Jauregui Julio J, Zamani Shirin, Abawi Hummira H, Herzenberg John E
*Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore ‡Department of Orthopaedic Surgery, University of Maryland Medical System, Baltimore, MD †Department of Orthopaedic Surgery, Atieh Hospital, Tehran, Iran.
J Pediatr Orthop. 2017 Apr/May;37(3):199-203. doi: 10.1097/BPO.0000000000000611.
Posterior capsulotomy can correct residual clubfoot deformity, but has been associated with ankle stiffness. The purpose of this study was to evaluate clinical ankle range of motion (ROM) following posterior capsulotomy immediately postsurgery and during long-term follow-up.
A retrospective clinical and radiographic review of 257 patients (398 feet) was performed to evaluate all patients who required a posterior capsulotomy as part of their clubfoot management. Twenty feet (16 patients) were identified with a mean age of 73.3±37.7 months and mean Pirani score of 5.2±0.8 points. Following capsulotomy, a long-leg cast was placed and maintained for a mean of 26 days (range, 21 to 35 d). At cast removal, parents were trained and instructed to immediately begin home physiotherapy. The capsulotomy cohort was age and sex matched to a cohort treated exclusively with the Ponseti method for comparison. Children in the comparison cohort had a mean Pirani score of 5.7±0.8 points.
The mean dorsiflexion in the capsulotomy cohort significantly increased comparing the preoperative to the immediate postoperative ROM (from -6.5 to +9.7 degrees). No significant reduction in this gain was observed at latest follow-up (to +8.3 degrees). No significant difference in the plantar-flexion angle was found. Radiographically, a significant improvement in the lateral anterior tibial-calcaneal angle angles was found (P<0.05).
If utilizing our protocol for early mobilization, limited use of capsulotomy to treat relapsed clubfoot does not necessarily reduce ankle ROM. Our protocol of placing the feet in casts for a shorter duration of time and providing early physiotherapy helps maintain ankle ROM after a posterior capsulotomy.
Level III-therapeutic study.
后关节囊切开术可纠正残留的马蹄内翻足畸形，但与踝关节僵硬有关。本研究的目的是评估后关节囊切开术后即刻及长期随访期间踝关节的临床活动范围（ROM）。
对257例患者（398足）进行回顾性临床和影像学检查，以评估所有需要后关节囊切开术作为马蹄内翻足治疗一部分的患者。确定了20足（16例患者），平均年龄为73.3±37.7个月，平均皮拉尼评分为5.2±0.8分。关节囊切开术后，放置长腿石膏并维持平均26天（范围21至35天）。拆除石膏时，对家长进行培训并指导其立即开始家庭物理治疗。关节囊切开术队列在年龄和性别上与仅采用庞塞蒂方法治疗的队列相匹配，以进行比较。比较队列中的儿童平均皮拉尼评分为5.7±0.8分。
与术前相比，关节囊切开术队列的平均背屈在术后即刻ROM时显著增加（从-6.5度增加到+9.7度）。在最新随访时（增加到+8.3度），未观察到该增益有显著降低。跖屈角度未发现显著差异。影像学上，胫前-跟骨外侧角有显著改善（P<0.05）。
如果采用我们的早期活动方案，有限使用关节囊切开术治疗复发性马蹄内翻足不一定会降低踝关节ROM。我们缩短石膏固定时间并提供早期物理治疗的方案有助于在后关节囊切开术后维持踝关节ROM。
III级治疗性研究。
