婴幼儿期接受庞塞蒂方法治疗的单侧马蹄内翻足患者踝关节背屈的量化研究

Quantification of Ankle Dorsiflexion in Ponseti-managed Unilateral Clubfoot Patients During Early Childhood.

作者信息

Tougas Caroline M, Ballester Andrew M, Morgan Rebecca D, Ebramzadeh Edward, Sangiorgio Sophia N, Zionts Lewis E

机构信息

Orthopaedic Institute for Children and the Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA.

The J. Vernon Luck, Sr., MD Orthopedic Research Center, Orthopaedic Institute for Children.

出版信息

J Pediatr Orthop. 2021 Feb 1;41(2):83-87. doi: 10.1097/BPO.0000000000001719.

DOI:10.1097/BPO.0000000000001719

PMID:33264177

Abstract

BACKGROUND

Following the initial correction of a clubfoot using the Ponseti method, diminished passive ankle dorsiflexion may be observed over time, which could represent a possible relapsed deformity. Alternatively, the change may be attributable to patient age or other variables. Our purpose was to quantify passive ankle dorsiflexion in the involved and contralateral unaffected limbs of Ponseti-managed unilateral clubfoot patients, and to determine what patient-related variables influence this finding.

METHODS

In total, 132 unilateral clubfoot patients were studied. Passive ankle dorsiflexion was measured in both limbs at each visit. Data were excluded from visits in which patients showed clear evidence of a relapse. Mean ankle dorsiflexion for clubfeet and contralateral unaffected limbs were reported for annual age intervals and compared using paired t tests. A general linear model was established to assess the effects of age, severity, sex, and side on ankle dorsiflexion.

RESULTS

Mean ankle dorsiflexion for unaffected limbs declined with age, measuring 53±6 degrees between 0 and 1 year of age and decreasing to 39±7 degrees by 4 to 5 years of age. Similarly, mean ankle dorsiflexion in treated clubfeet declined with age, measuring 44±7 degrees between 0 and 1 year and 29±7 degrees between 4 and 5 years. Overall, the difference between limbs in these patients averaged ~10 degrees for every age interval through 9 years (P<0.001). Ankle dorsiflexion of clubfeet in 95% of patients aged 0 to 2 years was at least 20 degrees, and in 95% of patients aged 3 to 5 years this was at least 15 degrees. Patient age (P<0.001) and severity of deformity (P<0.001) were found to be the only significant factors affecting ankle dorsiflexion in the affected limbs.

CONCLUSIONS

Ankle dorsiflexion in the Ponseti-treated clubfeet was influenced by age of the patient and the initial severity of the affected limb. Furthermore, our data suggest that, in patients who showed no relapse, a minimum of 20 degrees of ankle dorsiflexion in the corrected clubfoot is maintained through age 3 years and a minimum of 15 degrees is maintained through age 5 years.

LEVEL OF EVIDENCE

Level IV-this is a retrospective case series.

摘要

背景

使用庞塞蒂方法对马蹄内翻足进行初次矫正后，随着时间推移，可能会观察到被动踝关节背屈减弱，这可能代表一种可能的复发畸形。或者，这种变化可能归因于患者年龄或其他变量。我们的目的是量化接受庞塞蒂治疗的单侧马蹄内翻足患者患侧和对侧未受影响肢体的被动踝关节背屈，并确定哪些与患者相关的变量会影响这一结果。

方法

共研究了132例单侧马蹄内翻足患者。每次就诊时均测量双下肢的被动踝关节背屈。若患者有明确复发证据，则排除该次就诊数据。报告各年龄段马蹄内翻足和对侧未受影响肢体的平均踝关节背屈，并使用配对t检验进行比较。建立一般线性模型以评估年龄、严重程度、性别和侧别对踝关节背屈的影响。

结果

未受影响肢体的平均踝关节背屈随年龄下降，0至1岁时为53±6度，4至5岁时降至39±7度。同样，接受治疗的马蹄内翻足的平均踝关节背屈也随年龄下降，0至1岁时为44±7度，4至5岁时为29±7度。总体而言，在9年的每个年龄段中，这些患者双下肢之间的差异平均约为10度（P<0.001）。95%的0至2岁患者马蹄内翻足的踝关节背屈至少为20度，95%的3至5岁患者至少为15度。发现患者年龄（P<0.001）和畸形严重程度（P<0.001）是影响患侧肢体踝关节背屈的唯一显著因素。