孟加拉国先天性马蹄内翻足项目：400名儿童接受庞塞蒂疗法两年后的疗效审计
The Bangladesh clubfoot project: audit of 2-year outcomes of Ponseti treatment in 400 children.
作者信息
Perveen Roksana, Evans Angela M, Ford-Powell Vikki, Dietz Frederick R, Barker Simon, Wade Paul W, Khan Shariful I
机构信息
*Clinical Services, Walk For Life, Dhaka §Walk For Life Ponseti, LAMB Project, Rajabashor, Parbatipur, Dinajpur, Bangladesh †Walk For Life, Department of Podiatry, Lower Extremity and Gait Studies (LEGS) Research Program, La Trobe University, Bundoora, Melbourne, Vic., Australia ‡Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand ∥Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA ¶Department of Paediatric Orthopaedic Surgery, Royal Aberdeen Childrens Hospital, Aberdeen, UK.
出版信息
J Pediatr Orthop. 2014 Oct-Nov;34(7):720-5. doi: 10.1097/BPO.0000000000000225.
BACKGROUND
Congenital clubfoot deformity can cause significant disability, and if left untreated, may further impoverish those in developing countries, like Bangladesh. The Ponseti method has been strategically introduced in Bangladesh by a nongovernment organization, Walk For Life (WFL). WFL has provided free treatment for over 8000 Bangladeshi children with clubfeet, sustained by local ownership, and international support. This audit assesses the 2-year results in children for whom treatment began before the age of 3 years.
METHODS
The 10 largest WFL clinics, of the 24 across Bangladesh, were pragmatically accessed in this audit availing 1442 subjects meeting the study criteria, from which 400 children were randomly selected and examined. A specific assessment tool was developed and validated.
RESULTS
Results for 400 cases were returned: 269 males, 131 females. Typical clubfeet comprised 79% of cases, and 55% were bilateral. A tenotomy rate of 79%, and brace use after 2 years of 85%, were notable findings. Functionally, most children could walk independently (99.0%), run (95.5%), squat (93.3%), and manage steps unassisted (93.0%). The ability to squat was the most indicative outcome measure, correlating with: less corrective casts, good and continued brace use, nonvarus heel position, good ankle range of motion, good Bangla clubfoot scores, and the ability to walk. Relapsing deformity was suspected with heel varus (18.0% left; 21.5% right). Parental satisfaction was very high, but cost of 3000 Taka ($US 38.48) was deemed unaffordable by 59%.
CONCLUSIONS
The outcomes in young children after 2 years of Ponseti treatment for clubfoot deformity showed that 99% were able to walk independently. The assessment tool developed for this study avails ongoing monitoring. Without the patronage of WFL, most of these children would not have had access to treatment, and be unable to walk.
LEVEL OF EVIDENCE
Level II-lesser-quality prospective study.
背景
先天性马蹄内翻足畸形可导致严重残疾，若不治疗，可能会使孟加拉国等发展中国家的患者情况进一步恶化。一个非政府组织“为生命行走”（WFL）已在孟加拉国战略性地引入了庞塞蒂方法。WFL在当地的自主努力以及国际支持下，已为8000多名患有马蹄内翻足的孟加拉儿童提供了免费治疗。本次审计评估了3岁前开始治疗的儿童的两年治疗结果。
方法
本次审计实际走访了孟加拉国24家WFL诊所中规模最大的10家，共有1442名符合研究标准的受试者，从中随机选取400名儿童进行检查。开发并验证了一种特定的评估工具。
结果
返回了400例病例的结果：男性269例，女性131例。典型马蹄内翻足病例占79%，55%为双侧病例。值得注意的是，切断术使用率为79%，两年后支具使用率为85%。在功能方面，大多数儿童能够独立行走（99.0%）、跑步（95.5%）、蹲下（93.3%）以及独立上下台阶（93.0%）。蹲下能力是最具指示性的结果指标，与以下因素相关：矫正石膏使用次数较少、支具使用良好且持续、足跟无内翻、踝关节活动范围良好、孟加拉国马蹄内翻足评分良好以及行走能力。怀疑存在复发畸形的足跟内翻情况为：左侧18.0%；右侧21.5%。家长满意度非常高，但59%的家长认为3000塔卡（38.48美元）的费用难以承受。
结论
庞塞蒂法治疗马蹄内翻足畸形两年后，幼儿的治疗结果显示99%的儿童能够独立行走。为本研究开发的评估工具可用于持续监测。如果没有WFL的资助，这些儿童中的大多数将无法获得治疗，也无法行走。
证据级别
二级——质量较低前瞻性研究。
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