Liu Yubin, Zhao Dahang, Zhao Li, Li Hai, Yang Xuan
Department of Pediatric Orthopedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.
The Third Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Harbin, 150001, Heilongjiang Province, China.
Indian J Pediatr. 2016 Nov;83(11):1266-1274. doi: 10.1007/s12098-015-1860-x. Epub 2015 Sep 5.
Congenital clubfoot is one of the most common musculoskeletal deformities presenting at birth. Many high risk factors have been associated with clubfoot such as male gender, primiparous mothers and maternal smoking. Accurate understanding of clubfoot pathoanatomy is supposed to be the basis for deformity correction. Prenatal ultrasonography is of reference value in recognizing clubfoot during pregnancy. Neglected clubfoot can eventually cause a noticeable disability and severely influence the quality life in adulthood. Early recognition and treatment are presumed to be the key for prevention of late disabilities. Nowadays, Ponseti method, as one of the conservative treatment regimen, has been widely accepted because of the reported good results of long-term follow-up. However, special attention should be paid to the details in clinical practice for achieving even better correction and a lower rate of relapse. After the complete correction, brace wearing is critical for preventing deformity relapse. Non-compliance or non-adherence with the brace protocol has been considered as the predominant risk factor predisposing to the relapse of clubfoot, which is still a challenging problem. This paper was prepared to give a general introduction about clubfoot, in terms of the importance of early recognition and conservative management, especially Ponseti method, for preventing late disabilities.
先天性马蹄内翻足是出生时最常见的肌肉骨骼畸形之一。许多高危因素与马蹄内翻足有关,如男性、初产妇和母亲吸烟。准确了解马蹄内翻足的病理解剖结构应该是畸形矫正的基础。产前超声检查在孕期识别马蹄内翻足方面具有参考价值。未经治疗的马蹄内翻足最终可能导致明显的残疾,并严重影响成年后的生活质量。早期识别和治疗被认为是预防后期残疾的关键。如今,作为保守治疗方案之一的庞塞蒂方法,因其长期随访报告的良好效果而被广泛接受。然而,在临床实践中应特别注意细节,以实现更好的矫正和更低的复发率。完全矫正后,佩戴支具对于防止畸形复发至关重要。不遵守或不坚持支具方案被认为是导致马蹄内翻足复发的主要危险因素,这仍然是一个具有挑战性的问题。本文旨在就早期识别和保守治疗(尤其是庞塞蒂方法)对预防后期残疾的重要性,对马蹄内翻足进行概述。