Oleas-Santillán Geovanny, Reid Nichols Louise, Rogers Kenneth J, Richard Bowen James
Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
J Pediatr Orthop B. 2019 Sep;28(5):446-451. doi: 10.1097/BPB.0000000000000618.
Children having both typical developmental dysplasia of the hip (DDH) and clubfoot are rare, and early treatments of both conditions are recommended. The aim of this study was to evaluate the effects of the Ponseti method of clubfoot treatment on hips with DDH. After institutional review board approval, we identified children treated by the Ponseti and Pavlik methods between 2003 and 2016. During the Ponseti method treatment, the duration of manipulations, number of casts, tenotomies performed, and days in clubfoot orthosis were recorded. During DDH treatment, we registered duration for Pavlik and hip brace usage. Hips had dynamic sonography and radiographic evaluations. The cases were grouped according to the combination of DDH and clubfoot treatments: (a) concurrent, (b) sequential, and (c) hip observation. Seven cases of DDH and clubfoot were identified. The average number of Ponseti casts was 5.8 (range: 4-8 casts). The average number of days following the post-Achilles-tenotomy casting to the end of clubfoot bracing was 870 days (range: 90-1605 days). Eleven (four bilateral cases and three unilateral) clubfeet were corrected initially by the Ponseti method. The average number of days for Pavlik harness treatment was 74 (range: 10-126 days). Additionally, a hip orthosis was utilized in three children for an average of 131 days. At follow-up, all children had a high femoral neck-shaft angle averaging 152° (range: 144°-164°). One child (case 5) developed avascular necrosis of the femoral head, Kalamchi type I. Children with typical and nonsyndromic DDH and clubfoot treated by Pavlik harness and Ponseti methods are associated with abnormal hip development (coxa valga).
同时患有典型发育性髋关节发育不良（DDH）和马蹄内翻足的儿童较为罕见，建议对这两种病症尽早进行治疗。本研究旨在评估Ponseti法治疗马蹄内翻足对患有DDH的髋关节的影响。经机构审查委员会批准后，我们确定了2003年至2016年间采用Ponseti法和Pavlik法治疗的儿童。在Ponseti法治疗期间，记录了手法操作的持续时间、石膏固定的次数、进行跟腱切断术的次数以及佩戴马蹄内翻足矫形器的天数。在DDH治疗期间，我们记录了使用Pavlik吊带和髋部支具的持续时间。对髋关节进行动态超声检查和X线评估。根据DDH和马蹄内翻足治疗的组合方式将病例分组：（a）同时治疗，（b）序贯治疗，（c）髋关节观察。共确定了7例DDH合并马蹄内翻足的病例。Ponseti石膏固定的平均次数为5.8次（范围：4 - 8次）。跟腱切断术后石膏固定至马蹄内翻足矫形器治疗结束的平均天数为870天（范围：90 - 1605天）。11只（4例双侧和3例单侧）马蹄内翻足最初采用Ponseti法矫正。Pavlik吊带治疗的平均天数为74天（范围：10 - 126天）。此外，3名儿童使用髋部支具，平均使用131天。随访时，所有儿童的股骨颈干角均较高，平均为152°（范围：144° - 164°）。1名儿童（病例5）发生了Kalamchi I型股骨头缺血性坏死。采用Pavlik吊带和Ponseti法治疗的典型非综合征性DDH和马蹄内翻足患儿与髋关节发育异常（髋外翻）有关。
