CAJ | 학술논문

目的观察Ponseti方法对不同年龄先天性马蹄内翻足的治疗效果.方法应用Pon-seti方法治疗先天性马蹄内翻足患儿378例544足,按年龄分为:①新生儿期(≤28 d)36例55足;②小婴儿期(29～180 d)185例262足;③大婴儿期(181 d～12个月)81例113足;④幼儿期(1～3岁)52例78足;⑤儿童期(3岁)24例36足.根据病史分为:初治型125例177足;经治型253例367足.对所有患足进行Pirani评分,将0～0.5分判为优良,比较各组的优良率、应用石膏次数及跟腱切断的病足数,并进行随访.结果拆除最后一次石膏时总优良率为97.98%,儿童期优良率较其他年龄组低(P<0.01),其余各组间优良率差异无统计学意义,经治型与初治型间优良率差异也无统计学意义(P0.05).各组间应用石膏次数差别有统计学意义(P<0.01).1岁内各组间行跟腱切断的百分比差异有统计学意义(P<0.01),新生儿期最多,1岁后各组间差异无统计学意义(P0.05).初治型应用的石膏次数及行跟腱切断的百分比较经治型明显增多,两组间差异有统计学意义(P<0.01).随访353例512足,随访时间;3个月～5年3个月,平均2年5个月.有67例96足复发,各组间复发率差别无统计学意义,(P0.05).结论 Ponseti方法不仅适合CTE的早期治疗,而且对较大年龄的CTE患儿以及经过其他方法治疗失败或复发的CTE患儿近期也能取得较好效果.
목적 관찰Ponseti방법대불동년령선천성마제내번족적치료효과.방법 응용Pon-seti방법치료선천성마제내번족환인378례544족,안년령분위:①신생인기(≤28 d)36례55족;②소영인기(29～180 d)185례262족;③대영인기(181 d～12개월)81례113족;④유인기(1～3세)52례78족;⑤인동기(3세)24례36족.근거병사분위:초치형125례177족;경치형253례367족.대소유환족진행Pirani평분,장0～0.5분판위우량,비교각조적우량솔、응용석고차수급근건절단적병족수,병진행수방.결과 탁제최후일차석고시총우량솔위97.98%,인동기우량솔교기타년령조저(P<0.01),기여각조간우량솔차이무통계학의의,경치형여초치형간우량솔차이야무통계학의의(P0.05).각조간응용석고차수차별유통계학의의(P<0.01).1세내각조간행근건절단적백분비차이유통계학의의(P<0.01),신생인기최다,1세후각조간차이무통계학의의(P0.05).초치형응용적석고차수급행근건절단적백분비교경치형명현증다,량조간차이유통계학의의(P<0.01).수방353례512족,수방시간;3개월～5년3개월,평균2년5개월.유67례96족복발,각조간복발솔차별무통계학의의,(P0.05).결론 Ponseti방법불부괄합CTE적조기치료,이차대교대년령적CTE환인이급경과기타방법치료실패혹복발적CTE환인근기야능취득교호효과.
Objective To observe the therapeutic effects of Ponseti method for congenital talipes equinovarus(CTE) among different age groups. Methods Five hundred and forty-four feet in 378 cases of CTE were treated with Ponseti method. According to the age differences, they were divided into 5 groups:①the neonatal group (≤28 d) : 55 feet in 36 cases; ②the younger infancy group (29 d～180 d) : 262 feet in 185cases; ③the older infancy group (181d-12months) : 113 feet in 81 cases; ④the toddler age group (1～3 years) : 78 feet in 52 cases; ⑤the childhood group (3 years) : 36 feet in 24 cases. According to the initial treatment background, patients were divided into two groups, the initial treatment group (177 feet in 125 cases) and the re-treatment group (367 feet in 253 cases). The deformation degree of CTE was evaluated by the Pirani scoring system. A scoring of 0～0. 5 was regarded as excellent. For each group, we evaluated the percentage of excellence according to the Pirani score, the number of casts used, and the percentage of percutaneous achillotenotomy. The results were compared among different groups. Results The percentage of excellence in all patients was 97.98%,and in the childhood group it was lower than that in the other groups (P<0.01), but it showed no significant differences between the initial treatment group and the re-treatment group (P 0.05). There were significant differences in the number of casts used among each group (P<0.001). The percentage of percutaneous achillotenotomy showed significant differences between each group before 1-years old, but after 1-years old there were no differences between each group. Both the number of casts used and the percentage of percutaneous achillotenotomy in the initial treatment group were more than those in the re-treatment type. There was obvious difference between these two groups (P <0.01). Five hundred and twelve feet in 353 cases were followed up for an average of 29 months. Ninety-six feet in 67 cases recurred, the percentage of recurrence showed no differences among different age groups(P0.05). Conclusions Ponseti method is not only suitable for the treatment of young CTE patients, but also applicable for older CTE patients and CTE patients with recurrence.