Jochymek Jiří, Turek Jakub
Department of Paediatric Surgery, Orthopaedics and Traumatology (DPSOT) of the Children´s Medical Centre (CMC), Faculty Hospital in Brno, Medical Faculty of the Masaryk University in Brno, Brno, Czech Republic.
Department of Paediatric Surgery, Orthopaedics and Traumatology (DPSOT) of the Children´s Medical Centre (CMC), Faculty Hospital in Brno, Medical Faculty of the Masaryk University in Brno, Brno, Czech Republic.
Acta Orthop Traumatol Turc. 2018 Mar;52(2):87-91. doi: 10.1016/j.aott.2017.11.007. Epub 2018 Feb 13.
The aim of this study was to assess the role of sonographic evaluation of Talar dysplasia in predicting the outcome of standard Ponseti method in the treatment of clubfoot deformity.
A total 23 children (15 boys and 8 girls; mean age: 18.2 ± 5.4 days (8-32)) who underwent Ponseti treatment were included in the study. Before the treatment, maximal talus length of affected and non-affected feet were measured by US and relative talar dysplasia ratio (RTDR) was calculated. The patients were categorized 2 groups according to RTDR: group A - mild and group B - severe deformity. Pirani score was used for clinical evaluation. The groups were compared in terms of number of the applied casts, need of percutaneous tenotomy of Achilles tendon (AchT) and frequency of deformity recurrence.
Pirani score was 4.46 for population (4.33 for group A; 4.54 for group B). Number of casts significantly differed between groups (p < 0.001) and positive correlation was found (r = 0.851, p < 0.001). AchT was performed in 56% cases for group A and in 86% cases for group B; no statistically significant difference was obtained (p = 0.162). Recurrence occurred in 2 patients belonging to group B without significant difference compared to group A (p = 0.502).
Talar dysplasia assessment appeared as a promising prognostic factor for predicting the outcome of the Ponseti technique in treatment of clubfoot deformity.
Level IV, diagnostic study.
本研究旨在评估距骨发育不良的超声评估在预测先天性马蹄内翻足畸形标准Ponseti方法治疗效果中的作用。
本研究纳入了23例接受Ponseti治疗的儿童（15例男孩和8例女孩；平均年龄：18.2±5.4天（8 - 32天））。治疗前，通过超声测量患侧和未患侧足部的距骨最大长度，并计算相对距骨发育不良率（RTDR）。根据RTDR将患者分为两组：A组 - 轻度畸形和B组 - 重度畸形。使用Pirani评分进行临床评估。比较两组在应用石膏的数量、跟腱经皮切断术（AchT）的需求以及畸形复发频率方面的差异。
总体Pirani评分为4.46（A组为4.33；B组为4.54）。两组之间的石膏数量有显著差异（p < 0.001），且发现呈正相关（r = 0.851，p < 0.001）。A组56%的病例进行了AchT，B组为86%；未获得统计学显著差异（p = 0.162）。B组有2例患者出现复发，与A组相比无显著差异（p = 0.502）。
距骨发育不良评估似乎是预测Ponseti技术治疗先天性马蹄内翻足畸形效果的一个有前景的预后因素。
IV级，诊断性研究。
