Hughes K, Gelfer Y, Cokljat M, Wientroub S, Yavor A, Hemo Y, Dunkley M, Eastwood D M
St. George's Hospital, London, UK.
St. George's University of London, London, UK.
J Child Orthop. 2019 Aug 1;13(4):353-360. doi: 10.1302/1863-2548.13.190060.
The Ponseti method is a well-established approach to treating clubfoot. Potentially, both the underlying pathology and adherence to post-correction bracing can affect lower limb function and age of independent standing and walking. This cohort study investigates the age at which infants with idiopathic clubfoot treated using the Ponseti method achieved three selected developmental milestones and whether or not this correlated with treatment compliance.
A prospectively collected database from four centres was visited. Inclusion criteria were patients with idiopathic clubfoot with no comorbidities or prior treatment. Age at attainment of independent standing, walking, nocturnal continence was compared across three groups: I) congenital talipes equinovarus (CTEV) children compliant with treatment; II) CTEV children non-compliant with treatment; and III) typically-developed siblings. Minimum follow-up was five years.
In all, 130 patients (198 feet) fitted the inclusion criteria: 43:87 (F:M). Standing was achieved by a mean 12.0 months in group I (sd 2.50); 12.0 months (sd 2.0) in II and ten months (sd 3.0) in III. Walking was achieved by a mean 15 months (sd 4.0) in group I, 14 months (sd 1.75) in II and 12 months (sd 3) in III, respectively. Both the compliant and non-compliant CTEV children were significantly slower at achieving standing and walking compared to sibling controls (p < 0.0001). There was no significant difference between age of nocturnal continence between the three groups.
Infants with idiopathic clubfoot treated according to the Ponseti method achieve independent standing and walking approximately two months later than their typically-developed siblings. The delay is not related to the use of the foot abduction brace.
III.
庞塞蒂方法是治疗马蹄内翻足的一种成熟方法。潜在地，潜在病理状况和矫正后支具的依从性都可能影响下肢功能以及独立站立和行走的年龄。这项队列研究调查了采用庞塞蒂方法治疗的特发性马蹄内翻足婴儿达到三个选定发育里程碑的年龄，以及这是否与治疗依从性相关。
访问了来自四个中心的前瞻性收集的数据库。纳入标准为无合并症或既往未接受治疗的特发性马蹄内翻足患者。比较了三组达到独立站立、行走、夜间自控的年龄：I）依从治疗的先天性马蹄内翻足（CTEV）儿童；II）不依从治疗的CTEV儿童；III）发育正常的兄弟姐妹。最短随访时间为五年。
共有130例患者（198只脚）符合纳入标准：43例女性，87例男性。I组平均在12.0个月（标准差2.50）时实现站立；II组为12.0个月（标准差2.0），III组为10个月（标准差3.0）。I组平均在15个月（标准差4.0）时实现行走，II组为14个月（标准差1.75），III组为12个月（标准差3）。与兄弟姐妹对照组相比，依从和不依从的CTEV儿童在实现站立和行走方面均明显较慢（p<0.0001）。三组之间夜间自控年龄无显著差异。
按照庞塞蒂方法治疗的特发性马蹄内翻足婴儿实现独立站立和行走的时间比发育正常的兄弟姐妹晚约两个月。这种延迟与使用外展支具无关。
III级
