Effectiveness of Ponseti technique in management of arthrogrypotic clubfeet - a prospective study.

IF 1.4 Q3 EMERGENCY MEDICINE
International Journal of Burns and Trauma Pub Date : 2023-04-15 eCollection Date: 2023-01-01
Noor Alam, Mohd Baqar Abbas, Yasir S Siddiqui, Mohd Julfiqar, Mazhar Abbas, Mohd Jesan Khan, Madhav Chowdhry
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Abstract

Background: Clubfoot constitutes roughly 70 percent of all foot deformities in arthrogryposis syndrome and 98% of those in classic arthrogryposis. Treatment of arthrogrypotic clubfoot is difficult and challenging due to a combination of factors like stiffness of ankle-foot complex, severe deformities and resistance to conventional treatment, frequent relapses and the challenge is further compounded by presence of associated hip and knee contractures.

Method: A prospective clinical study was conducted using a sample of nineteen clubfeet in twelve arthrogrypotic children. During weekly visits Pirani and Dimeglio scores were assigned to each foot followed by manipulation and serial cast application according to the classical Ponseti technique. Mean initial Pirani score and Dimeglio score were 5.23 ± 0.5 and 15.79 ± 2.4 respectively. Mean Pirani and Dimeglio score at last follow up were 2.37 ± 1.9 and 8.26 ± 4.93 respectively. An average of 11.3 casts was required to achieve correction. Tendoachilles tenotomy was required in all 19 AMC clubfeet.

Result: The primary outcome measure was to evaluate the role of Ponseti technique in management of arthrogrypotic clubfeet. The secondary outcome measure was to study the possible causes of relapses and complications with additional procedures required to manage clubfeet in AMC an initial correction was achieved in 13 out of 19 arthrogrypotic clubfeet (68.4%). Relapse occurred in 8 out of 19 clubfeet. Five of those relapsed feet were corrected by re-casting ± tenotomy. 52.6% of arthrogrypotic clubfeet were successfully treated by the Ponseti technique in our study. Three patients failed to respond to Ponseti technique required some form of soft tissue surgery.

Conclusion: Based on our results, we recommend the Ponseti technique as the first line initial treatment for arthrogrypotic clubfeet. Although such feet require a higher number of plaster casts with a higher rate of tendo-achilles tenotomy but the eventual outcome is satisfactory. Although, relapses are higher than classical idiopathic clubfeet, most of them respond to re-manipulation and serial casting ± re-tenotomy.

前瞻性研究:Ponseti 技术在治疗关节突性跛足中的有效性。
背景:在关节外翻综合征的所有足部畸形中,马蹄内翻足约占 70%,而在典型关节外翻中,马蹄内翻足占 98%。由于踝足复合体僵硬、严重畸形和对常规治疗的抵触、频繁复发等综合因素,关节发育不良型马蹄内翻足的治疗非常困难和具有挑战性:方法:以 12 名关节畸形儿童中的 19 个马蹄内翻足为样本,进行了一项前瞻性临床研究。在每周的就诊过程中,对每只脚进行皮拉尼和迪梅格里奥评分,然后根据经典的庞塞提技术进行操作和连续石膏应用。初始皮拉尼评分和 Dimeglio 评分的平均值分别为 5.23 ± 0.5 和 15.79 ± 2.4。最后一次随访时,皮拉尼评分和 Dimeglio 评分的平均值分别为 2.37 ± 1.9 和 8.26 ± 4.93。平均需要11.3次石膏固定才能达到矫正效果。所有19例AMC马蹄内翻足患者都需要进行腱膜跟腱切开术:主要结果指标是评估 Ponseti 技术在关节突关节型足的治疗中的作用。次要结果是研究复发和并发症的可能原因,以及处理 AMC 中的足外翻所需的额外手术。19 例足癣患者中有 8 例复发。其中 5 例复发足通过重新铸造和腱膜切开术得到了矫正。在我们的研究中,52.6%的关节强直性clubbfeet通过Ponseti技术成功治疗。结论:基于我们的研究结果,我们推荐使用Ponseti技术治疗关节突关节型足:根据我们的研究结果,我们建议将 Ponseti 技术作为关节外翻型马蹄内翻足的一线初始治疗方法。虽然这类足需要较多的石膏固定和较高的腱膜跟腱切开术,但最终结果是令人满意的。虽然复发率高于传统的特发性足外翻,但大多数患者都能通过重新操作和连续石膏固定以及再韧带切开术恢复健康。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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