents gave informed consent, and the medical research and ethics board approved the study protocol. Biodata was gathered, clubfoot patterns were analyzed, Dimeglio-Bensahel scoring was done, the number of casts applied was tallied, and patterns of surgeries were documented. The cost of care, recurrence and outcomes were evaluated. Kruskal-Wallis analysis and Mann-Whitney U technique were used, and an alpha error of < 0.05 at a CI of 95% were taken to be significant.
We randomized 153 clubfeet (in 105 clubfoot patients) into two treatment groups. Fifty NPCG patients (36.2%) underwent manipulation and extensive soft tissue surgery and 55 PCG patients (39.9%) were treated with Ponseti methods. Fifty-two patients of the Ponseti group had no form of surgery (94.5% vs. 32%, p<0.000). Extensive soft tissue surgery was indicated in 17 (34.0%) of the NPCG group, representing 8.9% of the total of 191 major orthopaedic surgeries within the study period. Thirty-five patients (70.0%) from the NPCG group required more than six casts compared to thirteen patients (23.6%) of the PCG (p<0.000). The mean care cost was high within the NPCG when compared to the Ponseti group (48% vs. 14.5%, p<0.000). The Ponseti-treated group had fewer treatment complications (p<0.003), a lower recurrence rate (p<0.000) and satisfactory early outcome (p<0.000).
Major clubfoot surgery was not commonly indicated among patients treated with the Ponseti method. The Ponseti clubfoot technique has reduced total care costs, cast utilization, clubfoot surgery frequency and has also changed the patterns of surgery performed for clubfoot in Nigeria.
先天性马蹄内翻足的治疗一直存在争议，在资源有限的国家尤其如此。西非尚未报道过对马蹄内翻足手术与庞塞蒂方法进行比较评估的情况。
确定庞塞蒂技术对尼日利亚马蹄内翻足手术频率和模式的影响。
这是一项基于医院的前瞻性意向性治疗比较研究，对采用庞塞蒂方法（PCG）和广泛软组织手术（NPCG）治疗的马蹄内翻足进行研究。第一步是在大学教学医院环境中使用Excel软件将马蹄内翻足患者非选择性双盲随机分为两组。对照组为NPCG患者。患者家长给予知情同意，医学研究与伦理委员会批准了研究方案。收集了生物数据，分析了马蹄内翻足模式，进行了迪梅廖 - 本萨赫尔评分，统计了石膏应用次数，并记录了手术模式。评估了护理成本、复发情况和治疗结果。采用了克鲁斯卡尔 - 沃利斯分析和曼 - 惠特尼U检验技术，95%置信区间下α错误<0.05被认为具有显著性。
我们将153例马蹄内翻足（105例马蹄内翻足患者）随机分为两个治疗组。50例NPCG患者（36.2%）接受了手法操作和广泛软组织手术，55例PCG患者（39.9%）采用庞塞蒂方法治疗。庞塞蒂组的52例患者未进行任何形式的手术（94.5%对32%，p<0.000）。NPCG组中有17例（34.0%）需要进行广泛软组织手术，占研究期间191例主要骨科手术总数的8.9%。NPCG组的35例患者（70.0%）需要超过6次石膏固定，而PCG组为13例患者（23.6%）（p<0.000）。与庞塞蒂组相比，NPCG组的平均护理成本较高（分别为48%和14.5%，p<0.000）。庞塞蒂治疗组的治疗并发症较少（p<0.003），复发率较低（p<0.000），早期治疗效果良好（p<0.000）。
在采用庞塞蒂方法治疗的患者中，通常不需要进行主要的马蹄内翻足手术。庞塞蒂马蹄内翻足技术降低了总护理成本、石膏使用量、马蹄内翻足手术频率，也改变了尼日利亚马蹄内翻足的手术模式。
