Zhang Jiangchao, Wang Ningqing, Lv Haixiang, Liu Zhenjiang
Department of Orthopedics, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
Front Pediatr. 2022 Jul 5;10:924028. doi: 10.3389/fped.2022.924028. eCollection 2022.
To quantitatively evaluate the effectiveness of the Ponseti method for the correction of clubfoot, we decided to use magnetic resonance imaging (MRI) to evaluate changes in the tarsal bone relationship.
This is a retrospective study of fifteen children with clubfeet who were treated with the Ponseti method. MRI studies were obtained using a 3.0T Machine (GE Healthcare, United States). T1-weighted and T2-weighted images were acquired in the standard anatomic sagittal, transverse, and coronal planes. For the measurement, the best slice that clearly demonstrated the anatomy was chosen. Sagittal talocalcaneal angle, sagittal tibiocalcaneal angle, coronal tibiocalcaneal angle, transverse talar neck angle, transverse talonavicular angle, and transverse talocalcaneal angle were measured. The eighteen corrected clubfeet were compared with the twelve unilateral normal feet at clinical and radiological levels using a Pirani scoring system and MRI, respectively.
In total, 15 cases (twelve boys and three girls) with clubfeet were examined by using MRI. Twelve cases had unilateral and three had bilateral involvement (eleven left clubfeet and seven right clubfeet), giving a total of eighteen clubfeet when compared with twelve normal feet. The mean age of patients at examination was 47.7 months (8-96 months). The recovery of the corrected clubfoot in these patients met the goals of Ponseti treatment (functional, normal looking, pain-free, and plantigrade foot). Before Ponseti treatment, the mean Pirani score of clubfoot was 5.5 (5-6). During this follow-up, the Pirani score was 0.07 (0-0.05). The results of the MRI indicated that only the transverse talonavicular angle showed a significant difference between the treated clubfeet and the normal feet ( < 0.001). One case had dorsal talonavicular subluxation in the sagittal plane and had the lateral subluxation of the navicular in the transverse plane, which has never been reported in previous studies.
Although the appearance and function of clubfoot were recovered well after the Ponseti method, the results of MRI indicated that the Ponseti method successfully corrected the varus, cavus, and equinus deformities and incompletely corrected the adduction deformity regarding transverse talonavicular angle. At the same time, the Ponseti method may cause dorsal talonavicular subluxation in the sagittal plane and lateral subluxation of the navicular in the transverse plane on MRI.
为了定量评估庞塞蒂方法矫正马蹄内翻足的有效性，我们决定使用磁共振成像（MRI）来评估跗骨关系的变化。
这是一项对15例接受庞塞蒂方法治疗的马蹄内翻足患儿的回顾性研究。使用3.0T机器（美国通用电气医疗集团）进行MRI检查。在标准解剖矢状面、横断面和冠状面获取T1加权和T2加权图像。为进行测量，选择能清晰显示解剖结构的最佳层面。测量矢状面距跟角、矢状面胫跟角、冠状面胫跟角、横断面距骨颈角、横断面距舟角和横断面距跟角。分别使用皮拉尼评分系统和MRI在临床和影像学层面将18例矫正后的马蹄内翻足与12例单侧正常足进行比较。
总共对15例（12例男孩和3例女孩）马蹄内翻足患儿进行了MRI检查。12例为单侧受累，3例为双侧受累（11例左侧马蹄内翻足和7例右侧马蹄内翻足），与12例正常足相比，共有18例马蹄内翻足。检查时患者的平均年龄为47.7个月（8 - 96个月）。这些患者矫正后的马蹄内翻足恢复情况达到了庞塞蒂治疗的目标（功能正常、外观正常、无痛且足能放平）。在庞塞蒂治疗前，马蹄内翻足的平均皮拉尼评分为5.5（5 - 6）。在此次随访期间，皮拉尼评分为0.07（0 - 0.05）。MRI结果表明，仅横断面距舟角在治疗后的马蹄内翻足与正常足之间存在显著差异（<0.001）。1例在矢状面有距舟背侧半脱位，在横断面有舟骨外侧半脱位，这在以往研究中从未有过报道。
尽管采用庞塞蒂方法后马蹄内翻足的外观和功能恢复良好，但MRI结果表明，庞塞蒂方法成功矫正了内翻、高弓和马蹄畸形，但在横断面距舟角方面内收畸形未完全矫正。同时，庞塞蒂方法在MRI上可能导致矢状面距舟背侧半脱位和横断面舟骨外侧半脱位。
