应用Ponseti方法微创治疗先天性马蹄内翻足

Ponseti method for minimally invasive treatment of congenital clubfoot

目的总结Ponseti方法微创治疗先天性马蹄内翻足的临床经验。方法2010年1月至2012年6月在西安市儿童医院骨科应用Ponseti方法微创治疗（手法矫正加石膏固定加经皮跟腱切断加足外展支具治疗）的先天性马蹄内翻足患儿160例，按年龄分组为：新生儿期（出生一28天）45例，小婴儿期（1—6个月）52例，大婴儿期（6—12个月内）50例，幼儿期（1—3岁）13例。对各组的治疗效果进行分析。结果按Pirani评价方法，158例245足（98．8％）获满意纠正。各年龄组别治疗前后Pirani评分为：新生儿期治疗前（4．56±0．43）高于治疗后（0．16±0．26），t=58．24，P〈0．05；小婴儿期治疗前（4．72±0．48）高于治疗后（0．13±0．25），t=84．24，P〈0．05；大婴儿期治疗前（4．54±0．53）高于治疗后（0．17±0．23），t=82．30，P〈0．05；幼儿期治疗前（4．77±0．56）高于治疗后（0．23±0．25），t=43．08，P〈0．05。142例患儿获得有效随访，现均处于支具使用期。随访时间最短6个月，最长28个月，平均17．45±2．33个月。随访惠儿外观畸形矫正，踝关节背屈〉10°，内收内翻高弓均消失，已行走患儿跟腱有力，足发育良好，步态正常。结论Ponseti方法治疗先天性马蹄内翻足疗效确切，是一种微创的治疗方法，值得推广。

Objective To summarize the clinical experience of Ponseti method for minimally invasive treatment of congenital clubfoot. Methods From January 2010 to June 2012 160 cases with 248 congenital clubfeet were treated with Ponseti method in orthopedics department of Xi＇ an Children＇ s Hospital, According to age they were divided into neonatal period （birth-28 days, 45 cases）, young infant period （1-6 months, 52 cases）, infant period （6-12 months l 50 cases） and children period （1-3 years, 13 cases）. The curative effect of different groups was analyzed. Results According to Pirani scoring method, 158 cases with 245 clubfeet （98.8%） obtained satisfying correct. The Pirani score of neonatal period, young infant period, infant period and children period before treatment （4.56 ±0.43, 4.72 ± 0.48, 4.54±0.53, 4.77 ±0.56, respectively） was higher than that after treatment （0.16 ±0.26, 0.13±0.25, 0.17 ±0.23, 0.23 ＋ 0.25, respectively） （t value was 58.24, 84.24, 82.30 and 43.08, respectively, all P 〈0.05）. Totally 142 cases were followed up effectively and they were in brace use period. Follow-up time ranged 6 to 28 months with an average of 17.45±2.33 months. The abnormity of followed-up patients was rectified with ankle dorsiflexion 〉 10°. Adduetion, varus and hollow foot disappeared, and the walking patients had powerful heel tendon with well developed feet and normal gait. Conclusion Ponseti method for the treatment of congenital clubfoot is effective and is minimally invasive. It is worthy to be popularized.