X线在Ponseti方法治疗先天性马蹄内翻足后畸形复发预测中的意义

The value of X-ray in predicting the recurrence of congenital clubfoot after treatment with Ponseti 's method

目的探讨X线在先天性马蹄内翻足(CCF)患儿经Ponseti方法治疗后畸形复发预测中的意义。方法回顾分析2007年12月至2012年12月广州市妇女儿童医疗中心采用Ponseti方法治疗的57例CCF患儿(81足)的病历资料。依据畸形复发情况将全部病例分为康复组和复发组。在行Ponseti方法治疗前1 d对患足行X线检查,并分别于治疗后第3、6、9、12、18、24和36个月行双足背屈应力下正、侧位X线检查,测量正、侧位距骨跟骨角(CTAOPP,CTAOSP)、正、侧位距骨-第1跖骨角(FTMAOPP,FTMAOSP)和侧位胫骨跟骨角(CTA)。以统计学方法分析各项测量指标随时间变化的趋势及其对马蹄内翻足复发预测的价值。结果 2组间CTAOSP,FTMAOSP与CTA的差异有统计学意义(P均<0.05);不同性别间各个角度指标差异均无统计学意义(P均>0.05);性别与CTAOSP这2个因素对畸形复发的影响存在交互作用,CTAOSP越小的女性患儿畸形复发的可能性越大。Ponseti方法治疗后12个月的CTAOSP具有最大的AUC值。结论 X线检查在CCF患儿经Ponseti方法治疗后畸形复发的预测中有意义,其中Ponseti方法治疗后12个月的CTAOSP的预测诊断意义最大。

Objective To investigate the value of X-ray in predicting the recurrence of congenital club- foot （CCF） after treatment with Ponseti＇ s method. Methods From December 2007 to December 2012, 57 eases （81 feet） of CCF treated with Ponseti＇ s method were studied retrospectively. All cases were indiveded into recovery group and recurrence group according to the outcome. X-ray examination were taken on the day before treatment and at the 3,6,9,12,18,24 and 36 months after treatment. All the X-ray examination should be taken under dorsiflexion stress of both feet. Calcaneus-talus angle on positive place （ CTAOPP）, first talus- metatarsal angle on positive place （ FTMAOPP）, calcaneus-talus angle on side place （ CTAOSP）, first talus- metatarsal angle on side place（FTMAOSP） and calcaneal tibial angle （CTA） were measured on the plain X- ray. All the angle indite were analyzed statistically between the 2 groups. Results The differences of CTAOSP, FTMAOSP and CTA between the 2 groups were statistically significant （ all P 〈 0.05）. The angles in 2 genders were not different statistically （ all P 〉 0.05 ）. The gender and the CTAOSP had an interaction effect on the relapse of clubfoot： the girls with smaller CTAOSP were more prone to relapse . The CTAOSP at 12 months after treatment of Ponseti＇ s method had the maximum value of AUC, so it had the maximum diagnostic value. Conclusion X-ray examination is valuable in predicting the recurrence of CCF after treatment of Ponse- ti＇s method, The CTAOSP at 12 months after treatment has the maximum diagnostic value.