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先天性马蹄内翻足的临床检查与分类系统:一项叙述性综述

Clinical examination and classification systems of congenital clubfoot: a narrative review.

作者信息

Canavese Federico, Dimeglio Alain

机构信息

Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Lille, France.

Nord-de-France University, Faculty of Medicine Henri Warembourg, Lille, France.

出版信息

Ann Transl Med. 2021 Jul;9(13):1097. doi: 10.21037/atm-20-7524.

Abstract

Clinical examination of the newborn's foot is a complex exercise that requires a lot of sensitivity, practice and deep understanding of normal and pathological anatomy, and the clinical assessment of a child with congenital talipes equinovarus, or congenital clubfoot, must be complete and it should not be limited to a simple orthopedic evaluation of the foot; the search for a cause is a pressing concern. This narrative review article aims to provide the key information about clinical examination of children with congenital clubfoot; classification systems are also described. Clinical examination of children with congenital clubfoot is essential. In particular, it is important to evaluate the mental age of the child (developmental milestones), to rule out the presence of a spinal dysraphism, to eliminate a mild form of neurological disease (congenital myopathy or arthrogryposis), as well as to carefully examine the face and hands of the patient. The examination of the foot and the classification of the clubfoot deformity complete the clinical evaluation. In the end, the pediatric orthopedic surgeon must not underestimate any clinical signs, and must act as a pediatrician. This narrative review summarizes the key points in taking a history and performing a comprehensive clinical examination for patients with congenital clubfoot; the review also briefly describes the normal foot anatomy and growth as to give the reader the opportunity to better understand the morphological and functional modifications secondary to congenital clubfoot.

摘要

新生儿足部的临床检查是一项复杂的操作,需要高度的敏感性、实践经验以及对正常和病理解剖的深入理解。对患有先天性马蹄内翻足(即先天性畸形足)患儿的临床评估必须全面,不应局限于对足部进行简单的骨科评估;寻找病因是当务之急。这篇叙述性综述文章旨在提供有关先天性畸形足患儿临床检查的关键信息;还将介绍分类系统。对先天性畸形足患儿进行临床检查至关重要。尤其重要的是评估患儿的心理年龄(发育里程碑),排除脊髓脊膜膨出的存在,排除轻度神经疾病(先天性肌病或关节挛缩症),以及仔细检查患儿的面部和手部。足部检查和畸形足畸形的分类完善了临床评估。最后,小儿骨科医生绝不能低估任何临床体征,并且必须像儿科医生一样行事。这篇叙述性综述总结了先天性畸形足患者病史采集和全面临床检查的要点;该综述还简要描述了正常足部解剖结构和生长情况,以便让读者更好地理解先天性畸形足继发的形态和功能改变。

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