Zionts Lewis E, Frost Nathan, Kim Rachel, Ebramzadeh Edward, Sangiorgio Sophia N
Orthopaedic Hospital, UCLA/Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
J Pediatr Orthop. 2012 Oct-Nov;32(7):706-13. doi: 10.1097/BPO.0b013e3182694f4d.
The Mitchell-Ponseti (MP) foot abduction orthosis was introduced to provide a more user-friendly alternative to the traditional Denis-Browne (DB) brace in the treatment of idiopathic clubfoot. We describe our experience with the effectiveness of the MP brace to maintain correction of clubfeet corrected using the Ponseti method.
We evaluated 57 consecutive infants with 84 idiopathic clubfeet who were treated using the Ponseti method. After initial correction of the deformity was obtained, all infants were placed in the MP brace.
The patients were followed for a minimum of 2 years (mean, 37.9 mo; range, 24 to 56 mo). Seventy-nine feet (94%) had heel-cord tenotomy or lengthening. The families of 34 (60%) patients were adherent with the postcorrective brace protocol. Skin problems were observed in 8 patients (14%), 6 of which were superficial dorsal skin abrasion, and none of the sandals required customization by an orthotist. A recurrence occurred in 40 feet (48%). Correction was regained with manipulation and cast application in all cases. Nineteen feet (23%) in 14 patients have had, or are scheduled for, an anterior tibial tendon transfer. At latest follow-up, all feet were plantigrade and had at least 10 degrees of dorsiflexion. None of the patients required surgical releases. Of 31 patients followed for at least 3 years, 26 (84%) used the brace for a minimum of 3 years.
Using the MP foot abduction orthosis, we were able to achieve compliance rates that were at least comparable with those of earlier reports using the DB brace. Families found the brace easy to use. The MP brace may be considered a useful alternative to the DB brace.
Level II--prospective.
米切尔 - 庞塞蒂（MP）足外展矫形器被引入，旨在为治疗特发性马蹄内翻足提供一种比传统丹尼斯 - 布朗（DB）支具更便于使用的替代方案。我们描述了使用MP支具维持经庞塞蒂方法矫正的马蹄内翻足矫正效果的经验。
我们评估了57例连续的婴儿，他们共有84只特发性马蹄内翻足，均采用庞塞蒂方法进行治疗。在获得畸形的初步矫正后，所有婴儿均佩戴MP支具。
患者随访至少2年（平均37.9个月；范围24至56个月）。79只脚（94%）进行了跟腱切断术或延长术。34例（60%）患者的家庭遵守了矫正后支具方案。8例患者（14%）出现皮肤问题，其中6例为浅表性足背皮肤擦伤，且所有凉鞋均无需矫形师定制。40只脚（48%）出现复发。所有病例经手法操作和石膏固定后均恢复了矫正。14例患者中的19只脚（23%）已经或计划进行胫前肌腱转移术。在最近一次随访时，所有的脚均为平足，且背屈至少10度。没有患者需要进行手术松解。在31例随访至少3年的患者中，26例（84%）使用支具至少3年。
使用MP足外展矫形器，我们能够达到至少与早期使用DB支具的报告相当的依从率。家庭发现该支具易于使用。MP支具可被视为DB支具的一种有用替代方案。
二级——前瞻性研究。
