Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
J Pediatr Orthop B. 2021 Sep 1;30(5):467-470. doi: 10.1097/BPB.0000000000000812.
We aimed to determine the quantitative value of derotation of calcaneo pedal block (DCPB) of Dimeglio system equivalent to talar head reduction of Pirani system. We also compared the ankle dorsiflexion obtained post tenotomy for different measures of DCPB. The study involved 53 idiopathic clubfoot children (86 feet) treated with Ponseti technique. Percutaneous Achilles tenotomy to correct ankle equinus was performed when forefoot adduction, heel varus were corrected and ankle dorsiflexion was <10°. Pirani's coverage of lateral head of talus was taken as a determinant of adequate DCPB and to perform tenotomy. Mean patient age at enrollment was 60.9 ± 71.1 days. The median pre and posttreatment Dimeglio scores were 13 (range 4-20) and 0 (range 0-3), respectively. DCPB at the time of talar head reduction was 53.8 ± 9.8°. In 85% feet, talar head reduction was obtained by DCPB 60° and all were reduced by 70°. The average ankle dorsiflexion improved significantly with DCPB ≥ 50°. The measure at which DCPB matched with talar head reduction of Pirani system was variable (40-70°). In all feet, talar head was reduced by 70° DCPB. Post tenotomy, ankle dorsiflexion was better with DCPB ≥ 50°.
我们旨在确定 Dimeglio 系统下跟骨足内翻旋转截骨术（DCPB）的定量值，相当于 Pirani 系统下距骨头部复位的程度。我们还比较了不同 DCPB 测量值下跟腱切断术后踝关节背屈的情况。这项研究涉及 53 例特发性马蹄足畸形患儿（86 只脚），均采用 Ponseti 技术治疗。当前足内收、跟骨内翻和踝关节背屈<10°时，行经皮跟腱切断术以矫正踝关节跖屈畸形。将 Pirani 系统下距骨外侧头部的覆盖作为充分 DCPB 的决定因素，并进行跟腱切断术。纳入患者的平均年龄为 60.9±71.1 天。治疗前后 Dimeglio 评分中位数分别为 13（范围 4-20）和 0（范围 0-3）。距骨头部复位时 DCPB 为 53.8±9.8°。85%的足在 DCPB 60°时获得距骨头部复位，所有足均在 DCPB 70°时复位。DCPB≥50°时，踝关节背屈显著改善。DCPB 与 Pirani 系统下距骨头部复位相匹配的程度是可变的（40-70°）。所有足在 DCPB 70°时距骨头部均复位。跟腱切断术后，DCPB≥50°时踝关节背屈更好。
