做好准备：先天性马蹄内翻足的庞塞蒂石膏固定法和足外展矫形器支具治疗结果

Brace Yourselves: Outcomes of Ponseti Casting and Foot Abduction Orthosis Bracing in Idiopathic Congenital Talipes Equinovarus.

作者信息

Kuzma Alexander L, Talwalkar Vishwas R, Muchow Ryan D, Iwinski Henry J, Milbrandt Todd A, Jacobs Cale A, Walker Janet L

机构信息

Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY.

Department of Orthopaedics, Mayo Clinic, Rochester, MN.

出版信息

J Pediatr Orthop. 2020 Jan;40(1):e25-e29. doi: 10.1097/BPO.0000000000001380.

DOI:10.1097/BPO.0000000000001380

PMID:30969199

Abstract

BACKGROUND

Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients.

METHODS

After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor. Dimeglio score and family demographic information were collected. Initial treatment was by the Ponseti method, with or without Achilles tenotomy. Following correction, patients had three months of full-time FAO bracing during which parents kept a log of compliance. Patients were followed until recurrence (need for further treatment) or age 5.

RESULTS

In total, 42 patients with 64 affected feet met the above criteria and were included in the final analysis. Twenty-six feet (40%) went on to develop recurrence requiring further treatment, including casting, bracing, or surgery. Because of poor tolerance of the original FAO, 20 feet were transitioned to an alternative FAO, and 14 of these (70%) went on to recur (P<0.01). The casting duration (P=0.02) had a statistically significant relationship to recurrence. Patients who were casted for 9 weeks or more had a higher rate of recurrence (57.1% vs. 27.8%; P=0.02). Age at treatment start, Dimeglio score, demographic factors, and compliance during full-time bracing, whether by report or sensor, did not show a significant relationship with recurrence.

CONCLUSIONS

The study showed a statistically significant relationship between the difficulty of CTEV correction and the risk of recurrent deformity requiring treatment. This relationship could be used to provide prognostic information for patients' families. Caregiver-reported compliance was not significantly related to recurrence.

LEVEL OF EVIDENCE

Level III-Prognostic Retrospective Cohort Study.

摘要

背景

如庞塞蒂所描述的，足部外展矫形器（FAO）被认为可降低先天性马蹄内翻足（CTEV）治疗后的复发率。本项目的目的是在一组特发性CTEV患者中，研究采用庞塞蒂方法治疗后使用FAO支具的效果。

方法

经机构审查委员会（IRB）批准，在之前一项通过家庭报告和传感器进行支具依从性的前瞻性研究中，确定了一组年龄在3至46天的特发性CTEV患者。收集了迪梅廖评分和家庭人口统计学信息。初始治疗采用庞塞蒂方法，伴或不伴跟腱切断术。矫正后，患者进行为期三个月的全日制FAO支具治疗，在此期间家长记录依从情况。对患者进行随访直至复发（需要进一步治疗）或5岁。

结果

共有42例患者的64只患足符合上述标准并纳入最终分析。26只足（40%）出现复发，需要进一步治疗，包括石膏固定、支具治疗或手术。由于对原FAO耐受性差，20只足改用另一种FAO，其中14只（70%）复发（P<0.01）。石膏固定时间（P=0.02）与复发有统计学显著关系。石膏固定9周或更长时间的患者复发率更高（57.1%对27.8%；P=0.02）。开始治疗时的年龄、迪梅廖评分、人口统计学因素以及全日制支具治疗期间的依从性，无论是通过报告还是传感器测量，均与复发无显著关系。