采用Ponseti方法治疗的特发性马蹄内翻足僵硬复发的早期影像学危险因素。

Early radiographic risk factors for rigid relapse in idiopathic clubfoot treated with the Ponseti method.

作者信息

Mishima Kenichi, Kitoh Hiroshi, Matsushita Masaki, Sugiura Hiroshi, Hasegawa Sachi, Kitamura Akiko, Nishida Yoshihiro, Ishiguro Naoki

机构信息

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.

出版信息

Foot Ankle Surg. 2018 Dec;24(6):509-513. doi: 10.1016/j.fas.2017.06.003. Epub 2017 Jun 17.

DOI:10.1016/j.fas.2017.06.003

PMID:29409275

Abstract

BACKGROUND

This study aimed at identifying early risk factors for rigid relapse in idiopathic clubfoot using foot radiographs.

METHODS

Thirty-four patients with 43 idiopathic clubfeet treated with the Ponseti method were retrospectively reviewed.

RESULTS

There were seven rigid relapse recalcitrant to manipulation and requiring extensive soft-tissue release. Three radiograabphic measurements on the maximum dorsiflexion lateral (MD-Lat) radiograph, talocalcaneal (TaloCalc-Lat), tibiocalcaneal (TibCalc-Lat), and calcaneus-first metatarsal (CalcMT1-Lat) angles, showed significant differences between patients with and without rigid relapse. The TaloCalc-Lat and CalcMT1-Lat angles showed significant hazard ratio for rigid relapse by multivariate survival analysis. Clubfeet demonstrating TibCalc-Lat>90° and CalcMT1-Lat<5° have a 24.9-fold odds ratio to develop rigid relapse compared to those demonstrating TibCalc-Lat≤90° or CalcMT1-Lat≥5°.

CONCLUSIONS

The TaloCalc-Lat, TibCalc-Lat, and CalcMT1-Lat angles on the MD-Lat radiograph immediately before the tenotomy, probably representing intrinsic tightness of the midfoot and/or hindfoot, are significant risk factors for rigid relapse in patients treated with the Ponseti method.

摘要

背景

本研究旨在通过足部X光片确定特发性马蹄内翻足僵硬复发的早期风险因素。

方法

回顾性分析34例采用Ponseti方法治疗的43只特发性马蹄内翻足患者。

结果

有7例僵硬复发，手法治疗无效，需要广泛的软组织松解。在最大背屈侧位（MD-Lat）X光片上进行的三项放射学测量，即距跟（TaloCalc-Lat）、胫跟（TibCalc-Lat）和跟骨-第一跖骨（CalcMT1-Lat）角，在有和没有僵硬复发的患者之间显示出显著差异。多因素生存分析显示，TaloCalc-Lat和CalcMT1-Lat角对僵硬复发具有显著的风险比。与TibCalc-Lat≤90°或CalcMT1-Lat≥5°的马蹄内翻足相比，TibCalc-Lat>90°且CalcMT1-Lat<5°的马蹄内翻足发生僵硬复发的比值比为24.9倍。