Harran Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 63300 Şanlıurfa, Türkiye.
Jt Dis Relat Surg. 2021;32(1):170-176. doi: 10.5606/ehc.2021.77135. Epub 2021 Jan 6.
This study aims to present the results of complex clubfoot patients treated with modified Ponseti method and put forth the warning clinical signs of complex deformities.
A total of 11 patients (10 males, 1 female; mean age 60.1±49.7; range, 2 to 180 days) with 16 complex clubfeet treated with modified Ponseti method were included in this study conducted between January 2016 and June 2019. All the data of the patients were collected prospectively and reviewed retrospectively. Demographic features, clubfoot severity, number of casts, position of each foot before cast removal, ankle dorsiflexion (DF), complications, and additional procedures were noted at all clinical visits.
Eleven (11.2%) of 98 patients had complex clubfoot deformity. Six (7.7%) of 78 newly diagnosed patients and five (25%) of 20 referred patients had complex clubfeet. We treated 16 complex clubfeet of 11 patients. The mean follow-up period was 13.3 (range, 10 to 16) months. All deformities were initially corrected using a mean of seven (range, 5 to 8) casts and Achilles tenotomy. Relapses occurred in three (18.75%) patients, but all recovered after recasting. The creases above the heels disappeared in all of the patients, whereas plantar creases persisted on two (12.5%) feet. Pirani scores and DF improved statistically significantly after treatment, and DF improved significantly between tenotomy and the final visit.
The modified Ponseti method is an effective treatment for complex clubfoot. Classical clinical appearance, treatment-resistant deformities and referred patients should be warning signs for complex clubfoot.
本研究旨在介绍采用改良 Ponseti 方法治疗复杂马蹄足患者的结果，并提出复杂畸形的警示临床征象。
本研究纳入了 2016 年 1 月至 2019 年 6 月期间采用改良 Ponseti 方法治疗的 11 例（10 男，1 女；平均年龄 60.1±49.7 岁；范围 2 至 180 天）16 例复杂马蹄足患者。所有患者的数据均前瞻性收集并回顾性分析。记录患者的人口统计学特征、足畸形严重程度、石膏更换次数、去除石膏前每只脚的位置、踝关节背屈（DF）、并发症和额外手术。
98 例患者中有 11 例（11.2%）存在复杂马蹄足畸形。78 例新诊断患者中有 6 例（7.7%），20 例转诊患者中有 5 例（25%）存在复杂马蹄足。我们共治疗了 11 例患者的 16 例复杂马蹄足。平均随访时间为 13.3 个月（范围 10 至 16 个月）。所有畸形均采用平均 7 次（范围 5 至 8 次）石膏更换和跟腱切断术初步矫正。3 例（18.75%）患者出现复发，但所有患者均在重新固定后恢复。所有患者足跟上方的折痕消失，而 2 例（12.5%）患者足底仍有折痕。治疗后 Pirani 评分和 DF 均有统计学显著改善，且 DF 在跟腱切断术与最终随访之间有显著改善。
改良 Ponseti 方法是治疗复杂马蹄足的有效方法。典型临床表现、治疗抵抗性畸形和转诊患者应作为复杂马蹄足的警示征象。
