Ganesan Balasankar, Luximon Ameersing, Al-Jumaily Adel, Balasankar Suchita Kothe, Naik Ganesh R
The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR.
Centre for Health Technology (CHT), Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, Sydney, Australia.
PLoS One. 2017 Jun 20;12(6):e0178299. doi: 10.1371/journal.pone.0178299. eCollection 2017.
Congenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: hindfoot equinus, hindfoot varus, midfoot cavus, and forefoot adduction. Although a number of conservative and surgical methods have been proposed to correct the clubfoot deformity, the relapses of the clubfoot are not uncommon. Several previous literatures discussed about the technical details of Ponseti method, adherence of Ponseti protocol among walking age or older children. However there is a necessity to investigate the relapse pattern, compliance of bracing, number of casts used in treatment and the percentages of surgical referral under two years of age for clear understanding and better practice to achieve successful outcome without or reduce relapse. Therefore this study aims to review the current evidence of Ponseti method (manipulation, casting, percutaneous Achilles tenotomy, and bracing) in the management of clubfoot under two years of age.
Articles were searched from 2000 to 2015, in the following databases to identify the effectiveness of Ponseti method treatment for clubfoot: Medline, Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, and Scopus. The database searches were limited to articles published in English, and articles were focused on the effectiveness of Ponseti method on children with less than 2 years of age.
Of the outcome of 1095 articles from four electronic databases, twelve articles were included in the review. Pirani scoring system, Dimeglio scoring system, measuring the range of motion and rate of relapses were used as outcome measures.
In conclusion, all reviewed, 12 articles reported that Ponseti method is a very effective method to correct the clubfoot deformities. However, we noticed that relapses occur in nine studies, which is due to the non-adherence of bracing regime and other factors such as low income and social economic status.
先天性马蹄内翻足（CTEV），又称畸形足，是儿童常见的先天性骨科足部畸形，其特征为足部畸形的四个组成部分：足跟马蹄畸形、足跟内翻、中足高弓和前足内收。尽管已经提出了许多保守和手术方法来矫正畸形足，但畸形足复发并不罕见。先前的几篇文献讨论了庞塞蒂方法的技术细节、行走年龄或更大儿童对庞塞蒂方案的依从性。然而，有必要调查复发模式、支具的依从性、治疗中使用石膏的次数以及两岁以下手术转诊的百分比，以便清楚了解并更好地实践，从而在不复发或减少复发的情况下取得成功结果。因此，本研究旨在回顾庞塞蒂方法（手法矫正、石膏固定、经皮跟腱切断术和支具治疗）在两岁以下儿童畸形足治疗中的现有证据。
检索了2000年至2015年期间以下数据库中的文章，以确定庞塞蒂方法治疗畸形足的有效性：医学索引数据库（Medline）、护理及相关健康文献累积索引数据库（CINHAL）、医学期刊数据库（PubMed）和斯高帕斯数据库（Scopus）。数据库检索仅限于以英文发表的文章，且文章重点关注庞塞蒂方法对两岁以下儿童的有效性。
在四个电子数据库检索出的1095篇文章中，有12篇文章被纳入综述。采用皮拉尼评分系统、迪梅廖评分系统、测量活动范围和复发率作为结果指标。
总之，所有纳入综述的12篇文章均报道庞塞蒂方法是矫正畸形足的一种非常有效的方法。然而，我们注意到有九项研究出现了复发情况，这是由于支具治疗方案依从性不佳以及其他因素，如低收入和社会经济地位等。
