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采用改良哥本哈根方法治疗马蹄内翻足:10年随访

Treatment of clubfoot with the modified Copenhagen method: A 10-year follow-up.

作者信息

Utrilla-Rodríguez Elia, Munuera-Martínez Pedro V, Albornoz-Cabello Manuel

机构信息

1 University Hospital Virgen Macarena, Seville, Spain.

2 University of Seville, Seville, Spain.

出版信息

Prosthet Orthot Int. 2018 Jun;42(3):328-335. doi: 10.1177/0309364617741777. Epub 2017 Nov 20.

Abstract

BACKGROUND

Clubfoot is one of the most frequent congenital malformations in the world. Non-operative methods follows limiting surgery to a minimum. The modified Copenhagen method has not been studied enough.

STUDY DESIGN

longitudinal retrospective study.

OBJECTIVES

To evaluate prognostic factors for clinical rehabilitation with the modified Copenhagen method in a 10-year follow-up period.

METHODS

A retrospective study was carried out on a 10-year follow-up of 82 children diagnosed with clubfoot at birth and treated with the modified Copenhagen method. Their sex, side, severity, bilaterality, forefoot orientation, and age when the nonoperative treatment was started were registered, and a cluster analysis was performed to determine which variables were most significant for predicting whether surgical treatment was needed.

RESULTS

Of the clubfeet, 13.4% were grade I, 65.9% were grade II, and 20.7% were grade III according to the Harrold and Walker classification. In total, 58 patients needed surgery at some point during the follow-up period. The severity and talo-first metatarsal angle made it possible to determine whether the patients required surgery in 68% (56/82) of the cases.

CONCLUSION

The results of the study suggest the possibility of providing physicians with an algorithm which might facilitate assessing whether the children will require surgery or not, depending on the data obtained from the cluster analysis. Clinical relevance This study provides health professionals with an algorithm that might facilitate assessing whether the children will require surgery or not.

摘要

背景

马蹄内翻足是世界上最常见的先天性畸形之一。非手术方法尽量减少手术。改良哥本哈根方法的研究还不够充分。

研究设计

纵向回顾性研究。

目的

评估改良哥本哈根方法在10年随访期内临床康复的预后因素。

方法

对82例出生时诊断为马蹄内翻足并采用改良哥本哈根方法治疗的儿童进行了为期10年的回顾性研究。记录他们的性别、患侧、严重程度、双侧性、前足方向以及开始非手术治疗时的年龄,并进行聚类分析,以确定哪些变量对预测是否需要手术治疗最为重要。

结果

根据哈罗德和沃克分类,马蹄内翻足中,13.4%为I级,65.9%为II级,20.7%为III级。在随访期间,共有58例患者在某个时间点需要手术。严重程度和距骨-第一跖骨角在68%(56/82)的病例中能够确定患者是否需要手术。

结论

研究结果表明,有可能为医生提供一种算法,根据聚类分析获得的数据,这可能有助于评估儿童是否需要手术。临床意义 本研究为卫生专业人员提供了一种算法,可能有助于评估儿童是否需要手术。

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