兄弟姐妹对 Ponseti 治疗中足内翻患儿支具依从性和复发的影响。

Effects of younger siblings on the brace compliance and recurrence in children with clubfoot during Ponseti treatment.

机构信息

Department of Orthopaedics and Traumatology, Harran University, School of Medicine, Şanlıurfa, Turkey.

出版信息

Acta Orthop Traumatol Turc. 2021 Mar;55(2):102-106. doi: 10.5152/j.aott.2021.20040.

DOI:10.5152/j.aott.2021.20040

PMID:33847570

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11229609/

Abstract

OBJECTIVE

This study aimed to determine the effects of the number of total siblings, younger siblings, and complex clubfoot deformity on the brace compliance and recurrence in the management of children with clubfoot deformity using the Ponseti technique.

METHODS

The data from 91 children, including 22 girls and 69 boys (total 130 idiopathic clubfeet), seen from 2016 to 2019 were prospectively collected and retrospectively reviewed. The deformity was unilateral in 52 (57.1%) children (32 right, 20 left) and bilateral in 39 (42.9%). The mean age at presentation was 2 (range, 1-30) weeks, and the mean follow-up was 21.5 (range, 12-36) months. All the clubfeet were treated according to the Ponseti method. After removing the cast, a foot abduction brace (Dennis Brown splint) was worn. A complex clubfoot deformity was identified in 12% (n=11) children. At the follow-up, the Pirani score, recurrence status, and brace compliance were recorded. Recurrent deformity was defined as any deformity recurrence requiring manipulation, recasting, or surgical treatment. Brace compliance was assessed per the parents' report.

RESULTS

The median number of children in a family was 3 (range, 1-12). A total of 53 (58.2%) parents had up to 3 children, and 38 (41.8%) parents had more than 3 children. Of the patients, 22 (24.2%) had younger siblings and 25 (26.4%) had a family history of clubfoot. A total of 58 feet (44.6%) in 40 children (43.9%) developed recurrence. Brace non-compliance was the main risk factor for recurrence, increasing the recurrence rate 32-fold compared with that of compliant parents (odds ratio [OR], 32.67, 95% confidence interval [CI], 10.02-106.49; p=0.001). The rate of non-compliance with brace use was 51.6% (n=47). Brace non-compliance was significantly associated with having a younger sibling (OR, 3.9; 95% CI, 1.36-11.2; p=0.011) and having a complex deformity (OR, 11.62; 95% CI, 1.42-95.1; p=0.022) but was not associated with the total number of children (OR, 1.61; 95% CI, 0.7-3.73; p=0.265).

CONCLUSION

Our study shows that having new siblings in the first years of the Ponseti treatment may increase the brace non-compliance by minimizing the attention paid to the children with clubfeet by their parents. Nonetheless, complex clubfoot deformity may promote brace compliance by increasing the parents' interest during the treatment process.

LEVEL OF EVIDENCE

Level IV, Therapeutic Study.

摘要

目的

本研究旨在探讨总兄弟姐妹数量、年幼兄弟姐妹数量和复杂马蹄内翻足畸形对采用 Ponseti 技术治疗儿童马蹄内翻足畸形时支具依从性和复发的影响。

方法

前瞻性收集了 2016 年至 2019 年就诊的 91 名儿童（130 只特发性马蹄内翻足，包括 22 名女孩和 69 名男孩）的数据，并进行了回顾性分析。52 名（57.1%）儿童为单侧畸形（32 只右脚，20 只左脚），39 名（42.9%）儿童为双侧畸形。就诊时的平均年龄为 2 周（范围 1-30 周），平均随访时间为 21.5 个月（范围 12-36 个月）。所有的马蹄内翻足均采用 Ponseti 方法治疗。去除石膏后，佩戴足外展支具（丹尼斯·布朗夹板）。12%（n=11）的儿童存在复杂马蹄内翻足畸形。随访时，记录 Pirani 评分、复发情况和支具依从性。复发定义为任何需要手法复位、重新打石膏或手术治疗的畸形复发。支具依从性根据家长的报告进行评估。

结果

家庭中儿童的中位数数量为 3 个（范围 1-12 个）。53 名（58.2%）家长有 3 个及以下的孩子，38 名（41.8%）家长有 3 个以上的孩子。22 名（24.2%）患者有年幼的兄弟姐妹，25 名（26.4%）有家族性马蹄内翻足病史。40 名（43.9%）儿童的 58 只（44.6%）脚出现复发。支具不依从是复发的主要危险因素，与依从的家长相比，不依从的家长复发率增加 32 倍（比值比[OR]，32.67，95%置信区间[CI]，10.02-106.49；p=0.001）。不依从支具使用的比例为 51.6%（n=47）。支具不依从与有年幼的兄弟姐妹（OR，3.9；95% CI，1.36-11.2；p=0.011）和复杂畸形（OR，11.62；95% CI，1.42-95.1；p=0.022）显著相关，但与儿童总数（OR，1.61；95% CI，0.7-3.73；p=0.265）无关。