Gao Ryan, Tomlinson Matthew, Walker Cameron
*Middlemore Hospital †Department of Engineering Science, University of Auckland, Auckland, New Zealand.
J Pediatr Orthop. 2014 Sep;34(6):639-42. doi: 10.1097/BPO.0000000000000182.
A number of grading systems for severity of clubfoot have been reported in the literature, but none are universally accepted. The aim of this study was to find the correlation between 2 of the most widely utilized classification systems (the Pirani score and the Dimeglio score) with number of Ponseti casts required to achieve initial clubfeet correction.
A retrospective study of prospectively collected data was performed. All clubfeet assessed at our dedicated clubfoot clinic from January 2007 to December 2011 were included. Clubfoot severity was assessed using both the Pirani score and the Dimeglio score. The total number of casts was calculated from the first cast to the time of initiation of the foot abduction orthosis.
The mean number of Ponseti casts required to achieve initial correction was 5.8 (range, 2 to 10 casts). A low correlation (rs 0.21) was identified when the total Dimeglio score was compared with the number of casts. No correlation (rs 0.12) was identified between the Pirani score and the number of casts.
The Dimeglio and Pirani scores remain the most widely accepted clubfoot severity grading systems. However, their prognostic value remains questionable, at least in the early treatment stages.
Prognostic study level II.
文献中已报道了多种用于评估马蹄内翻足严重程度的分级系统，但尚无一种被普遍接受。本研究的目的是找出两种应用最广泛的分类系统（皮拉尼评分和迪梅廖评分）与实现马蹄内翻足初始矫正所需的庞塞蒂石膏次数之间的相关性。
对前瞻性收集的数据进行回顾性研究。纳入2007年1月至2011年12月在我们专门的马蹄内翻足诊所评估的所有马蹄内翻足病例。使用皮拉尼评分和迪梅廖评分评估马蹄内翻足的严重程度。从第一次石膏固定到开始使用足部外展矫形器的时间计算石膏的总数。
实现初始矫正所需的庞塞蒂石膏平均次数为5.8次（范围为2至10次）。将迪梅廖总分与石膏次数进行比较时，发现相关性较低（rs 0.21）。皮拉尼评分与石膏次数之间未发现相关性（rs 0.12）。
迪梅廖评分和皮拉尼评分仍然是最广泛接受的马蹄内翻足严重程度分级系统。然而，它们的预后价值仍然值得怀疑，至少在早期治疗阶段是这样。
预后研究II级。
