行走年龄后的潘塞蒂方法-429 例足部的多中心研究：结果、可能的治疗修改以及根据年龄组的结果。
Ponseti Method After Walking Age - A Multi-Centric Study of 429 Feet: Results, Possible Treatment Modifications and Outcomes According to Age Groups.
机构信息
Hospital de Base do Distrito Federal and Clinical Center Orthopectus - Brasília, DF, Brazil.
Hospital Sírio Libanês - Brasília, DF, Brazil.
出版信息
Iowa Orthop J. 2020;40(2):1-12.
OBJECTIVE
Ponseti method is suitable to treat neglected clubfoot after the walking age. However, limited evidence exists on its effectiveness, outcomes and rate of relapse. Methods: 429 clubfeet in 303 patients with no previous treatment and older than one-year were treated with the Ponseti method in 15 centers from seven countries. The median age at treatment onset was three years, and the median follow-up of 1.3 years. Standard Ponseti Method was applied. Bilateral abduction brace was recommended after casting. Patients were classified according to group ages (<2 years, 2-4 years, >4-8years, >8 years). Feet were evaluated by Pirani score and a clinical outcome classification. Relapses were described in a subset of 103 clubfeet with minimal follow-up of two years.
RESULTS
Ponseti method was able to correct the deformity in 87% (373 of 429) of neglected clubfeet, after a mean of 6.8 casts. Residual equinus was treated with percutaneous sectioning of the Achilles tendon in 356 (83%) of 429 clubfeet. A bilateral foot abduction brace was prescribed and used in 70% of children. Relapses occurred in 31% (32 of 103) of clubfeet and were associated with age less than 4 years at treatment onset, and bracing noncompliance.
CONCLUSION
The Ponseti method is effective to correct neglected clubfeet. Relapses occurred in one-third of clubfeet, mainly in children younger than four years and in noncompliance with the brace. Our study reinforces the recommendation for the Ponseti method with no major modification to treat neglected clubfoot in patients after walking age..
目的
Ponseti 方法适用于治疗行走后被忽视的马蹄足。然而，其疗效、结果和复发率的证据有限。方法：来自 7 个国家的 15 个中心对 303 例无既往治疗且年龄大于 1 岁的未治疗的马蹄足患者的 429 只足采用 Ponseti 方法进行治疗。治疗开始时的中位年龄为 3 岁，中位随访时间为 1.3 年。应用标准的 Ponseti 方法。在打石膏后建议使用双侧外展支具。根据年龄分组（<2 岁、2-4 岁、>4-8 岁、>8 岁）对患者进行分类。采用 Pirani 评分和临床结果分类评估足部。在 103 例具有至少 2 年最小随访的马蹄足中描述了复发情况。
结果
Ponseti 方法能够在 429 只被忽视的马蹄足中纠正 87%（373 只）的畸形，平均需要 6.8 次石膏固定。在 429 只马蹄足中，356 只（83%）的残余马蹄内翻采用经皮跟腱切断术治疗。70%的儿童开具了双侧足部外展支具，并使用了支具。31%（32 例）的马蹄足发生了复发，与治疗开始时年龄<4 岁和支具不依从有关。
结论
Ponseti 方法可有效纠正被忽视的马蹄足。三分之一的马蹄足发生了复发，主要发生在年龄小于 4 岁且不依从支具治疗的患儿中。我们的研究强化了在行走后年龄的患者中采用 Ponseti 方法治疗被忽视的马蹄足的建议，无需进行重大修改。
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