Boden Richard A, Nuttall Graham H, Paton Robin W
Royal Blackburn Hospital, Blackburn, United Kingdom.
Acta Orthop Belg. 2011 Aug;77(4):522-8.
The optimal management of idiopathic clubfoot has changed over three decades. Recently there has been an enthusiastic embracing of the Ponseti technique with a move away from the traditional stretch and strap technique. The purpose of this 14-year comparative prospective longitudinal study was to directly assess the differences in results between these two treatment methods. Over the period of this study there were 52,514 births in the local population and all newborns with clubfoot were referred directly to the paediatric orthopaedic surgeon. Patient demographics, the Harrold & Walker Classification, and associated risk factors for clubfoot were collected prospectively and analyzed. If conservative treatment failed to correct the deformity adequately, a radical subtalar release (RSR) was undertaken (the primary outcome measure of the study). There were 114 feet (80 patients): 64 feet treated 'traditionally' and 50 feet with the Ponseti technique. Idiopathic clubfoot was present in 76.25% of patients. Mean time to RSR was 333 and 44.1 weeks for the traditional and Ponseti groups respectively. In the traditional group 65.6% (CI: 53.4 to 76.1%) of feet underwent RSR surgery compared to 25.5% (CI : 15.8 to 383%) in the Ponseti group. When idiopathic clubfoot alone was analysed, these rates reduce to 56.5% (CI: 423 to 69.8%) and 15.8% (CI: 7.4 to 30.4%) respectively. The Relative Risk of requiring RSR in traditional compared to Ponseti groups was 2.58 (CI: 1.59 to 4.19) for all patients and 3.58 (CI: 1.65 to 7.78) for idiopathic clubfoot. Introduction of the Ponseti technique into our institution significantly reduced the need for RSR in fixed clubfoot.
在过去三十年里，特发性马蹄内翻足的最佳治疗方法发生了变化。最近，人们对庞塞蒂技术热情高涨，逐渐摒弃了传统的拉伸和绑扎技术。这项为期14年的比较性前瞻性纵向研究的目的是直接评估这两种治疗方法在结果上的差异。在本研究期间，当地人口中有52514例出生，所有患有马蹄内翻足的新生儿都被直接转诊给小儿骨科医生。前瞻性收集并分析了患者的人口统计学数据、哈罗德和沃克分类法以及马蹄内翻足的相关风险因素。如果保守治疗未能充分矫正畸形，则进行距下关节松解术（RSR）（该研究的主要结局指标）。共有114只脚（80例患者）：64只脚采用“传统”方法治疗，50只脚采用庞塞蒂技术治疗。76.25%的患者患有特发性马蹄内翻足。传统组和庞塞蒂组距下关节松解术的平均时间分别为333周和44.1周。传统组65.6%（置信区间：53.4%至76.1%）的脚接受了距下关节松解术，而庞塞蒂组为25.5%（置信区间：15.8%至38.3%）。仅分析特发性马蹄内翻足时，这些比率分别降至56.5%（置信区间：42.3%至69.8%）和15.8%（置信区间：7.4%至30.4%）。与庞塞蒂组相比，传统组需要进行距下关节松解术的相对风险在所有患者中为2.58（置信区间：1.59至4.19），在特发性马蹄内翻足患者中为3.58（置信区间：1.65至7.78）。将庞塞蒂技术引入我们的机构显著减少了固定性马蹄内翻足患者对距下关节松解术的需求。
