胎儿马蹄足长期随访结果分析

Long-term follow-up study of fetal clubfoot

目的 探讨孕期超声发现胎儿马蹄足的不同处理建议. 方法 回顾性分析自2013年1月至2014年12月在西安市儿童医院门诊接受产前咨询的13例孕妇,通过超声检查初诊胎儿马蹄足,未终止妊娠,产后明确诊断12例患儿有17只患足,并且新生儿期均应用潘塞缇（ Ponseti）方法予以治愈的病例资料. 结果 产前超声诊断与随访结果：产前超声诊断胎儿马蹄足13例,均为单纯性胎儿马蹄足,经产后随访证实,其中1例单纯左足内翻为正常新生儿,其余12例符合产前超声诊断,诊断符合率为92.3%. 对12例患儿均应用Ponseti方法进行早期治疗,并定期随访,目前均处于夜间穿戴外展支具,及定期复查阶段. 随诊时间3-18个月,平均13.3 ±3.2个月. 所有患儿均临床治愈,治愈率为100.0%. 外观畸形矫正,踝关节背伸〉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 产前超声确诊胎儿马蹄足可信度高. 先天性马蹄足经过Ponseti方法治疗效果好. 对于胎儿马蹄足的产前咨询建议单纯性足内翻应避免盲目终止妊娠,而对于足内翻合并其他严重畸形应考虑终止妊娠.

Objective To discuss the different recommendations on the treatment of fetal clubfoot diagnosed by pregnancy ultrasound. Methods A retrospective analysis was conducted on 13 pregnant women receiving prenatal consulting in Xi＇an Children＇ s Hospital from January 2013 to December 2014, who were diagnosed with fetal clubfoot but pregnancy was not terminated.After birth 12 neonates were confirmed with 17 clubfeet, and they received Ponseti method for treatment.Results Thirteen cases were diagnosed with simple fetal clubfoot by pregnancy ultrasound, and the postpartum follow-up confirmed 12 cases except for 1 case of normal newborn with simple left strephenopodia.The compliance rate was 92.3%.All of 12 patients were treated with Ponseti method in early age and followed up regularly.Currently they wore abduction brace at night and were followed up regularly.Follow-up sustained for 3 to 18 months with an average of 13.3 ±3.2 months.All patients were clinically cured, and the cure rate was 100.0%.The deformity was corrected with ankle dorsiflexion 〉10°.Varus adduction high arches disappeared, and infants who could walk had powerful achilles tendon and good foot development and normal gait.Conclusion Ultrasonography has a high reliability on the diagnosis of fetal clubfoot.Ponseti method has good treatment effect on congenital clubfoot.Simple fetal clubfoot diagnosed by ultrasonography should avoid blind termination of pregnancy, but pregnancy should be terminated when associated with other severe malformations.