Halanski Matthew A, Maples Dayle L, Davison Jan E, Huang Jen-Chen, Crawford Haemish A
Helen DeVos Children's Hospital, Pediatric Orthopaedics, 1425 Michigan St NE, Suite D, Grand Rapids, MI 49503, USA.
Iowa Orthop J. 2010;30:29-34.
To better delineate between incomplete clubfoot correction and true clubfoot recurrence based on the time at which the deformity reappears and the treatment necessary to correct the foot.
A chart review of all idiopathic clubfoot at a single institution treated by either the Ponseti method or short leg casting and surgery were reviewed for recurrent deformity involving the tibia, ankle, or foot. Comparisons of treatment required to correct deformities were made between those noticed within six months of initial treatment and those noticed after six months. Similar comparisons were made based on the initial treatment of the deformity.
Forty-four of 51 patients showed some clinical deformities after their initial treatment. Over half of these deformities either resolved or did not require operative intervention at a minimum of two years follow-up, while 43% (19/44) were felt to require surgery. Eight patients had deformities re-appear within six months of initial treatment and eleven patients after six months. Six of the eight patients requiring surgery with deformities noticed less than six months after initial treatment required correction of structural deformities (osteotomies and posterior-medial releases), whereas 10/11 patients requiring surgery for deformities noticed after six months required correction for dynamic deformities. These differences were significant (p=0.01). No difference in terms of the number of deformities noticed (22/25 and 22/26) and number requiring surgery (11/22 in the Ponseti group and 8/22 in the surgical group) were found. However, deformities requiring further surgery in the surgical group re-appeared earlier 0.23±0.2 years than those in the Ponstei group 1.7±1 years (p=0.001). These earlier re-appearing deformities required more structural surgery (6/8) than those in the later appearing Ponseti group (1/11; p=0.01).
Nearly half of all re-appearing deformities required surgery. The deformities noticed within six months of initial correction required more structural surgery to correct than those noticed after six months. We propose that the recurrent deformities noticed before six months of age represent incomplete corrections and those after six months true recurrences. Feet initially treated with surgery may be more prone to incomplete correction whereas those treated by the Ponseti method may be more prone to recurrence.
Not all re-appearing clubfoot deformities are the same. The initial treatment and time at which they first appear may have implications as to the surgery required to correct.
根据畸形再次出现的时间以及矫正足部所需的治疗方法，更好地区分马蹄内翻足矫正不完全与真正的马蹄内翻足复发。
回顾了在单一机构接受Ponseti法或短腿石膏固定及手术治疗的所有特发性马蹄内翻足患者的病历，以检查涉及胫骨、踝关节或足部的复发性畸形。对初次治疗后6个月内发现的畸形与6个月后发现的畸形进行矫正所需治疗方法的比较。根据畸形的初始治疗方法进行了类似的比较。
51例患者中有44例在初次治疗后出现了一些临床畸形。在至少两年的随访中，超过一半的这些畸形自行缓解或无需手术干预，而43%（19/44）的患者被认为需要手术。8例患者在初次治疗后6个月内畸形复发，11例患者在6个月后复发。初次治疗后不到6个月发现畸形且需要手术的8例患者中有6例需要矫正结构畸形（截骨术和后内侧松解术），而6个月后发现畸形且需要手术的11例患者中有10例需要矫正动态畸形。这些差异具有统计学意义（p = 0.01）。在发现的畸形数量（22/25和22/26）以及需要手术的数量方面（Ponseti组为11/22，手术组为8/22）未发现差异。然而，手术组中需要进一步手术的畸形比Ponseti组更早出现，手术组为0.23±0.2年，Ponseti组为1.7±1年（p = 0.001）。这些较早出现的畸形比Ponseti组中较晚出现的畸形需要更多的结构手术（6/8比1/11；p = 0.01）。
几乎一半的复发性畸形需要手术。初次矫正后6个月内发现的畸形比6个月后发现的畸形需要更多的结构手术来矫正。我们提出，6个月龄前发现的复发性畸形代表矫正不完全，6个月后发现的为真正复发。最初接受手术治疗的足部可能更容易出现矫正不完全，而采用Ponseti法治疗的足部可能更容易复发。
并非所有复发性马蹄内翻足畸形都是相同的。它们最初出现的治疗方法和时间可能对所需的矫正手术有影响。
