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目的探讨采用Ponseti方法早期保守治疗先天性马蹄内翻足的疗效。并分析治疗过程中常出现问题的原因及对策。方法 2010年2月至2012年2月,小儿骨科采用Ponseti方法治疗先天性马蹄内翻足45例,排除伴发多关节挛缩畸形、脊膜膨出、脊髓栓系、脑瘫以及一些遗传综合症者。男28例,女17例。单侧25例,双侧20例,共65足,年龄2周～1岁。应用Ponseti法(手法矫正+石膏固定+经皮跟腱切断或延长+足外展支具)治疗,并教会患儿家长正确的矫正手法,石膏固定过程中观察注意事项及正确穿戴支具方法,提高其依从性,定期来院复查。结果所有病例平均随访20个月,最长32个月,治疗过程中1例1足出现石膏压疮,1例1足出现石膏滑脱,3例3足佩戴支具依从性差致畸形复发。Pirani评分系统进行评价疗效,42例62足矫形效果满意,3例3足畸形复发行手术治疗。结论改良Ponseti方法保守治疗先天性马蹄内翻足疗效确切,该方法是一种很好的早期治疗先天性马蹄内翻足的保守疗法,注意细节及正确应用该方法在治疗过程中极为重要。
Objective To investigate the early conservative treatment of congenital clubfoot by Ponseti’s method. And analyze the causes and countermeasures of problems that often appear in the course of treatment. Methods From February 2010 to February 2012, 45 children with congenital clubfoot were treated with Ponseti method in pediatric orthopedics. Exclusion of multiple joint contracture deformity, meningocele, tethered cord, cerebral palsy and some genetic syndromes . 28 males and 17 females. 25 cases of unilateral, bilateral in 20 cases, a total of 65 feet, age 2 weeks to 1 year old. Ponseti method (orthodontics + plaster fixation + percutaneous Achilles tendon to cut off or extend the + foot abduction brace) treatment, and teach the parents correct correction methods, observed during the plaster fixation process and the proper method of wearing the brace, Improve their compliance, regular review to the hospital. Results All cases were followed up for an average of 20 months and up to 32 months. One case of plaster pressure ulcer occurred in one case during the treatment, one case had gypsum spondylolisthesis in one case, and three cases of three-foot metacarpal deformity-related deformity recurrence. Pirani scoring system to evaluate the efficacy of 62 cases of 62 feet orthopedic satisfactory, 3 cases of 3 foot deformity recurrence surgery. CONCLUSION: The conservative treatment of congenital clubfoot by modified Ponseti method is effective. This method is a good conservative therapy for early treatment of congenital clubfoot. Pay attention to the details and correct application of this method in the treatment process is extremely important.