Corbu Andrei, Cosma Dan Ionut, Vasilescu Dana Elena, Cristea Stefan
Department of Orthopedics and Traumatology, Clinical Rehabilitation Hospital Cluj-Napoca, Cluj, Romania.
Department of Orthopedics and Traumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Ther Clin Risk Manag. 2020 Sep 8;16:813-819. doi: 10.2147/TCRM.S262199. eCollection 2020.
Although many short-term studies have shown the superiority of Ponseti treatment to surgical treatment, studies with long-term follow-up of patients into adolescence are lacking. The aim of this study was to compare the morphological, functional and radiological results of the two methods into and during adolescent age, when both soft tissue and bony procedures can be performed to correct residual deformities.
We retrospectively evaluated two groups of patients diagnosed with congenital idiopathic clubfoot and treated with either the Ponseti method (34 clubfeet) and surgery in the form of posteromedial release (31 clubfeet). All included clubfeet were clinically fully corrected after initial treatment and final plaster removal. Evaluation was performed with the International Clubfoot Study Group (ICFSG) score.
The age at follow-up was 12.8±1.6 years in the Ponseti group and 13.5±1.7 years in the surgical group. Excellent or good results were obtained in 26 feet (76%) of the Ponseti group and in 14 feet (45%) in the surgical group. The Ponseti treatment was significantly superior to posteromedial release in terms of the final score (10.58±6.49 versus 17.26±8.83, p<0.001), functional score (p<0.001) and radiological score (p<0.001). Residual deformities were clinically present in both groups but were less frequent and less severe in Ponseti-treated patients. Flat-top talus was found to be present in both groups, but the Ponseti method was more protective than surgical treatment against this outcome (relative risk=0.494, p=0.002). The overall foot and ankle mobility was significantly better in the Ponseti group (p<0.001).
The Ponseti method was superior to surgery for treatment of clubfoot and achieved better long-term morphological, functional and radiological results. It preserves better mobility of the foot and ankle, and results in less frequent and less severe residual deformities than surgical treatment.
尽管许多短期研究表明Ponseti治疗法优于手术治疗，但缺乏对患者进行青春期长期随访的研究。本研究的目的是比较这两种方法在青少年期及青春期期间的形态学、功能和放射学结果，此时可以进行软组织和骨手术来纠正残留畸形。
我们回顾性评估了两组诊断为先天性特发性马蹄内翻足的患者，分别采用Ponseti方法治疗（34例马蹄内翻足）和后内侧松解术形式的手术治疗（31例马蹄内翻足）。所有纳入的马蹄内翻足在初始治疗和最终拆除石膏后临床均完全矫正。采用国际马蹄内翻足研究组（ICFSG）评分进行评估。
Ponseti组的随访年龄为12.8±1.6岁，手术组为13.5±1.7岁。Ponseti组26足（76%）获得优或良的结果，手术组14足（45%）获得优或良的结果。就最终评分（10.58±6.49对17.26±8.83，p<0.001）、功能评分（p<0.001）和放射学评分（p<0.001）而言，Ponseti治疗明显优于后内侧松解术。两组均存在临床残留畸形，但Ponseti治疗的患者残留畸形的发生率更低且程度更轻。两组均发现有扁平距骨，但Ponseti方法比手术治疗对这种结果的保护作用更强（相对风险=0.494，p=0.002）。Ponseti组的足踝总体活动度明显更好（p<0.001）。
Ponseti方法治疗马蹄内翻足优于手术治疗，在长期形态学、功能和放射学方面取得了更好的结果。与手术治疗相比，它能更好地保留足踝活动度，并减少残留畸形的发生率和严重程度。
