Wang Ying-Yu, Su Yu-Cheng, Tu Yu-Kang, Fang Ching-Ju, Hong Chih-Kai, Huang Ming-Tung, Lin Yung-Chieh, Hsieh Min-Ling, Kuan Fa-Chuan, Shih Chien-An, Lin Chii-Jeng
Chang Gung Memorial Hospital at Linkuo, Taoyuan City, Taiwan.
National Cheng Kung University Hospital, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Bone Joint Surg Am. 2024 Feb 21;106(4):356-367. doi: 10.2106/JBJS.22.01210. Epub 2023 Nov 28.
Clubfoot, or congenital talipes equinovarus deformity, is a common anomaly affecting the foot in infants. However, clinical equipoise remains between different interventions, especially those based on the Ponseti method. The aim of this study was to examine the clinical outcomes of the various interventions for treating idiopathic clubfoot.
Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Scopus, and CINAHL were conducted. Randomized controlled trials comparing different interventions, including the Ponseti method, accelerated Ponseti method, Ponseti method with botulinum toxin type A (Botox) injection, Ponseti method with early tibialis anterior tendon transfer (TATT), Kite method, and surgical treatment, were included. Network meta-analyses (NMAs) were conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) reporting guidelines. The primary outcomes were the change in total Pirani score and maximal ankle dorsiflexion. Secondary outcomes were the number of casts, time in casts, and rates of tenotomy, total complications, relapse, adverse events, and additional required major surgery.
Eleven randomized controlled trials involving 740 feet were included. According to the SUCRA (surface under the cumulative ranking curve)-based relative ranking, the Ponseti method was associated with the best outcomes in terms of Pirani score changes, maximal ankle dorsiflexion, number of casts, adverse events, and total complications, whereas the accelerated Ponseti method was associated with the best outcomes in terms of time in casts and tenotomy rate. Early TATT ranked best in terms of relapse rate. The Ponseti method with Botox injection was associated with the best outcomes in terms of the need for additional major surgery.
The NMAs suggest that the Ponseti method is the optimal treatment overall, despite potential drawbacks such as longer time in casts and higher rates of tenotomy, relapse, and the need for additional surgery compared with other modified approaches. Therefore, clinicians should consider how treatments can be tailored individually.
Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
马蹄内翻足，即先天性马蹄内翻足畸形，是影响婴儿足部的常见异常情况。然而，不同干预措施之间，尤其是基于庞塞蒂方法的干预措施之间，临床 equipoise 仍然存在。本研究的目的是检查治疗特发性马蹄内翻足的各种干预措施的临床结果。
检索了Cochrane对照试验中央注册库（CENTRAL）、MEDLINE、Embase、Scopus和CINAHL。纳入了比较不同干预措施的随机对照试验，包括庞塞蒂方法、加速庞塞蒂方法、庞塞蒂方法联合A型肉毒杆菌毒素（肉毒素）注射、庞塞蒂方法联合早期胫前肌腱转移（TATT）、凯特方法和手术治疗。根据PRISMA（系统评价和Meta分析的首选报告项目）报告指南进行网络Meta分析（NMA）。主要结局是皮拉尼总分的变化和最大踝关节背屈。次要结局是石膏固定次数、石膏固定时间、跟腱切断术发生率、总并发症发生率、复发率、不良事件发生率以及额外需要的大手术率。
纳入了11项涉及740只足的随机对照试验。根据基于累积排名曲线下面积（SUCRA）的相对排名，庞塞蒂方法在皮拉尼评分变化、最大踝关节背屈、石膏固定次数、不良事件和总并发症方面与最佳结局相关，而加速庞塞蒂方法在石膏固定时间和跟腱切断术发生率方面与最佳结局相关。早期TATT在复发率方面排名最佳。庞塞蒂方法联合肉毒素注射在额外大手术需求方面与最佳结局相关。
NMA表明，尽管与其他改良方法相比，庞塞蒂方法存在潜在缺点，如石膏固定时间较长、跟腱切断术发生率较高、复发率较高以及需要额外手术，但总体而言是最佳治疗方法。因此，临床医生应考虑如何进行个体化治疗。
治疗水平I。有关证据水平的完整描述，请参阅作者指南。
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