Phoenix Children's Hospital, Phoenix, AZ.
Cohen Children's Medical Center, Queens, NY.
J Pediatr Orthop. 2021;41(5):301-305. doi: 10.1097/BPO.0000000000001789.
Amniotic band syndrome (ABS) is a congenital disorder resulting in fibrous bands that can cause limb anomalies, amputations, and deformities. Clubfoot has been reported in up to 50% of patients with ABS. The purpose of this study is to compare treatment characteristics and outcomes of clubfoot patients with ABS to those with idiopathic clubfoot treated with the Ponseti method.
An Institution Review Board (IRB) approved retrospective review of prospectively gathered data was performed at a single pediatric hospital over a 20-year period. Patients with either idiopathic clubfeet or clubfeet associated with concomitant ABS who were <1 year of age and treated by the Ponseti method were included. Initial Dimeglio score, number of casts, need for heel cord tenotomy, recurrence, and need for further surgery were recorded. Outcomes were classified as "good" (plantigrade foot±heel cord tenotomy), "fair" (need for a limited procedure), or "poor" (need for a full posteromedial release).
Forty-three clubfeet in 32 patients with ABS, and 320 idiopathic clubfeet in 215 patients were identified. Average age at last follow up was not different between ABS and idiopathic cohorts (7.4 vs. 5.2 y, P=0.233). Average Dimeglio score was lower in the ABS cohort (12.3 vs. 13.7, P=0.006). Recurrence rate was significantly higher in the ABS (62.8%) compared with idiopathic cohort (37.2%) (P=0.001). Clinical outcomes were significantly better in the idiopathic cohort (69.4% "good", 26.9% "fair", 3.8% "poor") compared with the ABS cohort (41.9% "good", 34.9% "fair", and 23.3% "poor") (P<0.001). Within the ABS cohort, no significant differences in clinical outcomes were found based upon location, severity, or presence of an ipsilateral lower extremity band.
Clubfeet associated with ABS have higher rates of recurrence, a greater need for later surgery, and worse clinical outcomes than idiopathic clubfeet. This information may prove helpful in counseling parents of infants with ABS associated clubfeet.
Level III.
羊膜带综合征（ABS）是一种先天性疾病，会导致纤维带的形成，从而导致肢体畸形、截肢和畸形。多达 50%的 ABS 患者会出现马蹄足。本研究的目的是比较 ABS 合并马蹄足患者与单纯性马蹄足患者采用 Ponseti 方法治疗的特点和疗效。
对一家儿童医院 20 年来前瞻性收集的数据进行机构审查委员会（IRB）批准的回顾性分析。纳入年龄＜1 岁、采用 Ponseti 方法治疗的特发性马蹄足或合并 ABS 的马蹄足患者。记录初始 Dimeglio 评分、石膏固定次数、跟腱切断术的需求、复发和进一步手术的需求。疗效分为“良好”（足底平面±跟腱切断术）、“尚可”（需要有限的手术）或“差”（需要完全经皮后内侧松解术）。
共纳入 32 例 ABS 合并马蹄足患儿 43 只足，215 例单纯性马蹄足患儿 320 只足。ABS 组和特发性组的末次随访时平均年龄无差异（7.4 岁比 5.2 岁，P=0.233）。ABS 组平均 Dimeglio 评分较低（12.3 分比 13.7 分，P=0.006）。ABS 组的复发率明显高于特发性组（62.8%比 37.2%，P=0.001）。特发性组的临床疗效明显优于 ABS 组（69.4%“良好”，26.9%“尚可”，3.8%“差”）（P<0.001）。在 ABS 组中，根据位置、严重程度或同侧下肢带的存在，临床疗效无显著差异。
合并 ABS 的马蹄足复发率较高，需要更多的后期手术，临床疗效较差。这些信息可能有助于为 ABS 合并马蹄足患儿的家长提供咨询。
III 级。
