Kowalczyk Bart, Felus Jaroslaw
Department of Orthopedics, University Children's Hospital of Krakow, Krakow, Poland
Department of Orthopedics, University Children's Hospital of Krakow, Krakow, Poland.
Foot Ankle Int. 2015 Sep;36(9):1072-7. doi: 10.1177/1071100715581656. Epub 2015 Apr 29.
Wide soft tissue releases (STRs) are considered the classic operative approach to the arthrogrypotic clubfoot, but recently the Ponseti method with Achilles tenotomy has been proposed as the initial treatment for those deformities.
A retrospective comparison of clinical results and treatment course after 5 to 10 years of follow-up (FU) in arthrogrypotic clubfeet treated initially with STRs or the Ponseti method was performed. Mann-Whitney and χ(2) tests were used to assess significant differences between variables.
Twenty-nine children with 57 arthrogrypotic clubfeet were divided into 2 subgroups: the Ponseti subgroup (9 children, 18 clubfeet, mean FU: 7.3 years), which achieved 14 good and 4 satisfactory final results. The complication rate was 5.5%. Reoperation rate was 1.2 per foot, with 90.9% being STRs and 9.1% wedge osteotomies. The mean total anesthesia and surgery time equaled 116.6 and 77.4 minutes, respectively. The interval between primary and redo surgery was 27.3 months on average. The STR subgroup (20 children, 39 clubfeet, FU: 9.0 years on average) scored 20 good, 8 satisfactory, and 11 unsatisfactory results. Rate of complications was 23%. The mean total anesthesia and surgery times were 161.4 minutes and 102.8 minutes, respectively. The interval between the initial and secondary operations was 62.8 months on average. The revision rate was 1.0 per foot with 32.5% repeated STRs, while 67.5% were talectomies, osteotomies, or salvage procedures.
The use of the Ponseti method as the initial treatment in arthrogrypotic clubfeet improved clinical outcomes, reduced invasiveness of revisions, and shortened overall time of anesthesia and surgery.
Level III, retrospective comparative series.
广泛软组织松解术（STRs）被认为是治疗先天性多发性关节挛缩症马蹄内翻足的经典手术方法，但最近有人提出采用经皮跟腱切断的庞塞蒂方法作为这些畸形的初始治疗方法。
对最初采用STRs或庞塞蒂方法治疗的先天性多发性关节挛缩症马蹄内翻足患者进行5至10年随访后的临床结果和治疗过程进行回顾性比较。采用曼-惠特尼检验和χ²检验评估变量之间的显著差异。
29例患有57只先天性多发性关节挛缩症马蹄内翻足的儿童被分为2个亚组：庞塞蒂亚组（9例儿童，18只足，平均随访7.3年），最终结果为14例优和4例良。并发症发生率为5.5%。再次手术率为每只足1.2次，其中90.9%为STRs，9.1%为楔形截骨术。平均总麻醉时间和手术时间分别为116.6分钟和77.4分钟。初次手术与再次手术之间的间隔平均为27.3个月。STR亚组（20例儿童，39只足，平均随访9.0年），结果为20例优，8例良，11例差。并发症发生率为23%。平均总麻醉时间和手术时间分别为161.4分钟和102.8分钟。初次手术与二次手术之间的间隔平均为62.8个月。翻修率为每只足1.0次，其中32.5%为重复STRs，而67.5%为距骨切除术、截骨术或挽救手术。
在先天性多发性关节挛缩症马蹄内翻足的初始治疗中使用庞塞蒂方法可改善临床结果，降低翻修手术的侵袭性，并缩短总的麻醉和手术时间。
III级，回顾性比较系列研究。
