Agarwal Anil, Agrawal Nargesh, Barik Sitanshu, Gupta Neeraj
1 Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
J Orthop Surg (Hong Kong). 2018 May-Aug;26(2):2309499018772364. doi: 10.1177/2309499018772364.
Evidences suggest that different subgroups of idiopathic clubfoot exist with differences in severity and treatment outcomes. This study compares the severity and treatment outcomes of unilateral and bilateral clubfoot.
We retrospectively studied 161 patients (bilateral 66, unilateral 95) with primary idiopathic clubfeet to evaluate the differences in severity and treatment. The parameters analyzed were precasting Pirani score, number of casts required, pretenotomy Pirani score, pretenotomy dorsiflexion, rate of tenotomy, and post-tenotomy dorsiflexion achieved. A Pirani score of at least 5 was classified as very severe and 4.5 or less was classified as less severe.
There were 49=(74.24%) male and 17 (25.75%) female patients in the bilateral group and 76 (80%) male and 19 (20%) female patients in the unilateral group. Out of 95 unilateral patients, 34 were left sided (35.8%). Comparing severity, the mean precasting Pirani score in bilateral patients (5.4 ± 0.6) was statistically more than the unilateral patients (4.9 ± 0.7). The number of casts required was significantly more in bilateral feet compared to unilateral (bilateral 5.3 ± 1.7, unilateral 4.7 ± 1.7; p < 0.011). Achilles tenotomy was required in all feet. Post Ponseti treatment, the foot deformity correction achieved (pretenotomy Pirani score, pretenotomy, and post-tenotomy dorsiflexion) was statistically similar in both unilateral and bilateral feet.
Idiopathic bilateral clubfoot was more severe than unilateral foot at initial presentation and required more number of corrective casts. Post Ponseti treatment, the deformity correction in bilateral foot was similar to unilateral foot.
有证据表明，特发性马蹄内翻足存在不同亚组，其严重程度和治疗结果存在差异。本研究比较了单侧和双侧马蹄内翻足的严重程度及治疗结果。
我们回顾性研究了161例原发性特发性马蹄内翻足患者（双侧66例，单侧95例），以评估严重程度和治疗方面的差异。分析的参数包括石膏固定前的皮拉尼评分、所需石膏的数量、跟腱切断术前的皮拉尼评分、跟腱切断术前的背屈角度、跟腱切断率以及跟腱切断术后达到的背屈角度。皮拉尼评分至少为5分被归类为非常严重，4.5分及以下被归类为不太严重。
双侧组有49例（74.24%）男性和17例（25.75%）女性患者，单侧组有76例（80%）男性和19例（20%）女性患者。在95例单侧患者中，34例为左侧（35.8%）。比较严重程度，双侧患者石膏固定前的平均皮拉尼评分（5.4±0.6）在统计学上高于单侧患者（4.9±0.7）。与单侧相比，双侧所需石膏的数量明显更多（双侧5.3±1.7，单侧4.7±1.7；p<0.011）。所有足部均需要进行跟腱切断术。庞塞蒂治疗后，单侧和双侧足部在足部畸形矫正方面（跟腱切断术前的皮拉尼评分、跟腱切断术前和跟腱切断术后的背屈角度）在统计学上相似。
特发性双侧马蹄内翻足在初次就诊时比单侧足更严重，需要更多的矫正石膏。庞塞蒂治疗后，双侧足部的畸形矫正与单侧足相似。
