先天性马蹄内翻足Ponseti疗法治疗初经皮跟腱切断术的预测(1)
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摘要：目的：探讨先天性马蹄内翻足(CCF)患儿治疗前如何预测患儿行跟腱手术的可能性。方法：173足CCF(133例)，均依据Ponseti方法治疗。每例治疗前、中、后都据Dimeglio评分系统进行评分。结果: 173足中有131例需性经皮跟腱切断术，占治疗足的75.7%，经皮跟腱切断手术组手术前石膏矫形次数为8.5(5-10)次，未行手术组的石膏矫形次数为4.1(3-6)(5.0±1.1)次(P<0.001)，治疗前 IV组51足，其中48足(94.1%)行经皮跟腱切断手术，在去除最后一次石膏时，据Dimeglio评分系统再次评分，两组没有显著差异。结论:Dimeglio 评分IV级的CCF，绝大多数需要经皮跟腱切断术。需要经皮跟腱切断术的CCF，同不需要切断术CCF一样，在最后一次石膏去除后，畸形都能被完全矫正。
关键词：畸形足，先天性；石膏.外科；跟腱切断手术；Dimeglio评分
Predicting the Need for Tenotomy in the Ponseti Method for Correction of Clubfeet,SUN Keming，YAO Manye, JI Zejuan,department of pediatric orthopeadics,Children's Hospital of Zhengzhou City , Zhengzhou 450053.
Abstract：The purpose of this study was to determine how to predict the need for tenotomy at the initiation of the Ponseti treatment.Methods 173clubfeet (35 patients) were prospectively rated according to Dimeglio scoring systems. who were consecutively treated.The treatment was consisted of weekly manipulations and serial long leg cast,as described by Ponseti, Results Tenotomies were performed in 131 of173 feet (75.7%). Those that underwent tenotomy required significantly more casts (P <0.001). 94.7% of the Dimeglio Grade IV feet required tenotomies. Following removal of the last cast,there was no significant difference between those that did and did not have a tenotomy.Conclusions Children with clubfeet who have an initial score are rated as Grade IV feet by the Dimeglio system are very likely to need a tenotomy. At the end of casting, feet were equally well corrected whether or not they needed a tenotomy.
Key words：clubfoot，congenital；casts，surgical；Achilles tenotomy；Dimeglioscore Ponseti
中图分类号：R622 文献标识码：B 文章编号：1004-7484(2012)01-0042-03
疗法是一种通过轻柔的手法按摩、系列石膏固定结合足外展支具治疗先天性马蹄内翻足(congenital clubfoot，CCF)的方法[1]，它不同与以往KITE方法，他要求第一次石膏时要旋后外展前足，最后一次石膏前约有70% to 80%需行经皮跟腱切断术。虽然Ponseti曾经描述可以通过几次塑性良好的石膏，避免对跖骨下方的压迫，来矫正踝关节马蹄。然而经皮跟腱切断术仍然有其优势，它操作简单，很好的矫正踝关节马蹄，从而避免出现摇椅足畸形。当其他畸形已经矫正，而足背伸小于15°，就可以行经皮跟腱切断术来矫正。
CCF有许多评分法，但这些评分系统从没被用来协助决定治疗和预测治疗的组成部分。Dimeglio et al的CCF严重程度评分系统已被证明是可靠、可重复操作的评分系统，但之前只是用来对疗效的评价，而从未被用来协助治疗的选择。我们研究目的就是在治疗初能否预测经皮跟腱切断的必要性及评价其应用的疗效。
材料与方法
采集2006年3月—2010年3月应用Ponseti技术完成CCF133例，男100例，女33例，左侧30例，右侧63例，双侧40例。开始治疗年龄最小1天，最大18个月，平均110.6天。每例治疗前、中、后都据Dimeglio评分系统进行评分，评分系统包括8部分：足跖屈、内翻、前足旋转、前足内收、后足折痕、中足折痕、高弓、肌肉发育异常。得分由0到20分分为4级。得分越高，级别越高，反映足的畸形越重。
治疗方法 采用 Ponseti 保守疗法, 即早期轻柔手法复位连续石膏固定+经皮跟踺切断术+足外展矫形支具 ......
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