Ponseti方法在不同年龄先天性马蹄内翻足中的应用

Ponseti method for congenital talipes equinovarus in different ages

目的观察Ponseti方法对不同年龄先天性马蹄内翻足的治疗效果。方法应用Pon—seti方法治疗先天性马蹄内翻足患儿378例544足，按年龄分为：①新生儿期（≤28d）36例55足；②小婴儿期（29～180d）185例262足；③大婴儿期（181d～12个月）81例113足；④幼儿期（1～3岁）52例78足；⑤儿童期（〉3岁）24例36足。根据病史分为：初治型125例177足；经治型253例367足。对所有患足进行Pirani评分，将0～0．5分判为优良，比较各组的优良率、应用石膏次数及跟腱切断的病足数，并进行随访。结果拆除最后一次石膏时总优良率为97．98％，儿童期优良率较其他年龄组低（P〈0．01），其余各组间优良率差异无统计学意义，经治型与初治型间优良率差异也无统计学意义（P〉0．05）。各组间应用石膏次数差别有统计学意义（P〈0．01）。1岁内各组间行跟腱切断的百分比差异有统计学意义（P〈0．01），新生儿期最多，1岁后各组间差异无统计学意义（P〉0．05）。初治型应用的石膏次数及行跟腱切断的百分比较经治型明显增多，两组间差异有统计学意义（P〈0．01）。随访353例512足，随访时间：3个月～5年3个月，平均2年5个月。有67例96足复发，各组间复发率差别无统计学意义，（P〉0．05）。结论Ponseti方法不仅适合CTE的早期治疗，而且对较大年龄的CTE患儿以及经过其他方法治疗失败或复发的CTE患儿近期也能取得较好效果。

Objective To observe the-therapeutic effects of Ponseti method for congenital talipes equinovarus（CTE） among different age groups. Methods Five hundred and forty-four feet in 378 cases of CTE were treated with Ponseti method. According to the age differences, they were divided into 5 groups： （1）the neonatal group （≤28 d） ： 55 feet in 36 cases; （2）the younger infancy group （29 d-180 d） ： 262 feet in 185cases; （3）the older infancy group （181d-12months） ： 113 feet in 81 cases; （4）the toddler age group （1-3 years） ： 78 feet in 52 cases; （5）the childhood group （〉3 years） ： 36 feet in 24 cases. According to the initial treatment background, patients were divided into two groups： the initial treatment group （177 feet in 125 cases） and the re-treatment group （367 feet in 253 cases）. The deformation degree of CTE was evaluated by the Pirani scoring system. A scoring of 0-0. 5 was regarded as excellent. For each group, we evaluated the percentage of excellence according to the Pirani score, the number of casts used, and the percentage of percutaneous achillotenotomy. The results were compared among different groups. Results The percentage of excellence in all patients was 97. 98%,and in the childhood group it was lower than that in the other groups （P〈0. 01）, but it showed no significant differences between the initial treatment group and the re-treatment group （P〉 0. 05）. There were significant differences in the number of casts used among each group （P〈0. （101）. The percentage of percutaneous achillotenotomy showed significant differences between each group before 1-years old, but after 1 years old there were no differences between each group. Both the number of casts used and the percentage of percutaneous achillotenotomy in the initial treatment group were more than those in the re-treatment type. There was obvious difference between these two groups （P 〈0. 01）. Five hundred and twelve feet in 353 cases were followed up for an average of 29 months. Ninety-six feet in 67 cases recurred, the percentage of recurrence showed no differences among differ ent age groups（P〉0. 05）. Conchtsions Ponseti method is not only suitable for the treatment of young CTE patients, but also applicable for older CTE patients and CTE patients with recurrence.