Brazell Chris, Carry Patrick M, Jones Alex, Baschal Robin, Miller Nancy, Holmes Kaley S, Georgopoulos Gaia
Department of Orthopaedic Surgery, Musculoskeletal Research Center.
Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO.
J Pediatr Orthop. 2019 May/Jun;39(5):e402-e405. doi: 10.1097/BPO.0000000000001325.
The Dimeglio score (DS) is widely used to assess clubfoot severity, but its ability to predict long-term outcomes following Ponseti treated isolated clubfoot (IC) is controversial. This study tested the association between the initial DS and its individual parameters with the number of Ponseti clubfoot casts required to achieve correction and the rate of early recurrence following treatment.
Data were retrospectively collected from patients who underwent treatment of IC between March 2012 and March 2015 and were followed for ≥2 years. DSs were collected at the initial casting visit. The number of Ponseti casts required to achieve clubfoot correction before tenotomy and recurrence of deformity were collected as the primary outcome variables. Recurrence was defined as any loss of correction leading to repeat casting or tenotomy during the bracing phase. Negative binomial and logistic regression analyses were used to test the association between the 8 Dimeglio parameters and number of casts and incidence of recurrence, respectively.
A total of 53 patients (37 male and 16 female) were included in the study. The median number of casts required to achieve an acceptable correction was 5 (range, 2 to 16). The incidence of recurrence was 24.53% (13/53). An increase in derotation, varus, equinus, muscle condition, and total DSs at the initial cast visit were associated with a significant (P<0.05) increase in the number of casts required to achieve an acceptable correction. The derotation parameter [rate ratio: 1.30, 95% confidence interval (CI): 1.13-1.50, P=0.0003] was most strongly associated with number of casts. Total DSs at initial visit was the only variable significantly associated with the incidence of deformity recurrence (odds ratio: 1.36, 95% confidence interval: 1.01-1.84, P=0.0482).
Initial DS is correlated with the number of casts required for correction in Ponseti treated IC. DS may help physicians establish realistic expectations for families with regard to the length of treatment and the possibility of recurrence following Ponseti treatment.
Level II-retrospective prognostic study.
迪梅廖评分（DS）被广泛用于评估马蹄内翻足的严重程度，但其预测经庞塞蒂方法治疗的孤立性马蹄内翻足（IC）长期预后的能力存在争议。本研究检验了初始DS及其各个参数与实现矫正所需的庞塞蒂马蹄内翻足石膏固定次数以及治疗后早期复发率之间的关联。
回顾性收集2012年3月至2015年3月间接受IC治疗且随访时间≥2年的患者的数据。在初次石膏固定就诊时收集DS。将实现马蹄内翻足矫正所需的庞塞蒂石膏固定次数和畸形复发情况作为主要结局变量进行收集。复发定义为在支具治疗阶段因矫正丢失导致重复石膏固定或切断术的任何情况。分别采用负二项回归和逻辑回归分析来检验8个迪梅廖参数与石膏固定次数以及复发发生率之间的关联。
本研究共纳入53例患者（37例男性和16例女性）。实现可接受矫正所需的石膏固定次数中位数为5次（范围为2至16次）。复发率为24.53%（13/53）。初次石膏固定就诊时旋后、内翻、马蹄、肌肉状况以及总DS的增加与实现可接受矫正所需的石膏固定次数显著增加（P<0.05）相关。旋后参数[率比：1.30，95%置信区间（CI）：1.13 - 1.50，P = 0.0003]与石膏固定次数的关联最为密切。初次就诊时的总DS是与畸形复发发生率显著相关的唯一变量（比值比：1.36，95%置信区间：1.01 - 1.84，P = 0.0482）。
初始DS与经庞塞蒂方法治疗的IC矫正所需的石膏固定次数相关。DS可能有助于医生为家庭建立关于治疗时长以及庞塞蒂治疗后复发可能性的现实预期。
二级——回顾性预后研究。
