Alam Noor, Abbas Mohd Baqar, Siddiqui Yasir S, Julfiqar Mohd, Abbas Mazhar, Khan Mohd Jesan, Chowdhry Madhav
Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh, India.
Int J Burns Trauma. 2023 Apr 15;13(2):33-43. eCollection 2023.
Clubfoot constitutes roughly 70 percent of all foot deformities in arthrogryposis syndrome and 98% of those in classic arthrogryposis. Treatment of arthrogrypotic clubfoot is difficult and challenging due to a combination of factors like stiffness of ankle-foot complex, severe deformities and resistance to conventional treatment, frequent relapses and the challenge is further compounded by presence of associated hip and knee contractures.
A prospective clinical study was conducted using a sample of nineteen clubfeet in twelve arthrogrypotic children. During weekly visits Pirani and Dimeglio scores were assigned to each foot followed by manipulation and serial cast application according to the classical Ponseti technique. Mean initial Pirani score and Dimeglio score were 5.23 ± 0.5 and 15.79 ± 2.4 respectively. Mean Pirani and Dimeglio score at last follow up were 2.37 ± 1.9 and 8.26 ± 4.93 respectively. An average of 11.3 casts was required to achieve correction. Tendoachilles tenotomy was required in all 19 AMC clubfeet.
The primary outcome measure was to evaluate the role of Ponseti technique in management of arthrogrypotic clubfeet. The secondary outcome measure was to study the possible causes of relapses and complications with additional procedures required to manage clubfeet in AMC an initial correction was achieved in 13 out of 19 arthrogrypotic clubfeet (68.4%). Relapse occurred in 8 out of 19 clubfeet. Five of those relapsed feet were corrected by re-casting ± tenotomy. 52.6% of arthrogrypotic clubfeet were successfully treated by the Ponseti technique in our study. Three patients failed to respond to Ponseti technique required some form of soft tissue surgery.
Based on our results, we recommend the Ponseti technique as the first line initial treatment for arthrogrypotic clubfeet. Although such feet require a higher number of plaster casts with a higher rate of tendo-achilles tenotomy but the eventual outcome is satisfactory. Although, relapses are higher than classical idiopathic clubfeet, most of them respond to re-manipulation and serial casting ± re-tenotomy.
在关节挛缩症综合征中，马蹄内翻足约占所有足部畸形的70%，在典型关节挛缩症中占98%。由于踝足复合体僵硬、严重畸形、对传统治疗有抵抗性、频繁复发等多种因素，治疗关节挛缩性马蹄内翻足困难且具有挑战性，而相关的髋部和膝部挛缩的存在使这一挑战更加复杂。
对12例患有关节挛缩症儿童的19只马蹄内翻足进行了一项前瞻性临床研究。在每周的随访中，为每只脚评定皮拉尼（Pirani）评分和迪梅廖（Dimeglio）评分，然后根据经典的庞塞蒂（Ponseti）技术进行手法治疗并连续打石膏。初始皮拉尼评分和迪梅廖评分的平均值分别为5.23±0.5和15.79±2.4。末次随访时皮拉尼评分和迪梅廖评分的平均值分别为2.37±1.9和8.26±4.93。平均需要11.3次打石膏才能实现矫正。所有19例关节挛缩性马蹄内翻足均需要进行跟腱切断术。
主要观察指标是评估庞塞蒂技术在治疗关节挛缩性马蹄内翻足中的作用。次要观察指标是研究复发和并发症的可能原因以及在关节挛缩症中治疗马蹄内翻足所需的额外手术。19例关节挛缩性马蹄内翻足中有13例（68.4%）初步实现了矫正。19只马蹄内翻足中有8只复发。其中5只复发足通过重新打石膏±跟腱切断术得到矫正。在我们的研究中，52.6%的关节挛缩性马蹄内翻足通过庞塞蒂技术成功治疗。3例患者对庞塞蒂技术无反应，需要某种形式的软组织手术。
根据我们的结果，我们推荐庞塞蒂技术作为关节挛缩性马蹄内翻足的一线初始治疗方法。尽管这类足部需要更多次数的石膏固定，跟腱切断术的比例更高，但最终结果是令人满意的。虽然复发率高于典型特发性马蹄内翻足，但大多数复发足通过再次手法治疗和连续打石膏±再次跟腱切断术可以得到矫正。
