Ponseti方法矫正多关节挛缩型马蹄内翻足的疗效分析和诊疗流程探讨

Ponseti method for the correction of clubfeet with arthrogryposis multiplex congenita

目的探讨分析Ponseti方法治疗多关节挛缩(arthrogryposis multiplex congenita,AMC)型马蹄内翻足的诊疗流程。方法回顾性分析2016年1月1日至2018年12月31日,我院应用Ponseti方法诊治的113例先天性马蹄内翻足患儿,其中5例为AMC型马蹄内翻足,患儿均通过Ponseti手法矫形,多次跟腱切断进行治疗。具体方案为:首先进行Ponseti手法矫形,在外展达到平台期后(平台期的定义:连续2次石膏矫形的外展角度无明显改变),进行首次跟腱切断,然后继续外展石膏矫形,直到距舟关节复位,再进行第2次跟腱切断,矫正踝关节跖屈畸形,之后佩戴Mitchell支具3个月后复查,以后改为每半年复查,每次复查时评估患儿足部主动活动、被动活动和行走情况。结果5例AMC型马蹄内翻足患儿经过Ponseti方法治疗后,随访25~42个月,平均32.8个月,均获得了柔软、跖行、无痛的足,Dimeglio评分和Pirani评分从16.4分和5.6分,降低到2.0分和0.8分。结论本研究回顾性分析了我院对于AMC型马蹄内翻足的诊疗方法和治疗效果,并提出一种诊疗流程,可为AMC型马蹄内翻足的诊疗提供诊疗参考。

Objective To explore and analyze Ponseti method in the treatment of clubfoot with arthrogryposis multiplex congenita.Methods In this retrospective analysis,we summarized 113 cases of congenital clubfoot diagnosed and treated by Ponseti method in our hospital from January 2016 to December 2018,including 5 cases with arthrogryposis multiplex congenita.All the children were treated by Ponseti method and Achilles tendon was cut off for many times.Specific scheme:firstly,manual correction was performed;Achilles tendon was cut off for the first time when the abduction reached the plateau stage(no obvious change in the abduction angle after two consecutive plaster corrections);abduction plaster was continued until the talonavicular joint was reset;Achilles tendon was cut off for the second time to correct the plantar flexion deformity of ankle;Mitchell brace was applied,and all patients were reexamined 3 months later and then 6 months later.Active and passive activities of the feet and walking were evaluated during each reexamination.Results Five children with arthrogryposis multiplex congenita obtained soft,plantar and painless feet after Ponseti treatment.All of them were followed up for an average of 32.8 months(range:25-42 months).The Dimeglio score and Pirani score decreased from 16.4 and 5.6 to 2.0 and 0.8.Conclusions This study retrospectively analyzes Ponseti method in the treatment of clubfoot with arthrogryposis multiplex congenita,and put forward a diagnosis and treatment process which will provide references.