Department of Orthopaedics, University Hospital Bulovka, Prague, Czech Republic.
Int Orthop. 2013 Sep;37(9):1821-5. doi: 10.1007/s00264-013-2033-z. Epub 2013 Aug 7.
Congenital club foot is one of the most common birth defects involving the musculoskeletal system. At present two methods are used for the treatment of this deformity: French and Ponseti method. The purpose of this study was to compare the short-term (up to three years) and long-term (three to seven years) results of treatment with the Ponseti method.
A total of 195 consecutive infants (143 boys and 52 girls) with idiopathic club foot treated with the Ponseti method in the period of 2005-2012 were included in this study; the total number of feet was 303. The severity of the foot deformity was classified according to Diméglio. When relapse occurred up until three years of age, we started with the casting again. If conservative treatment was unsuccessful we proceeded to surgical treatment.
Primary correction was attained in all cases. Surgical correction of relapses was performed in 30 % of patients according to the Ponseti method (re-tenotomy of the Achilles tendon and transposition of the tibialis anterior) and in 70 % by alternative techniques. The number of relapses indicated for surgery increased with increasing period of follow-up: whereas in patients where the treatment started already in 2005 relapses occurred in 72 %, in patients included in 2011 the number of recurrences only reached 3 %.
It follows from our results that it is impossible to cure all club feet with casting, tenotomy of the Achilles tendon and transposition of the tibialis anterior only.
先天性马蹄足是最常见的涉及骨骼肌肉系统的先天缺陷之一。目前，有两种方法可用于治疗这种畸形：法国法和潘塞蒂法。本研究旨在比较潘塞蒂法治疗的短期（最长三年）和长期（三到七年）结果。
本研究共纳入 2005 年至 2012 年间采用潘塞蒂法治疗的 195 例特发性马蹄足畸形连续婴儿（男 143 例，女 52 例）；共 303 只脚。根据迪梅利奥（Diméglio）对足部畸形的严重程度进行分类。当 3 岁之前出现复发时，我们再次开始进行石膏固定。如果保守治疗失败，则进行手术治疗。
所有病例均获得了初次矫正。根据潘塞蒂法（跟腱延长再切开术和胫骨前肌移位术）对 30%的患者进行了复发的手术矫正，对 70%的患者采用了替代技术进行了手术矫正。需要手术矫正的复发例数随随访时间的延长而增加：2005 年开始治疗的患者中复发率为 72%，而 2011 年开始治疗的患者中复发率仅为 3%。
我们的结果表明，仅通过石膏固定、跟腱延长再切开术和胫骨前肌移位术不可能治愈所有马蹄足畸形。
