Eamsobhana Perajit, Kongwachirapaitoon Pipat, Kaewpornsawan Kamolporn
Department of Orthopedics Surgery, Siriraj Hospital, Mahidol University, 2 Wanglung Road, Bangkoknoi, Bangkok, Thailand.
Department of Orthopedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Eur J Orthop Surg Traumatol. 2017 Oct;27(7):1005-1009. doi: 10.1007/s00590-017-1975-z. Epub 2017 May 20.
Clubfoot is a complex three-dimensional deformity. Although brace compliance after initial correction was previously found to be significantly associated with recurrence in clubfoot, few previous studies have specifically examined evertor muscle function as a factor that contributes to recurrence in children with idiopathic and non-idiopathic clubfoot. The aim of this study was to investigate the relationship among brace compliance, evertor muscle grading, and recurrence rate in pediatric clubfoot patients.
Children with idiopathic clubfoot who were treated and followed for a minimum of 2 years were included. Patients who used their brace <20-23 h a day for the first 3 months and then <8-10 h per day during sleep and nap times thereafter were classified as group I. Patients who complied fully by using the brace 23 h a day for the first 3 months and then 8-10 h per day during sleep and nap times thereafter were classified as group II. Demographic and clinical data including age, gender, follow-up time, recurrence, evertor muscle grading, types of surgery, brace compliance, severity of initial deformity, age at onset, number of casts required for initial correction, and the need for Achilles tenotomy were collected and analyzed.
Seventy-nine children with clubfoot were included. There were 47 males and 32 females, mean age was 3.2 years (range 2.1-6.3), and the mean follow-up time was 31.4 months. All patients had follow-up of at least 2 years. Primary correction was obtained in all children. There was no significant difference in mean age, mean follow-up time, or recurrence rate between groups. There was, however, a statistically significant difference in mean brace time between groups (p = 0.002). The recurrence rate was 26.2% in group I and 22.2% in group II. The recurrence rate in group a (Pirani score 0) was 3.9%, group b (Pirani score 0.5) 43.8%, and group c (Pirani score 1) 75% (p < 0.001). No significant association was found between severity of the initial deformity, age at the onset of treatment, number of casts required for correction, or reported brace compliance and recurrence or rates of surgery. Only poor or absent evertor muscle activity was found to be statistically significantly associated with risk of recurrence.
Good evertor muscle grading was found to be a significant protective factor against recurrence of idiopathic clubfoot. Thus, improvement in muscle balance around the ankle, especially the evertor muscle, should be emphasized to parents after the casting regimen is completed and correction is achieved.
马蹄内翻足是一种复杂的三维畸形。尽管先前发现初次矫正后支具依从性与马蹄内翻足复发显著相关，但之前很少有研究专门将外翻肌功能作为特发性和非特发性马蹄内翻足患儿复发的一个影响因素进行研究。本研究的目的是探讨小儿马蹄内翻足患者支具依从性、外翻肌分级与复发率之间的关系。
纳入接受治疗并随访至少2年的特发性马蹄内翻足患儿。将前3个月每天使用支具时间<20 - 23小时，之后在睡眠和午睡时间每天使用<8 - 10小时的患者分为I组。将前3个月每天使用支具23小时，之后在睡眠和午睡时间每天使用8 - 至10小时且完全依从的患者分为II组。收集并分析人口统计学和临床数据，包括年龄、性别、随访时间、复发情况、外翻肌分级、手术类型、支具依从性、初始畸形严重程度、发病年龄、初次矫正所需石膏次数以及跟腱切断术的必要性。
纳入79例马蹄内翻足患儿。其中男性47例，女性32例，平均年龄3.2岁（范围2.1 - 6.3岁），平均随访时间31.4个月。所有患者随访至少2年。所有患儿均获得初次矫正。两组之间的平均年龄、平均随访时间或复发率无显著差异。然而，两组之间的平均支具佩戴时间存在统计学显著差异（p = 0.002）。I组复发率为26.2%，II组为22.2%。A组（皮拉尼评分0）复发率为3.9%，B组（皮拉尼评分0.5）为43.8%，C组（皮拉尼评分1）为75%（p < 0.001）。未发现初始畸形严重程度、治疗开始时的年龄、矫正所需石膏次数或报告的支具依从性与复发或手术率之间存在显著关联。仅发现外翻肌活动不良或缺失与复发风险存在统计学显著关联。
良好的外翻肌分级被发现是特发性马蹄内翻足复发 的一个重要保护因素。因此，在完成石膏固定方案并实现矫正后，应向家长强调改善踝关节周围的肌肉平衡，尤其是外翻肌。
