1 至 5 岁且至少随访 10 年的尼泊尔未经治疗的马蹄内翻足患者接受潘塞提（Ponseti）方法治疗的结果。

Outcomes of the Ponseti Method for Untreated Clubfeet in Nepalese Patients Seen Between the Ages of One and Five Years and Followed for at Least 10 Years.

机构信息

Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal.

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

出版信息

J Bone Joint Surg Am. 2018 Dec 5;100(23):2004-2014. doi: 10.2106/JBJS.18.00445.

DOI:10.2106/JBJS.18.00445

PMID:30516623

Abstract

BACKGROUND

To our knowledge, there are no reports of the Ponseti method initiated after walking age and with >10 years of follow-up. Our goal was to report the clinical findings and patient-reported outcomes for children with a previously untreated idiopathic clubfoot who were seen when they were between 1 and 5 years old, were treated with the Ponseti method, and had a minimum follow-up of 10 years.

METHODS

A retrospective review of medical records was supplemented by a follow-up evaluation of physical findings (alignment and range of motion) and patient-reported outcomes using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). The initial treatment was graded as successful if a plantigrade foot was achieved without the need for an extensive soft-tissue release and/or osseous procedure.

RESULTS

We located 145 (91%) of 159 patients (220 clubfeet). The average age at treatment was 3 years (range, 1 to 5 years), and the average duration of follow-up was 11 years (range, 10 to 12 years). The initial scores according to the systems of Pirani et al. and Diméglio et al. averaged 5 and 17, respectively, and an average of 8 casts were required. Surgical treatment, most commonly a percutaneous Achilles tendon release (197 feet; 90%), was required in 96% of the feet. A plantigrade foot was achieved in 95% of the feet. Complete relapse was rare (3%), although residual deformities were common. Patient-reported outcomes were favorable.

CONCLUSIONS

A plantigrade foot was achieved in 95% of the feet initially and was maintained in most of the patients, although residual deformities were common. Patient-reported outcomes were satisfactory, and longer-term follow-up with age-appropriate outcome measures will be required to evaluate function in adulthood.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

据我们所知，目前尚无文献报道过在行走年龄后采用 Ponseti 方法治疗，且随访时间超过 10 年。我们的目标是报告此前未经治疗的特发性马蹄足患儿的临床发现和患者报告的结局，这些患儿在 1 至 5 岁之间就诊，接受了 Ponseti 方法治疗，随访时间至少 10 年。

方法

对病历进行回顾性分析，并通过随访评估体格检查发现（对线和活动范围）和使用儿童牛津踝关节-足部问卷（Oxford Ankle Foot Questionnaire for Children，OxAFQ-C）评估患者报告的结局。如果获得了平足且无需广泛软组织松解和/或骨手术，则初始治疗被评为成功。

结果

我们找到了 145 名（91%）159 名患者（220 只患足）中的 145 名（220 只患足）。治疗时的平均年龄为 3 岁（1 至 5 岁），平均随访时间为 11 年（10 至 12 年）。Pirani 等和 Diméglio 等系统的初始评分分别平均为 5 和 17，平均需要 8 个石膏固定。96%的患足需要手术治疗，最常见的是经皮跟腱松解术（197 只脚）。95%的患足获得了平足。完全复发罕见（3%），但残留畸形常见。患者报告的结局良好。