结合影像学评估Ponseti法治疗先天性马蹄内翻足的效果及其复发的危险因素  

Effect of Ponseti Method in the Treatment of Congenital Talipes Equinovarus Combined with Imaging and the Risk Factors for Recurrence

作　　者：周迪鸣 员夏飞 韩亚辉 于小坤 严敦 赵伟[1] 张蛟[1] ZHOU Diming;YUAN Xiafei;HAN Yahui;YU Xiaokun;YAN Dun;ZHAO Wei;ZHANG Jiao(Pediatric Surgery Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院小儿外科,河南郑州450000

出　　处：《河南医学研究》2025年第5期795-799,共5页Henan Medical Research

摘　　要：目的结合影像学对经Ponseti法治疗的患有先天性马蹄内翻足(CTEV)的患儿进行疗效评估,采用多因素logistic回归探究与复发相关的影像学及临床指标。方法回顾性分析2017年1月至2020年12月于郑州大学第一附属医院就诊的CTEV患儿59例(共81足),比较治疗前及末次随访时患足的Pirani评分、Dimegilo评分、正位跟距角、正位距骨第一跖骨角、侧位跟距角、侧位距骨第一跖骨角、侧位胫距角、侧位跟骨第一跖骨角、侧位胫跟角是否有明显差异。并探究患儿性别、就诊年龄、支具依从性、石膏数量、是否行跟腱延长术及治疗后3个月正位跟距角、正位距骨第一跖骨角、侧位跟距角、侧位距骨第一跖骨角、侧位胫距角、侧位跟骨第一跖骨角、侧位胫跟角是否与复发相关。结果随访时间2~6 a,平均(4.33±1.10)a,59例(81足)需石膏数为(4.03±1.08)个,行跟腱延长术47例(62足,75.54%),复发14例(19足,23.45%),末次随访时Dimeglio分型Ⅰ度75足(92.6%),Ⅱ度6足(7.4%)。末次随访时相比治疗前,患足Pirani评分、Dimegilo评分降低,差异有统计学意义(P<0.001),正位跟距角、正位距骨第一跖骨角、侧位跟距角、侧位距骨第一跖骨角相比治疗前升高,侧位胫距角、侧位跟骨第一跖骨角、侧位胫跟角降低,差异有统计学意义(P<0.001)。治疗后3个月的正、侧位跟距角、支具依从性是复发的危险因素(P<0.05)。结论经Ponseti法治疗CTEV患足形态学评分及影像学指标均显著改善。治疗后3个月的正、侧位跟距角、患儿支具依从性是复发的危险因素,可以为CTEV术后随访及治疗提供参考。Objective To evaluate the curative effect of congenital talipes equinovarus(CTEV)in children treated by Ponseti method combined with imaging,and to explore the imaging and clinical factors related to the recurrence by multivariate logistic regression.Methods A total of 59 children(81 feet)with CTEV admitted to the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2020 were retrospectively analyzed.Pirani score,Dimegilo score,anteroposterior calcaneal angle,first metatarsal angle of talus on anteroposterior view,lateral calcaneal angle,first metatarsal angle of talus on lateral view,tibio-talus angle on lateral view,first metatarsal angle of calcaneus on lateral view,and tibio-calcaneal angle on lateral view were compared before treatment and at the last follow-up.The children’s gender,age of treatment,compliance with splints,number of casts,achilles tendon lengthening,and anteroposterior calcaneal angle,first metatarsal angle of talus on anteroposterior view,lateral calcaneal angle,first metatarsal angle of talus on lateral view,tibial talus angle on lateral view,first metatarsal angle of calcaneus on lateral view,and tibial calcaneal angle on lateral view at 3 months after treatment were investigated whether there is a correlation with recurrence.Results The average follow-up period was(4.33±1.10)years(range,2-6 years).The average number of casts required in 59 patients(81 feet)was(4.03±1.08)cases.Forty-seven cases(62 feet,75.54%)underwent achilles tendon lengthening,and 14 cases(19 feet,23.45%)had recurrence.According to Dimeglio classification,75 feet(92.6%)were gradeⅠand 6 feet(7.4%)were gradeⅡ.At the last follow-up,Pirani score and Dimegilo score of the affected foot were lower than those before treatment(P<0.001),and the anteroposterior talocalcaneal angle,the first metatarsal angle of the anteroposterior talus,the lateral talocalcaneal angle,and the first metatarsal angle of the lateral talus were higher than those before treatment(P<0.001).The lateral tibiotalar angle

关 键 词：马蹄内翻足 PONSETI方法 影像学测量 logistic回归 

分 类 号：R726.8[医药卫生—儿科]