Outcomes of the Ponseti Method for Untreated Clubfeet in Nepalese Patients Seen Between the Ages of One and Five Years and Followed for at Least 10 Years.

Autor:	Banskota B; Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal., Yadav P; Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal., Rajbhandari T; Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal., Shrestha OP; Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal., Talwar D; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Banskota A; Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal., Spiegel DA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2018 Dec 05; Vol. 100 (23), pp. 2004-2014.
DOI:	10.2106/JBJS.18.00445
Abstrakt:	Background: To our knowledge, there are no reports of the Ponseti method initiated after walking age and with >10 years of follow-up. Our goal was to report the clinical findings and patient-reported outcomes for children with a previously untreated idiopathic clubfoot who were seen when they were between 1 and 5 years old, were treated with the Ponseti method, and had a minimum follow-up of 10 years. Methods: A retrospective review of medical records was supplemented by a follow-up evaluation of physical findings (alignment and range of motion) and patient-reported outcomes using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). The initial treatment was graded as successful if a plantigrade foot was achieved without the need for an extensive soft-tissue release and/or osseous procedure. Results: We located 145 (91%) of 159 patients (220 clubfeet). The average age at treatment was 3 years (range, 1 to 5 years), and the average duration of follow-up was 11 years (range, 10 to 12 years). The initial scores according to the systems of Pirani et al. and Diméglio et al. averaged 5 and 17, respectively, and an average of 8 casts were required. Surgical treatment, most commonly a percutaneous Achilles tendon release (197 feet; 90%), was required in 96% of the feet. A plantigrade foot was achieved in 95% of the feet. Complete relapse was rare (3%), although residual deformities were common. Patient-reported outcomes were favorable. Conclusions: A plantigrade foot was achieved in 95% of the feet initially and was maintained in most of the patients, although residual deformities were common. Patient-reported outcomes were satisfactory, and longer-term follow-up with age-appropriate outcome measures will be required to evaluate function in adulthood. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Databáze:	MEDLINE
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