Ponseti法治疗婴儿先天性马蹄内翻足的随访观察

5-year follow up of infantile idiopathic clubfeet after Ponseti method

目的观察婴儿特发性马蹄内翻足Ponseti法矫正后平均5年的随访结果。方法回顾分析2005年3月至2008年6月，我院骨科采用Ponseti方法治疗先天性马蹄内翻足连续病例，人选标准：①先天性马蹄内翻足（生后即有足内翻畸形）；②首次治疗时年龄0～12个月；③仅采用Pon—seti方法矫正。排除标准：①治疗及随访过程中发现其他运动神经系统畸形：多关节挛缩症，髋关节脱位、膝关节脱位、羊膜束带、脊髓栓系、脊膜膨出，脑发育不良等；②就诊前曾采用其他方法治疗。临床结果的判定，优：跖行，无痛，行走生活良好，已行，或未行跟腱切断术；良：已行或已决定行胫前肌外移等非涉及关节囊的矫形手术者；差：已行或已决定行后内侧软组织松解术者。结果经病史分析得到56例76足符合标准。其中男42例，女14例，双足20例，单足36例（左侧11足，右侧25足），共计76足。随访年限最短3年，最长6年，平均5年。76足中62足（81．6％）临床结果为优，6足（7．9％）临床结果为良，8足（10．5％）临床结果为差。以患儿就诊时年龄是否超过3个月分为两组，两组均为38足，小年龄组中29／38（76．3％）为优，5／38（13．1％）为良，4／38（10．5％）为差，大年龄组中33／38（86．8％）为优，1／38（2．6％）为良，4／38（10．5％）为差，两组结果差异无统计学意义。结论①特发性马蹄内翻足采用Ponseti法矫正后在平均5年随访时，81．6％的足为优，7．9％的足为良，10．5％的足为差（需要行后内侧软组织松解术）；②在4～12个月之间开始矫形的特发性马蹄内翻足中，在平均5年随访时与0～3个月之间开始矫正的患儿相比，临床结果差异没有统计学意义。

Objective To report the clinical outcome at 5 years of infants with idiopathic clubfeet treated by Ponseti Method from one center in Shanghai, China. Methods A cohort of consecutive children with clubfeet treated by Ponseti method from March 2005 to June 2008 was reviewed retrospectively. To be included in this study, all the patients were under 12 months of age when treatment was begun, had idiopathic clubfeet deformities, and had not undergone previous treatment. Teratologic and paralytic clubfoot deformities were not included. Outcomes were classified as Good （plantigrade foot with or without a tendoachilles lengthening ）, Fair （ limited surgery ）, or Poor（ posteromedial release ）. Results 56 patients（42 Male.. 14 Female） with 76 clubfeet were identified. 20 patients were bilateral and 36 patient ware unilateral. The clinical outcome at an average of 5-years （minium of 3 years）, were reported. Among the 76 clubfeet, 62 feet （81.6%） were graded as Good 6 feet （9. 7%） were Fair and 8 feet （10. 5 %） were Poor. There was no statistically significant difference between the two groups even if the patients were further broken down by whether they started treatment before 3 months of age. Conclusions Satisfactory outcome of infantile idiopathic clubfeet treated by the Ponseti Method was seerL Patients who started treatment between 4 months and 12 months of age did not get a significant worse outcome in 5-year follow-up than those started earlier than 3 months of age.