Al-Hilli Ali Bakir
College of Medicine University of Baghdad, Iraq; Consultant Orthopedic Surgeon, Medical City, Baghdad, Iraq.
Foot (Edinb). 2020 Dec;45:101721. doi: 10.1016/j.foot.2020.101721. Epub 2020 Jul 25.
Relapsed clubfeet deformity after surgical treatment by posteromedial release are frequently encountered in pediatric orthopedic practice and further revision surgery may be needed. As surgery adds more fibrosis and scaring, complication may be devastating and treatment is challenging. Ponseti method, the gold standard technique for treatment of clubfoot may be of a value in the management of postoperative relapses.
Determine the effectiveness of Ponseti casting Method in treatment of relapsed idiopathic clubfoot in children after being treated with surgical posteromedial release.
Prospective interventional study of 17 patients (25 feet) presented with a relapsed idiopathic clubfoot deformity after previous surgical posteromedial release. The patients were reviewed using Pirani and Dimeglio score. Ponseti method was done to obtain supple, flexible foot rather than a fully corrected foot, the residual deformity were treated by, heel cord lengthening or tenotomy, tibialis anterior transfer, follow up was for a minimum of 12 months.
17 Patients (25 feet) their age ranging from 1 to 10 years were evaluated and treated. Casts were applied until the only deformities remaining were either hindfoot equinus and/or dynamic supination. 22 feet required a heel cord procedure for equinus and 13 required tibialis anterior transfer for dynamic supination. The follow up (average 56.1 months) was for a minimum of one year. 4 feet had persistent heel varus deformity which required Calcaneal osteotomy later. Three feet didn't need more casting and 2 feet were resistant cases that required further Ilizarov procedure, 4 needed lateral arch shortening and other 4 needed posterior capsulotomy. Improvement in the Pirani and Dimeglio scores was highly statistically significant.
Ponseti method for treatment of relapsed clubfeet after a previous posteromedial soft tissue surgical release is an effective, non invasive, with excellent results.
在小儿骨科临床实践中，经后内侧松解手术治疗后的复发性马蹄内翻足畸形很常见，可能需要进一步的翻修手术。由于手术会增加更多的纤维化和瘢痕形成，并发症可能是灾难性的，治疗具有挑战性。庞塞蒂方法作为治疗马蹄内翻足的金标准技术，可能在术后复发的处理中具有价值。
确定庞塞蒂石膏固定法治疗小儿经后内侧松解手术后复发性特发性马蹄内翻足的有效性。
对17例（25足）既往经后内侧松解手术治疗后出现复发性特发性马蹄内翻足畸形的患者进行前瞻性干预研究。使用皮拉尼和迪梅廖评分对患者进行评估。采用庞塞蒂方法使足部达到柔软、灵活，而非完全矫正，残余畸形通过跟腱延长或切断术、胫前肌移位进行治疗，随访至少12个月。
对17例年龄在1至10岁的患者（25足）进行了评估和治疗。应用石膏直至仅残留后足马蹄畸形和/或动态旋后畸形。22足因马蹄畸形需要进行跟腱手术，13足因动态旋后需要进行胫前肌移位。随访（平均56.1个月）至少1年。4足存在持续性足跟内翻畸形，后期需要进行跟骨截骨术。3足无需进一步石膏固定，2足为抵抗性病例，需要进一步的伊里扎洛夫手术，4足需要外侧足弓缩短，另外4足需要后关节囊切开术。皮拉尼和迪梅廖评分的改善具有高度统计学意义。
庞塞蒂方法治疗既往后内侧软组织松解术后的复发性马蹄内翻足是一种有效、非侵入性的方法，效果良好。
