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Title: [Analysis of the efficacy of the Ponseti method for treatment of secondary clubfoot in young children with tethered cord syndrome].
Author: Xia B, Dong YM, Zhang Y, Liu FY, Yuan JY, Yang B, Wang FP, Niu XQ, Hu WM.
Journal: Zhonghua Wai Ke Za Zhi; 2020 Dec 01; 58(12):942-946. PubMed ID: 33249813.
Abstract:
Objective: To explore the feasibility of Ponseti method in treatment of secondary clubfoot in young children with Tethered Cord Syndrome(TCS). Methods: The clinical data of 53 young children with clubfeet treated with Ponseti method from March 2014 to March 2017 at Department of Pediatric Orthopedics, the Third Affiliated Hospital of Zhengzhou University were analyzed retrospectively. These patients were divided into TCS group and Idiopathic group according to the etiology. There were 19 patients (33 feet) in TCS group,with an mean age of 2.8 months(range:0.2 to 24.0 months), including 13 males and 6 females, 5 patients with unilateral clubfeet and 14 patients with bilateral clubfeet. There were 34 patients (45 feet) in idiopathic group, with an mean age of 3.1 months(range: 0.1 to 21.0 months), including 18 males and 16 females, 23 patients with unilateral clubfeet and 11 patients with bilateral clubfeet. All the children received casts correction according to Ponseti method, and were followed up at 3 weeks, 3 months, 6 months and every 6 months after the Achilles tendon tenotomy or the last cast correction. Complications were recorded and therapeutic effect was evaluated of these children by Dimeglio Scoring System and the International Clubfoot Study Group (ICFSG) at the last follow-up. Independent t test, Mann-Witney U test or χ(2) test were used to compare the indicators of the two groups. Results: The number of plaster fixation in TCS group was (6.1±2.0) times, and that of idiopathic group was (4.8±1.0) times(t=3.482, P<0.01).In TCS group, 22 feet treated with Achilles tendon transection and that of idiopathic group was 40 feet(χ(2)=0.279, P=0.598). There were 18 cases recurrence in TCS group and 8 cases in Idiopathic group (t=11.149, P<0.01). In TCS group, 16 cases (27 feet) completed the initial correction, the success rate was 60.6% (27/33), 3 cases (6 feet) could not correct the deformity after 9 to 10 times of plaster fixation, and then underwent soft tissue release.In idiopathic group, 34 cases (45 feet) achieved initial correction after Ponseti treatment(χ(2)=6.488, P=0.011).At the last follow up, there were 5 cases (9 feet) in TCS group and 2 cases (2 feet) in idiopathic group underwent soft tissue release(χ(2)=6.110, P=0.013). The classification grade of ICFSG score of the two groups without soft tissue release were (2.1±0.6) and (1.8±0.7), the difference was not statistically significant (t=1.765, P=0.082). All the children had no skin ulceration, bedsores, skin allergy and other complications. Conclusion: Ponseti method is effective in the treatment of clubfoot secondary to TCS, and the functional recovery is similar to that of children with idiopathic clubfoot. 目的： 探讨Ponseti法治疗婴幼儿脊髓拴系综合征（TCS）继发性马蹄内翻足的可行性。 方法： 回顾性分析2014年3月至2017年3月于郑州大学第三附属医院小儿骨科接受Ponseti法治疗的53例马蹄内翻足患儿的临床资料。根据病因将患儿分为TCS组和特发组。其中TCS组19例（33足），男13例，女6例，中位数年龄2.8个月（范围：0.2~24.0个月），患足为单侧5例，双侧14例；特发组34例（45足），男18例，女16例，中位数年龄3.1个月（范围：0.1~21.0个月），患足为单侧23例，双侧11例。所有患儿均按Ponseti法进行石膏矫正，并于跟腱切断术后或末次石膏固定后3周、3个月、半年及之后每半年进行一次随访，记录患者并发症情况，末次随访时采用Dimeglio评分系统及国际马蹄内翻足功能评分（ICFSG）评估患儿治疗效果。采用独立样本t检验、Mann-Witney U检验或χ(2)检验对两组患儿的检测指标进行比较。 结果： 经Ponseti法治疗完成初次矫正的过程中，TCS组石膏固定次数为（6.1±2.0）次，特发组为（4.8±1.0）次，差异有统计学意义（t=3.482，P<0.01）；TCS组行经皮跟腱切断22足，特发组40足，差异无统计学意义（χ(2)=0.279，P=0.598）；TCS组初次治疗后复发18例，特发组8例，差异有统计学意义（t=11.149，P<0.01）。TCS组16例（27足）完成初始矫正，成功率为60.6%（27/33）；3例（6足）经9~10次石膏固定后无法矫正畸形，改行软组织松解术；特发组34例（45足）经Ponseti方法治疗全部达到初始矫正，差异有统计学意义（χ(2)=6.488，P=0.011）。末次随访时，TCS组行软组织松解术患儿共5例（9足），特发组2例（2足），差异有统计学意义（χ(2)=6.110，P=0.013）；未行软组织松解术的TCS组患儿ICFSG评分分级为（2.1±0.6）级，特发组为（1.8±0.7）级，差异无统计学意义（t=1.765，P=0.082）。所有患儿在石膏矫形过程中无皮肤溃烂、褥疮、皮肤过敏等并发症发生。 结论： 使用Ponseti法治疗婴幼儿TCS继发马蹄内翻足治疗效果满意，患足功能恢复情况与特发性马蹄内翻足患儿相当。.

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