Rangasamy Karthick, Baburaj Vishnu, Gopinathan Nirmal Raj, Behera Prateek, Sudesh Pebam, Ravi Subramanian Sabarathinam
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India.
J Clin Orthop Trauma. 2022 Jun 25;31:101939. doi: 10.1016/j.jcot.2022.101939. eCollection 2022 Aug.
BACKGROUND/PURPOSE: Atypical clubfeet are distinct from idiopathic clubfeet. It is resistant to correction by conventional casting methods and often requires a modification of Ponseti's casting technique. Although the initial correction rates are reasonable, relapse and complications are frequent. There is limited literature on the results of modified Ponseti casting of these feet. We conducted this meta-analysis to study a few important aspects of atypical/complex clubfeet treatment by the modified Ponseti technique.
What are the results of atypical or complex clubfeet after treatment by the modified Ponseti technique?
Five electronic databases (PubMed, Embase, Scopus, Ovid, and Cochrane Library) were searched for articles reporting on the results of atypical/complex clubfeet treated by the modified Ponseti technique. Details of the number of casts required for correction, rate of percutaneous Achilles tenotomy (PAT), other soft tissue procedures required, complications, and relapse rates were extracted into spreadsheets, and meta-analysis was carried out using OpenMeta Analyst software.
Ten studies were included for analysis with a total of 240 patients with 354 clubfeet. The initial correction was achieved in all feet. A pooled analysis of the data showed that a mean of six casts was required for the initial correction. The rate of PAT was 98.3%. The overall complication rate was 16.8%. 7.2% required an additional soft tissue procedure apart from the PAT, and relapse of the deformity was observed in a mean of 19.8% cases.
Modified Ponseti technique is effective in the initial management of atypical/complex clubfeet. Although the PAT rate is slightly higher in the Modified Ponseti technique, the remaining result parameters are comparable with the results of idiopathic clubfoot managed with the Ponseti method of casting. However, these children should be kept under follow-up for a longer duration to find the exact relapse rates.
背景/目的：非典型马蹄内翻足与特发性马蹄内翻足不同。它对传统的石膏固定矫正方法具有抵抗性，通常需要对庞塞蒂石膏技术进行改良。尽管初始矫正率尚可，但复发和并发症很常见。关于这些足部改良庞塞蒂石膏固定结果的文献有限。我们进行了这项荟萃分析，以研究改良庞塞蒂技术治疗非典型/复杂马蹄内翻足的几个重要方面。
改良庞塞蒂技术治疗非典型或复杂马蹄内翻足的结果如何？
检索了五个电子数据库（PubMed、Embase、Scopus、Ovid和Cochrane图书馆），以查找报告改良庞塞蒂技术治疗非典型/复杂马蹄内翻足结果的文章。将矫正所需石膏的数量、经皮跟腱切断术（PAT）的发生率、所需的其他软组织手术、并发症和复发率等详细信息提取到电子表格中，并使用OpenMeta Analyst软件进行荟萃分析。
纳入10项研究进行分析，共有240例患者，354只足部。所有足部均实现了初始矫正。对数据的汇总分析表明，初始矫正平均需要6次石膏固定。PAT的发生率为98.3%。总体并发症发生率为16.8%。7.2%的患者除PAT外还需要额外的软组织手术，平均19.8%的病例出现畸形复发。
改良庞塞蒂技术在非典型/复杂马蹄内翻足的初始治疗中有效。尽管改良庞塞蒂技术的PAT发生率略高，但其余结果参数与采用庞塞蒂石膏固定方法治疗特发性马蹄内翻足的结果相当。然而，这些儿童应进行更长时间的随访，以确定确切的复发率。
