Mehtani Anil, Prakash Jatin, Vijay Vipul, Kumar Nishikant, Sinha Abhinav
Department of Orthopaedics, Lady Hardinge Medical College.
Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India.
J Pediatr Orthop B. 2018 Jan;27(1):61-66. doi: 10.1097/BPB.0000000000000450.
Achieving adequate dorsiflexion in neglected clubfoot cases remains challenging. On a close observation of the Ponseti method, we have now made certain modifications from the standard Ponseti protocol. This has helped us improve functional results, as well as reduce the number of casts in this walking-age group. From March 2011 onward, we managed 62 neglected clubfeet in 41 patients with the modified protocol. All these patients were treated with serial weekly above-knee casts. The feet were assessed by Dimeglio and Pirani scorings, which were done every week. These children were closely monitored and followed up at regular intervals for any signs of relapses. The mean age group was 3.1 years (1.1-12 years). The mean follow-up period for these feet was 3 years (1.2-4 years). Mean Dimeglio score before treatment was 15.9, and after treatment it was 0.52. Mean Pirani score before treatment was 4.21 and after treatment it was 0.03. The average number of casts before tenotomy with our modified method was 6.9. Percutaneous tenotomy was done in all the cases. The mean dorsiflexion achieved at the end of treatment was 21.3° (15°-40°). Our modified Ponseti technique is a very effective and reproducible method for correction of neglected clubfeet. We feel that an extensive soft tissue surgery may not be required for neglected clubfeet even up to the age of 10 years.
在治疗被忽视的马蹄内翻足病例时，实现足够的背屈仍然具有挑战性。在仔细观察庞塞蒂方法后，我们现在对标准的庞塞蒂方案做了一些修改。这有助于我们改善功能结果，并减少这个步行年龄组的石膏固定次数。从2011年3月起，我们采用改良方案治疗了41例患者的62只被忽视的马蹄内翻足。所有这些患者均接受每周一次的系列膝上石膏固定治疗。每周通过迪梅廖和皮拉尼评分对足部进行评估。对这些儿童进行密切监测，并定期随访有无复发迹象。平均年龄组为3.1岁（1.1 - 12岁）。这些足部的平均随访期为3年（1.2 - 4年）。治疗前平均迪梅廖评分为15.9，治疗后为0.52。治疗前平均皮拉尼评分为4.21，治疗后为0.03。采用我们的改良方法，在跟腱切断术前平均石膏固定次数为6.9次。所有病例均进行了经皮跟腱切断术。治疗结束时实现的平均背屈角度为21.3°（15° - 40°）。我们改良的庞塞蒂技术是一种非常有效且可重复的治疗被忽视马蹄内翻足的方法。我们认为，即使对于10岁以下被忽视的马蹄内翻足，可能也不需要进行广泛的软组织手术。
