在足月儿期对患有马蹄内翻足的早产儿启动庞塞蒂疗法。
Initiating Ponseti management in preterm infants with clubfoot at term age.
作者信息
Scanlan Emily, Grima-Farrell Kate, IIhan Emre, Gibbons Paul, Gray Kelly
机构信息
Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia.
Department of Orthopaedic Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
出版信息
J Child Orthop. 2022 Apr;16(2):141-146. doi: 10.1177/18632521221080476. Epub 2022 Apr 30.
PURPOSE
Currently, the optimal time to initiate treatment among preterm infants with clubfoot is unknown. The aim of this study was to describe treatment outcomes up to 1 year post-correction following Ponseti management in infants who were born preterm but treated at term age.
METHODS
A retrospective chart audit was conducted at a major pediatric hospital on preterm infants with clubfoot who commenced Ponseti management at term age (≥37 weeks of gestation). Data are expressed as mean values (±standard deviation) or 95% confidence intervals (95% CIs).
RESULTS
Twenty-six participants (40 feet) born at 32.6/40 (±3.1) weeks of gestation were identified. Thirteen (50%) were male, 14 (54%) presented bilaterally, and 7 (27%) presented with syndromic clubfoot. Ponseti management was initiated at 41.4/40 (±2.8) weeks gestation. Baseline Pirani scores were 5.2 (95%CI: 4.8-5.6) in the idiopathic group and 5.7 (95%CI: 5.0-6.4) in the syndromic group. The number of casts to correction was 5.9 (95% CI: 5.1-6.6) for those with idiopathic clubfoot and 6.1 (95%CI: 5.0-7.3) for those with syndromic clubfoot. Achilles tenotomies were required in 13 (21 feet) with idiopathic clubfoot and five (7 feet) with syndromic clubfoot. Recurrence occurred in four infants (5 feet): 4 feet required further casting and bracing, and 1 foot required additional surgery.
CONCLUSION
Ponseti management at term age in preterm-born infants yields comparable 1-year outcomes to term-born infants. Further research is required to determine whether outcomes beyond 1 year of age align with growth and development demonstrated by term-born infants who are managed with the Ponseti method.
LEVEL OF EVIDENCE
Level IV.
目的
目前，对于早产足内翻婴儿开始治疗的最佳时机尚不清楚。本研究的目的是描述在足月接受治疗的早产足内翻婴儿接受庞塞蒂（Ponseti）治疗法矫正后长达1年的治疗效果。
方法
在一家大型儿科医院对足月（≥37周妊娠）开始接受庞塞蒂治疗法的早产足内翻婴儿进行回顾性病历审查。数据以平均值（±标准差）或95%置信区间（95%CI）表示。
结果
共确定了26名参与者（40只脚），其出生时孕周为32.6/40（±3.1）周。13名（50%）为男性，14名（54%）为双侧发病，7名（27%）为综合征性足内翻。庞塞蒂治疗法在妊娠41.4/40（±2.8）周时开始。特发性组的基线皮拉尼（Pirani）评分是5.2（95%CI：4.8 - 5.6），综合征性组为5.7（95%CI：5.0 - 6.4）。特发性足内翻患者矫正所需的石膏次数为5.9（95%CI：5.1 - 6.6）次，综合征性足内翻患者为6.1（95%CI：5.0 - 7.3）次。13名（21只脚）特发性足内翻患者和5名（7只脚）综合征性足内翻患者需要进行跟腱切断术。4名婴儿（5只脚）出现复发：4只脚需要进一步打石膏和支具治疗，1只脚需要额外手术。
结论
早产婴儿在足月时接受庞塞蒂治疗法，其1年治疗效果与足月出生婴儿相当。需要进一步研究以确定1岁以后的治疗效果是否与采用庞塞蒂方法治疗的足月出生婴儿的生长发育情况一致。
证据水平
四级。
Zotero 插件