Objective:To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months. Methods:Ponseti method was used to treat 157 cases (227 feet) of CTE ...Objective:To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months. Methods:Ponseti method was used to treat 157 cases (227 feet) of CTE in children older than 6 months. All cases were classified by age and by the degree of deformity severity. The age group classification was:(1)ⅠGroup (6 months to 12 months),113 feet in 81 cases; (2)Ⅱ Group (1 to 3 years old),78 feet in 52 cases; (3) Ⅲ Group (>3 years old),36 feet in 24 cases. The degree of deformity of CTE was evaluated with Pirani scoring system. The cases were classified into three groups according to the deformity degree:(1) Mild Group (scoring 1-2.5),85 feet in 56 cases; (2) Moderate Group (scoring 3-4.5),104 feet in 71 cases; (3) Severe Group (scoring 5-6),38 feet in 30 cases. A Pirani score of 0-0.5 is regarded as an excellent result. For each group,we evaluated the number of casts used,the percentage of excellent result according to the Pirani score,and the percentage of percutaneous achillotenotomy. The result was compared among different groups. Results:The overall percentage of excellent result among all cases was 96.92%. Among the age groups,the percentage of excellence was not statistically different betweenⅠGroup andⅡGroup (P>0.05). The percentage of excellence was lower in the Ⅲ group than the other groups (P>0.01). Among the groups classified by deformity degree,the percentage of excellence was the lowest in severe group (P<0.05),and the difference between the mild group and moderate group was not statistically different (P>0.05). The number of casts used among different groups were different (P<0.01). Among different groups,the percentages of percutaneous achillotenotomy were significantly different (P<0.01). 209 feet in 148 cases were followed up for average time duration of 3 years and 11 months. Relapse was observed in 40 feet in 29 cases. The percentages of relapse were not statistically different among different groups (P>0.05). Conclusion:Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.展开更多
Equinus deformity is one of the most common musculoskeletal deformities of Cerebral Palsy (CP) which is defined as an abnormality in ankle dorsiflexion that can cause severe walking disability. The standard surgical i...Equinus deformity is one of the most common musculoskeletal deformities of Cerebral Palsy (CP) which is defined as an abnormality in ankle dorsiflexion that can cause severe walking disability. The standard surgical intervention for Equinus deformity is Achilles Tendon Lengthening (ATL) with post-operative leg casting, however in some cases, it requires months of recovery post-operation to regain movement. The objective of this study was to find an alternative to leg casting that would provide a safe and faster time course to recovery. Therefore, we conducted a semi-experimental clinical trial study of a population that included 62 CP patients between the ages of 6 - 15 years of age with diplegia, hemiplegia, or quadriplegia that randomly underwent ATL followed by subsequent leg casting (control, 32 patients) or bandage and ankle-foot orthosis (AFO;experimental, 30 patients). Patients were periodically evaluated for mobility and walking ability pre-operation and at 2 weeks post- operation, 6 weeks post-operation, and then every month for 6 months. We found that all 32 patients in the experimental group regained their walking ability within two weeks (100%), while majority of patients in the control group (84%) regained their walking ability after 4 - 6 weeks, regardless of CP type. We also found that on 6-month follow-up, progression of walking abilities was similar in both groups. Rupture of the repaired tendon was not observed in any of the participants in either group. This study suggests applying a bandage with a foot or ankle orthosis as an alternative to long leg cast in children of 15 years of age or younger with CP treated with ATL for Equinus deformity to facilitate faster post-operative recovery. It also recommends follow-up studies on confounding factors, categorization of pre- and post-operative range of movement, and post-op complications with longer follow up while treating CP patient with ATL followed by AFO.展开更多
文摘Objective:To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months. Methods:Ponseti method was used to treat 157 cases (227 feet) of CTE in children older than 6 months. All cases were classified by age and by the degree of deformity severity. The age group classification was:(1)ⅠGroup (6 months to 12 months),113 feet in 81 cases; (2)Ⅱ Group (1 to 3 years old),78 feet in 52 cases; (3) Ⅲ Group (>3 years old),36 feet in 24 cases. The degree of deformity of CTE was evaluated with Pirani scoring system. The cases were classified into three groups according to the deformity degree:(1) Mild Group (scoring 1-2.5),85 feet in 56 cases; (2) Moderate Group (scoring 3-4.5),104 feet in 71 cases; (3) Severe Group (scoring 5-6),38 feet in 30 cases. A Pirani score of 0-0.5 is regarded as an excellent result. For each group,we evaluated the number of casts used,the percentage of excellent result according to the Pirani score,and the percentage of percutaneous achillotenotomy. The result was compared among different groups. Results:The overall percentage of excellent result among all cases was 96.92%. Among the age groups,the percentage of excellence was not statistically different betweenⅠGroup andⅡGroup (P>0.05). The percentage of excellence was lower in the Ⅲ group than the other groups (P>0.01). Among the groups classified by deformity degree,the percentage of excellence was the lowest in severe group (P<0.05),and the difference between the mild group and moderate group was not statistically different (P>0.05). The number of casts used among different groups were different (P<0.01). Among different groups,the percentages of percutaneous achillotenotomy were significantly different (P<0.01). 209 feet in 148 cases were followed up for average time duration of 3 years and 11 months. Relapse was observed in 40 feet in 29 cases. The percentages of relapse were not statistically different among different groups (P>0.05). Conclusion:Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.
文摘Equinus deformity is one of the most common musculoskeletal deformities of Cerebral Palsy (CP) which is defined as an abnormality in ankle dorsiflexion that can cause severe walking disability. The standard surgical intervention for Equinus deformity is Achilles Tendon Lengthening (ATL) with post-operative leg casting, however in some cases, it requires months of recovery post-operation to regain movement. The objective of this study was to find an alternative to leg casting that would provide a safe and faster time course to recovery. Therefore, we conducted a semi-experimental clinical trial study of a population that included 62 CP patients between the ages of 6 - 15 years of age with diplegia, hemiplegia, or quadriplegia that randomly underwent ATL followed by subsequent leg casting (control, 32 patients) or bandage and ankle-foot orthosis (AFO;experimental, 30 patients). Patients were periodically evaluated for mobility and walking ability pre-operation and at 2 weeks post- operation, 6 weeks post-operation, and then every month for 6 months. We found that all 32 patients in the experimental group regained their walking ability within two weeks (100%), while majority of patients in the control group (84%) regained their walking ability after 4 - 6 weeks, regardless of CP type. We also found that on 6-month follow-up, progression of walking abilities was similar in both groups. Rupture of the repaired tendon was not observed in any of the participants in either group. This study suggests applying a bandage with a foot or ankle orthosis as an alternative to long leg cast in children of 15 years of age or younger with CP treated with ATL for Equinus deformity to facilitate faster post-operative recovery. It also recommends follow-up studies on confounding factors, categorization of pre- and post-operative range of movement, and post-op complications with longer follow up while treating CP patient with ATL followed by AFO.
