Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, 136# Zhongshan 2 road, Chongqing, 400014, Yuzhong District, China.
Clinical Laboratory Department, Maternal and Child Health Care Hospital of Chongqing Yubei District, No.71, Shuanghu branch road, Chongqing, Yubei District, China.
J Orthop Surg Res. 2019 Jul 12;14(1):211. doi: 10.1186/s13018-019-1268-9.
Treatment of idiopathic congenital talipes equinovarus (CTEV) is challenging for pediatric orthopedic surgeons. The Ponseti method is an effective protocol for treatment due to its technique of manipulation, casting, and limited surgery. Plaster casting is an essential component of the Ponseti method. In this report, we describe a new brace that was developed for use in the treatment of clubfoot in newborns instead of a plaster cast.
This retrospective study was performed in two orthopedic medical centers. Between January 2011 and October 2013, 89 newborns with CTEV (131 ft) underwent corrective treatment using fixation braces in the experiment group (E-group) in our hospital, and 107 newborns with CTEV (141 ft) underwent plaster casting in the control group (C-group) in another medical center. All patients were treated according to the Ponseti method after the application of the inclusion and exclusion criteria. Plaster casts were applied to patients in the C-group. The patients in the E-group received the custom-made polyaxial fixation braces instead of plaster casts. Prospective follow-up was performed for a mean duration of 36 months. The efficacy of the treatment was assessed using Pirani's scoring system. Chi-squared and independent t tests were used for statistical analyses.
In the E-group, 85 patients (125 ft) achieved good appearance within 3 months of treatment initiation (average, 1.7 months). Four patients (6 ft) required percutaneous Achilles tenotomy. Seven patients developed sores during treatment because of improper brace application, but all sores healed without scarring with timely treatment. In the C-group, 96 patients (123 ft) achieved good appearance within 3 months of treatment initiation (average, 1.6 months). Eleven patients (18 ft) required percutaneous Achilles tenotomy. Twenty-one feet developed sores during treatment because of plaster cast pressure on the dorsum of the feet. Sixteen sores healed without scarring with timely treatment, and 5 ft had obvious scars. The overall mean Pirani scores 1 year after treatment were 0.26 ± 0.06 in the E-group and 0.25 ± 0.03 in the C-group, and the Pirani scores 3 years after treatment were 0.23 ± 0.05 in the E-group and 0.22 ± 0.03 in the C-group. There were significant differences in the percutaneous Achilles tenotomy and skin sores but no significant difference in the Pirani scores between these two groups.
Our results showed that the new polyaxial fixation brace used in this study was an effective tool for the corrective treatment of CTEV in newborns. We propose the use of this brace as an alternative treatment for newborns.
特发性先天性马蹄内翻足（CTEV）的治疗对儿科矫形外科医生来说具有挑战性。由于其操作、铸型和有限手术的技术，Ponseti 方法是一种有效的治疗方案。石膏铸型是 Ponseti 方法的重要组成部分。在本报告中，我们描述了一种新的支具，用于替代石膏铸型治疗新生儿的足内翻。
这是一项在两家骨科医疗中心进行的回顾性研究。2011 年 1 月至 2013 年 10 月，我们医院的实验组（E 组）对 89 例 CTEV（131 英尺）的新生儿采用固定支具进行矫正治疗，另一家医疗中心的对照组（C 组）对 107 例 CTEV（141 英尺）的新生儿采用石膏铸型。所有患者均符合纳入和排除标准后，采用 Ponseti 方法进行治疗。C 组患者采用石膏铸型。E 组患者则使用定制的多轴固定支具代替石膏铸型。所有患者均接受了平均 36 个月的前瞻性随访。采用 Pirani 评分系统评估治疗效果。采用卡方检验和独立 t 检验进行统计学分析。
E 组 85 例（125 英尺）患者在治疗开始后 3 个月内达到良好外观（平均 1.7 个月）。4 例（6 英尺）患者需要进行经皮跟腱切断术。7 例患者因支具应用不当出现皮肤溃疡，但所有溃疡均及时治疗，无瘢痕愈合。C 组 96 例（123 英尺）患者在治疗开始后 3 个月内达到良好外观（平均 1.6 个月）。11 例（18 英尺）患者需要进行经皮跟腱切断术。21 例患者因足背石膏压迫出现皮肤溃疡。16 例溃疡及时治疗后无瘢痕愈合，5 例有明显瘢痕。治疗 1 年后，E 组患者 Pirani 平均评分为 0.26±0.06，C 组为 0.25±0.03；治疗 3 年后，E 组患者 Pirani 平均评分为 0.23±0.05，C 组为 0.22±0.03。两组患者在经皮跟腱切断术和皮肤溃疡方面存在显著差异，但 Pirani 评分无显著差异。
我们的研究结果表明，本研究中使用的新型多轴固定支具是治疗新生儿 CTEV 的有效工具。我们建议将这种支具作为新生儿的一种替代治疗方法。
