目的 评价Ponseti方法 治疗幼儿先天性马蹄内翻足的临床疗效.方法收集2008年10月至2013年1月门诊就诊的先天性马蹄内翻足患儿(3周至12个月)130例(共192足).108例(158足)完成随访,患儿按月龄分成小婴儿组(≤6个月)和大婴儿组(>6个月,且 ≤12个月),均采用Ponseti方法治疗.使用Diméglio分类和评分方法评估治疗前后的效果.结果 平均随访(5.37±1.06)(4~8)年后,患儿总体优良率为92.41%,小婴儿组和大婴儿组优良率分别为92.59%和92.31%,差异无统计学意义(P>0.05).小婴儿组4足、大婴儿组8足,共12足,因未能坚持穿戴矫形支具,出现不同程度畸形复发,两组比较差异无统计学意义(P>0.05).与大婴儿组比较,小婴儿组平均打石膏次数少,跟腱切断百分比小,差异有统计学意义(P<0.05).结论 Ponseti方法是治疗3周至12个月幼儿先天性马蹄内翻足的有效方法,尤其是在出生6个月内开始治疗,畸形更易矫正;依从性差、未能坚持穿戴矫形鞋是畸形复发的主要原因.%Objective To evaluate the effects of Ponseti procedure on the congenital clubfoot at the infancy stage of life. Methods We collected 130 patients ( 192 feet ) with congenital clubfoot from October 2008 to January 2013. The age ranged 3 weeks-12 months. 108 patients ( 158 feet ) were followed up. According to the age, all patients were divided into 2 groups: younger infancy group ( ≤ 6 months ); older infancy group ( > 6 months, and ≤12 months ). All patients were treated by Ponseti. The results were evaluated by Diméglio scores. Results The mean follow-up was ( 5.37 ± 1.06 ) years ( range: 4 - 8 years ). The overall excellence rate was 92.41%. The excellence rate of the younger infancy group and the older infancy group were 92.59% and 92.31% respectively, showing no significant differences ( P > 0.05 ). Deformity reoccurred in 12 patients ( 4 patients in the younger infancy group, 8 patients in the older infancy group ) because they did not insist in wearing orthopedic shoes, showing no significant differences ( P >0.05 ). The number of casts used and the performance rate of percutaneous tendoachilles tenotomy were less and lower in the younger infancy group, showing significant differences ( P < 0.05 ). Conclusions Ponseti can obtain sactifactory effects in the treatment of congenital clubfoot deformity. If the children begin treatment in infancy, especially within the 6 months of birth, better outcomes can be achieved. The most common cause of relapse is the noncompliance of the bracing program.
展开▼
