Dragoni Massimiliano, Gabrielli Armando, Farsetti Pasquale, Bellini Diego, Maglione Pierluigi, Ippolito Ernesto
Department of Orthopaedic Surgery, University of Rome 'TOR VERGATA', Viale Oxford, Rome, Italy.
J Pediatr Orthop B. 2018 Sep;27(5):428-434. doi: 10.1097/BPB.0000000000000510.
In our study, we aimed to demonstrate whether a complex iatrogenic clubfoot really exists; identify the causative mechanisms; and determine the outcome if properly treated. We observed 54 clubfeet previously treated unsuccessfully by manipulation and casting elsewhere. All the feet had been classified at diagnosis as typical clubfeet. In 26 cases, the cast had slipped down, entrapping the foot in a plantar-flexed position. Nine clubfeet out of those 26 cases presented the clinical features of a complex iatrogenic deformity. These were treated with the modified Ponseti protocol and evaluated at follow-up according to the International Clubfoot Study Group Score. The length of follow-up averaged 7.2 years. Two feet showed an excellent result, five feet showed a good result, and two feet showed a fair result. The relapse rate was 55% in complex clubfeet. Relapsed clubfeet were treated by Achilles tenotomy or lengthening and anterior tibial tendon transfer. We believe that faulty manipulation and a poor casting technique may convert a typical clubfoot into a complex iatrogenic deformity. Risk factors include severe clubfoot, short and stubby foot, and unmolded casts slipping down.
在我们的研究中，我们旨在证明复杂的医源性马蹄足是否真的存在；确定致病机制；并确定如果得到妥善治疗的结果。我们观察了54例先前在其他地方经手法和石膏固定治疗失败的马蹄足。所有足部在诊断时均被归类为典型马蹄足。在26例中，石膏下滑，使足部处于跖屈位。这26例中的9例马蹄足呈现出复杂医源性畸形的临床特征。这些病例采用改良的庞塞蒂方案治疗，并根据国际马蹄足研究组评分在随访时进行评估。随访时间平均为7.2年。2例足部结果为优，5例为良，2例为中。复杂马蹄足的复发率为55%。复发的马蹄足采用跟腱切断术或延长术以及胫前肌腱转移术治疗。我们认为，错误的手法操作和不良的石膏固定技术可能会将典型马蹄足转变为复杂的医源性畸形。危险因素包括重度马蹄足、短粗足以及未塑形的石膏下滑。
