Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, State Hospital of São Paulo, São Paulo, SP, Brazil.
Centro Clínico Orthopectus e Hospital de Base, Brasília, DF, Brazil.
PLoS One. 2018 Nov 20;13(11):e0207153. doi: 10.1371/journal.pone.0207153. eCollection 2018.
The prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an intervention option for older, untreated children.
A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.
Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82-0.94, p < 0.01), relative to the total analysed. The recurrence rate was 18% (95% CI = 0.14-0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03-0.15, p = 0.19).
Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The results obtained exhibited considerable heterogeneity.
发展中国家由于出生后早期护理资源有限，导致步行年龄以上未治疗先天性马蹄足的患病率较高。潘塞蒂方法为年龄较大、未经治疗的儿童提供了一种干预选择。
通过对电子数据库（Medline、Scopus、Embase、Lilacs 和 Cochrane 图书馆）中收录的文章进行系统综述，选择观察性研究进行荟萃分析。对比例进行汇总分析，并计算 95%置信区间（CI）和发表偏倚评估。使用随机效应模型对成功、复发和并发症发生率进行加权汇总。
共纳入 12 项研究，包括 654 例诊断为步行年龄以上（大于 1 岁）儿童的先天性马蹄足，进行分析。使用随机效应模型进行聚类荟萃分析的比例发现，满意结局的发生率为 89%（95%CI=0.82-0.94，p<0.01），与总分析相比。复发率为 18%（95%CI=0.14-0.24，p=0.015），铸型并发症发生率为 7%（95%CI=0.03-0.15，p=0.19）。
潘塞蒂方法应用于未经治疗的特发性马蹄足年龄较大的儿童，可获得满意的结果，成本低，避免了可能导致并发症的手术。结果存在较大的异质性。
