Agarwal Ankur, Gupta Sumit, Sud Alok, Agarwal Sheetal
Department of Orthopaedics, Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Noida, India.
Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
J Clin Orthop Trauma. 2020 Mar-Apr;11(2):222-231. doi: 10.1016/j.jcot.2019.05.003. Epub 2019 May 7.
Serial Ponseti casting achieves deformity correction in early presenting idiopathic clubfoot cases normally in around 7 casts. However, there are resistant patients where correction requires more casts than usual. In such patients a modification in standard technique might be required right from the beginning. Such patients were collectively called as The aim of this study was to assess the outcome of our modification to Ponseti technique in
All idiopathic clubfoot cases who were 75th percentile or more in WHO age for weight chart (chubby infants) or untreated clubfoot patients presenting for first time to our clinic at more than 5 months age (late presenters and neglected cases) were included in the study. Patients who had been previously surgically intervened elsewhere, patients over 7 years of age, patients with syndromic clubfoot or clubfoot associated with neurological conditions were excluded from the study. The patients were treated by early tenotomy of tendoachillis and a plantar fascia release before starting serial casting by Ponseti technique. Post correction, strict bracing protocol was followed with regular follow up. Pirani scoring was done at each stage. Measurement of Talocalcaneal angle on AP radiograph, maximum degree of abduction and dorsiflexion was noted once every year.
There were total 28 patients in our study. In all, 47 feet were subjected to modified Ponseti protocol. There were 21 male patients. Median age at presentation was 4 months. Mean centile of weight for age as per WHO growth chart was 64. Mean Pirani score at presentation was 5.86 (S.D. ± 0.34). Mean number of casts required for correction was 3.75 ± 1.10. Maximum followup period was 25 months.
This modification of Ponseti casting for difficult clubfoot patients achieves correction in shorter duration with less number of casts.
对于早期出现的特发性马蹄内翻足病例，连续使用庞塞蒂石膏固定法通常在约7次石膏固定后可实现畸形矫正。然而，有些患者较为顽固，矫正需要比平常更多的石膏固定次数。对于这类患者，可能从一开始就需要对标准技术进行调整。这类患者被统称为……本研究的目的是评估我们对庞塞蒂技术的改良在……中的效果
所有在世界卫生组织年龄别体重图表中处于第75百分位或更高的特发性马蹄内翻足病例（肥胖婴儿），或5个月龄以上首次到我们诊所就诊的未经治疗的马蹄内翻足患者（就诊较晚和被忽视的病例）均纳入本研究。曾在其他地方接受过手术干预的患者、7岁以上的患者、综合征性马蹄内翻足患者或与神经疾病相关的马蹄内翻足患者被排除在研究之外。在开始使用庞塞蒂技术进行连续石膏固定之前，先对跟腱进行早期切断术并松解足底筋膜。矫正后，遵循严格的支具方案并定期随访。在每个阶段进行皮拉尼评分。每年在前后位X线片上测量距跟角、最大外展和背屈度数。
我们的研究共有28例患者。总计47只足接受了改良的庞塞蒂方案治疗。其中男性患者21例。就诊时的中位年龄为4个月。根据世界卫生组织生长图表，年龄别体重的平均百分位数为64。就诊时的平均皮拉尼评分为5.86（标准差±0.34）。矫正所需的平均石膏固定次数为3.75±1.10。最长随访期为25个月。
这种针对难治性马蹄内翻足患者的庞塞蒂石膏固定改良法能在更短时间内、使用更少的石膏固定次数实现矫正。
