CAJ | 학술논문

目的：评价Ponseti方法治疗延迟就诊的儿童先天性马蹄内翻足的临床疗效。方法采用Ponseti方法治疗19例(28足)12~36月龄的先天性马蹄内翻足患儿,按 Pirani系统和国际马蹄内翻足学会评分系统(ICFSG)进行效果评价。结果石膏固定4~10(6．0±1．3)次,石膏固定总时间7~13(9．0±1．3)周。26足(26/28)的患儿需行经皮跟腱延长术。 Pirani评分术前为3~6(4．9±0．9)分,术后3周拆除石膏时为0~1．5(0．4±0．5)分。按照Pirani评分标准,优良率为22/28。有2足出现Ⅰ度石膏压疮,经拆除石膏、换药等处理后治愈。无切口感染及血管神经损伤。末次随访时ICFSG评分1~33(13．8±11．1)分,其中优8足,良10足,中4足,差6足,优良率为18/28。6足(6/28)出现复发,其中3足行再次石膏矫形及胫前肌转位术,2足行跟腱延长、踝关节后关节囊松解、胫前肌转位术,1足行跟腱延长及中跗骨截骨、克氏针内固定术。结论Ponseti方法治疗延迟就诊的12~36月龄的先天性马蹄内翻足患儿可以避免广泛性软组织松解,近期疗效满意。其复发率较小年龄的先天性马蹄内翻足病例高。如出现复发病例需要进一步手术处理。
목적：평개Ponseti방법치료연지취진적인동선천성마제내번족적림상료효。방법채용Ponseti방법치료19례(28족)12~36월령적선천성마제내번족환인,안 Pirani계통화국제마제내번족학회평분계통(ICFSG)진행효과평개。결과석고고정4~10(6．0±1．3)차,석고고정총시간7~13(9．0±1．3)주。26족(26/28)적환인수행경피근건연장술。 Pirani평분술전위3~6(4．9±0．9)분,술후3주탁제석고시위0~1．5(0．4±0．5)분。안조Pirani평분표준,우량솔위22/28。유2족출현Ⅰ도석고압창,경탁제석고、환약등처리후치유。무절구감염급혈관신경손상。말차수방시ICFSG평분1~33(13．8±11．1)분,기중우8족,량10족,중4족,차6족,우량솔위18/28。6족(6/28)출현복발,기중3족행재차석고교형급경전기전위술,2족행근건연장、과관절후관절낭송해、경전기전위술,1족행근건연장급중부골절골、극씨침내고정술。결론Ponseti방법치료연지취진적12~36월령적선천성마제내번족환인가이피면엄범성연조직송해,근기료효만의。기복발솔교소년령적선천성마제내번족병례고。여출현복발병례수요진일보수술처리。
Objective To evaluate the outcome of Ponseti method in management of delayed admission of congenital clubfoot in children. Methods 19 cases (28 feet) of congenital clubfoot patients aged between 12 ~36 months were managed by Ponseti method, and the outcome was assessed by the Pirani score system and International Clubfoot Study Group (ICFSG) score. Results The times of cast immobilization were 4~10(6. 0 ± 1. 3). The duration of cast immobilization was 7~13 ( 9. 0 ± 1. 3 ) weeks. 26 feet ( 26/28 ) needed percutaneous tendo-achilles tenotomy. The Pirani score before surgery was 3~6(4. 9 ± 0. 9), while 3 weeks postoperation, it decreased to 0~1. 5(0. 4 ± 0. 5). According to Pirani criteria, the excellent-good rate was 22/28. 2 cases had degree Ⅰ cast pressure sore, which was cured by cast removal,dress changing and other management. None had incision infection, vessel injury or nerve injury. In the last follow-up, the ICFSG score was 1~33(13. 8 ± 11. 1), 8 cases with excellent results, 10 good, 4 fair and 6 poor. The excellent-good rate was 18/28. 6 feet(6/28) had relapse with 3 feet treated by re-cast-ing and tibialis anterior transfer, 2 feet managed by Achilles tenotomy, capsulotomy and tibialis anterior transfer, 1 foot with Achilles tenotomy, mid-tarsal osteotomy fixed by Kirschner wires. Conclusions Ponseti method has a fa-vorable outcome in management of delayed admission between 12~36 months in children with congenital clubfoot. It can avoid extensive soft tissue release. The relapse rate is higher than younger children, which is needed by further surgery.