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采用庞塞蒂方法治疗非特发性马蹄内翻足:一项系统评价。

Treatment of non-idiopathic clubfeet with the Ponseti method: a systematic review.

作者信息

De Mulder T, Prinsen S, Van Campenhout A

机构信息

Department of Orthopaedics, UZ Leuven Campus Pellenberg, Pellenberg, Belgium.

出版信息

J Child Orthop. 2018 Dec 1;12(6):575-581. doi: 10.1302/1863-2548.12.180066.

Abstract

PURPOSE

Although non-idiopathic clubfeet were long thought to be resistant to non-surgical treatment methods, more studies documenting results on treatment of these feet with the Ponseti method are being published. The goal of this systematic review is to summarize current evidence on treatment of non-idiopathic clubfeet using the Ponseti method.

METHODS

PubMed and Limo were searched, reference lists of eligible studies were screened and studies that met the inclusion criteria were included. Data on average number of casts, Achilles tendon tenotomy (ATT), initial correction, recurrence, successful treatment at final follow-up and complications were pooled. The Methodological Index for Non-Randomized Studies was used to assess the methodological quality of the selected studies.

RESULTS

In all, 11 studies were included, yielding a total of 374 non-idiopathic and 801 idiopathic clubfeet. Non-idiopathic clubfeet required more casts (7.2 5.4) and had a higher rate of ATT (89.4% 75.7%). Furthermore, these feet had a higher recurrence rate (43.3% 11.5%) and a lower rate of successful treatment at final follow-up (69.3% 95.0%). Complications were found in 20.3% of the non--idiopathic cohort. When comparing results between clubfeet associated with myelomeningocele and arthrogryposis, the first group presented with a lower number of casts (5.4 - 7.2) and a higher rate of successful treatment at final follow-up (81.8% 58.2%).

CONCLUSION

The Ponseti method is a valuable and non-invasive option in the primary treatment of non-idiopathic clubfeet in young children. Studies with longer follow-up are necessary to evaluate its long-term effect.

LEVEL OF EVIDENCE

Level III - systematic review of Level-III studies.This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and -Meta-Analyses).

摘要

目的

尽管长期以来人们认为非特发性马蹄内翻足对非手术治疗方法具有抵抗性,但越来越多关于使用庞塞蒂方法治疗此类足部的研究结果正在发表。本系统评价的目的是总结当前使用庞塞蒂方法治疗非特发性马蹄内翻足的证据。

方法

检索了PubMed和Limo,筛选了符合条件研究的参考文献列表,并纳入了符合纳入标准的研究。汇总了关于平均石膏固定次数、跟腱切断术(ATT)、初始矫正、复发、最终随访时的成功治疗以及并发症的数据。使用非随机研究的方法学指数来评估所选研究的方法学质量。

结果

总共纳入了11项研究,共有374例非特发性马蹄内翻足和801例特发性马蹄内翻足。非特发性马蹄内翻足需要更多的石膏固定(7.2±5.4),且跟腱切断术的发生率更高(89.4%±75.7%)。此外,这些足部的复发率更高(43.3%±11.5%),最终随访时的成功治疗率更低(69.3%±95.0%)。在20.3%的非特发性队列中发现了并发症。在比较与脊髓脊膜膨出和关节挛缩相关的马蹄内翻足的结果时,第一组的石膏固定次数较少(5.4 - 7.2),最终随访时的成功治疗率较高(81.8%±58.2%)。

结论

庞塞蒂方法是幼儿非特发性马蹄内翻足初级治疗中的一种有价值的非侵入性选择。需要进行更长时间随访的研究来评估其长期效果。

证据水平

III级 - III级研究的系统评价。本研究符合PRISMA指南(系统评价和荟萃分析的首选报告项目)的要求。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3a6/6293335/72a46a6266c5/jco-12-575-g0001.jpg

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