Arkin Cameron, Ihnow Stephanie, Dias Luciano, Swaroop Vineeta T
Ann & Robert H. Lurie Children's Hospital of Chicago.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr Orthop. 2018 Nov-Dec;38(10):e588-e592. doi: 10.1097/BPO.0000000000001248.
Clubfoot occurs in 30% to 50% of patients with spina bifida. The Ponseti casting method has changed treatment of idiopathic clubfoot to a primarily nonoperative regimen. The Ponseti method is now widely applied to clubfoot in spina bifida, however, few studies report treatment outcomes. Most available studies include heterogeneous diagnoses or short-term results. The purpose of this study is to report midterm outcomes in patients with spina bifida and clubfoot treated with the Ponseti method.
IRB-approved retrospective chart review of 17 consecutive patients (26 feet) below 1 year of age with spina bifida and clubfoot treated with Ponseti method. Charts reviewed for age at treatment initiation, number of casts, surgeries performed, recurrence of deformity, and further treatments. Primary outcome was recurrence of deformity requiring further treatment. Data were analyzed using t tests for means and χ tests for categorical data.
Initial correction was achieved in 26 of 26 feet patients. A total of 23 of 26 feet patients underwent a surgical procedure for the tendo-Achilles at an average age of 105 days, 12 percutaneous tenotomies (percT) and 11 open tendonectomy (openT). At average follow-up of 5 (1.8 to 7.5) years, 11 feet (42.3%) in 8 patients were successfully treated with Ponseti method. Of the 15 feet (57.7%) with recurrence, 10 required posterior releases, 4 posterior-medial-lateral releases and 1 tendon transfers. Average age at further treatment was 1.5 years (0.9 to 3.1 y). Those with recurrence required more casts before tendon surgery (7.6 vs. 6.1, P=0.02). A total of 100% patients (12/12) with percT had recurrence of deformity, compared with 18% (2/11) of patients with openT (P<0.0005).
Midterm evaluation of Ponseti method for clubfoot in spina bifida shows a successful outcome in 42.3%. Recurrence with openT was significantly lower than percT and also substantially lower than previously published recurrence rates in spina bifida (33.3% to 68%). In spina bifida, Ponseti method leads to reliable initial correction and is useful to decrease extensive soft tissue release. An open excision of the Achilles should be performed. Families should be counseled about high risk of recurrence and potential need for further treatment.
Level III-retrospective comparative study.
脊柱裂患者中30%至50%会出现马蹄内翻足。庞塞蒂石膏固定法已将特发性马蹄内翻足的治疗转变为主要的非手术方案。庞塞蒂方法现广泛应用于脊柱裂合并马蹄内翻足，但很少有研究报告治疗结果。大多数现有研究包括异质性诊断或短期结果。本研究的目的是报告采用庞塞蒂方法治疗的脊柱裂合并马蹄内翻足患者的中期结果。
经机构审查委员会批准，对17例年龄小于1岁、采用庞塞蒂方法治疗的脊柱裂合并马蹄内翻足患者（26只脚）进行回顾性病历审查。审查病历以获取治疗开始时的年龄、石膏固定次数、进行的手术、畸形复发情况及进一步治疗情况。主要结局是需要进一步治疗的畸形复发。采用t检验分析均值数据，采用χ检验分析分类数据。
26例患者的26只脚均实现了初始矫正。26例患者中的23只脚平均在105天龄时接受了跟腱手术，其中12例为经皮跟腱切断术（percT），11例为开放性肌腱切除术（openT）。平均随访5（1.8至7.5）年时，8例患者的11只脚（42.3%）采用庞塞蒂方法成功治疗。在15只（57.7%）复发的脚中，10只需要后路松解，4只需要后内侧外侧松解，1只需要肌腱转移。进一步治疗的平均年龄为1.5岁（0.9至3.1岁）。复发患者在肌腱手术前需要更多的石膏固定（7.6次对6.1次，P = 0.02）。经皮跟腱切断术（percT）的患者中100%（12/12）出现畸形复发，而开放性肌腱切除术（openT）的患者中为18%（2/11）（P < 0.0005）。
对脊柱裂合并马蹄内翻足采用庞塞蒂方法的中期评估显示，42.3%的患者治疗成功。开放性肌腱切除术（openT）后的复发率显著低于经皮跟腱切断术（percT），也大大低于先前发表的脊柱裂复发率（33.3%至68%）。在脊柱裂中，庞塞蒂方法能实现可靠的初始矫正，有助于减少广泛的软组织松解。应进行跟腱开放性切除术。应向家属咨询复发的高风险及可能需要进一步治疗的情况。
III级——回顾性比较研究。
