Zionts Lewis E, Packer Davida F, Cooper Shannon, Ebramzadeh Edward, Sangiorgio Sophia
Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007. E-mail address:
Department of Orthopaedics, Miami Children's Hospital, 3100 S.W. 62nd Avenue, Miami FL 33155.
J Bone Joint Surg Am. 2014 Oct 1;96(19):e164. doi: 10.2106/JBJS.M.01525.
The Ponseti method is an established approach to treating idiopathic clubfoot in infants. The method involves a period of cast immobilization and postcorrective bracing that potentially interferes with normal movements of the lower extremities. In the present study, we investigated the age at which infants who had idiopathic clubfoot treated using the Ponseti method achieved independent walking.
We prospectively evaluated patients of a single surgeon. Included in the study were all patients with idiopathic clubfoot who were full term at birth, were no more than twelve weeks of age at the start of treatment, had received no prior outside treatment, and were followed for a minimum of twenty-four months.
Ninety-four patients were included. The mean age at which patients began walking independently was 14.5 ± 2.6 months (range, ten to twenty-two months). By eighteen months, 90% of the patients were walking without assistance. Patients with moderate or severe clubfoot deformity began walking earlier than did patients with very severe deformity (a mean of 14.2 months compared with 15.8 months; p = 0.03). Patients who experienced a relapse before learning to walk began walking later than those who did not relapse (a mean of 15.9 months compared with 14.2 months; p = 0.04). Other patient and treatment-related variables had no significant influence on the onset of walking.
On the basis of our findings, parents of infants with idiopathic clubfoot treated using the Ponseti method may expect their child to achieve independent walking approximately two months later than infants without clubfoot deformity. A greater delay may be expected for those patients who have a very severe deformity or those who experience a deformity relapse.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
庞塞蒂方法是治疗婴儿特发性马蹄内翻足的既定方法。该方法包括一段石膏固定期和矫正后支具治疗期，这可能会干扰下肢的正常运动。在本研究中，我们调查了采用庞塞蒂方法治疗特发性马蹄内翻足的婴儿实现独立行走的年龄。
我们对一位外科医生的患者进行了前瞻性评估。纳入研究的所有患者均为足月出生的特发性马蹄内翻足患者，治疗开始时年龄不超过12周，此前未接受过外部治疗，且随访时间至少为24个月。
共纳入94例患者。患者开始独立行走的平均年龄为14.5±2.6个月（范围为10至22个月）。到18个月时，90%的患者无需帮助即可行走。中度或重度马蹄内翻足畸形患者比极重度畸形患者开始行走更早（平均14.2个月对15.8个月；p = 0.03）。在学会走路前经历复发的患者比未复发的患者开始行走更晚（平均15.9个月对14.2个月；p = 0.04）。其他与患者和治疗相关的变量对行走开始时间无显著影响。
根据我们的研究结果，采用庞塞蒂方法治疗特发性马蹄内翻足的婴儿的父母可能预期他们的孩子比无马蹄内翻足畸形的婴儿大约晚两个月实现独立行走。对于那些有极重度畸形或经历畸形复发的患者，可能预期会有更大的延迟。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
