Liu Hang,Li Ming,Liu Xing,et al.Evaluations of plantar mechanics after mini-invasive soft tissue release of idiopathic clubfoot[J].Journal of Clinical Pediatric Surgery,,19():775-778.[doi:10.3969/j.issn.1671-6353.2020.09.003]
Evaluations of plantar mechanics after mini-invasive soft tissue release of idiopathic clubfoot
- Keywords:
- Equinus Deformity/SU; Surgical Procedures; Minimally Invasive; Treatment Outcome; Mechanics
- CLC:
- R726.8;R681.8;R682.1+6
- Abstract:
- Objective To evaluate the short-term efficacies of mini-invasive multiplanar soft tissue release for Dimeglio grade Ⅳ idiopathic clubfoot by plantar scan and static plantar pressure. Methods From January 2016 to June 2018,17 cases (25 feet) of Dimeglio grade IV idiopathic clubfeet underwent mini-invasive multiplanar soft tissue releasing.There were 12 boys (18 feet) and 5 girls (7 feet).The operative age range was from 53 to 201 days and the evaluation age 29 to 35 months.The recovery status of clubfeet was evaluated by Dimeglio score,radiography,plantar scan and static plantar pressure analysis. Results Dimeglio scores were 0-2 points after serial casting and mini-invasive multiplanar soft tissue releasing and the appearance of affected feet was satisfactory.Radiography indicated that preoperative and postoperative anteroposterior talocalcaneal angle was 14.90±3.20°,33.51±7.52°respectively and lateral talocalcaneal angle 22.65±6.10°,33.08±4.12°.The differences were statistically significant (P<0.05).The arch indices were 0.35±0.02 and 0.35±0.01.There was no significant inter-group difference (P>0.05).The bimalleolar angles were 82.03±6.20° and 85.27±3.49°.There was no significant difference (P>0.05).The distribution percentage of pressures in bilateral talipes equinovarus was[(52.75±2.32)%:(47.25±2.32)%,P<0.05]and that of unilateral talipes equinovarus[(60.33±4.54)%:(39.70±4.55)%,P<0.05]. Conclusion Mini-invasive multiplanar soft tissue release is efficacious for idiopathic clubfoot of Dimeglio grade Ⅳ.The outcomes of plantar mechanic evaluations may be used as an important reference for targeted maintenance therapeutics of clubfoot.
References:
1 刘行,李明,刘星,等.微创Carroll手术治疗先天性马蹄内翻足疗效初步分析[J].临床小儿外科杂志,2016,15(6):540-543,547.DOI:10.3969/j.issn.1671-6353.2016.06.006.Liu H,Li M,Liu X,et al.Preliminary analysis of efficacy of mini-invasive Carroll’s technique in the treatment of congenital clubfoot[J].J Clin Ped Sur,2016,15(6):540-543,547.DOI:10.3969/j.issn.1671-6353.2016.06.006.
2 Zhang G,Zhang Y,Li M.A Modified Ponseti method for the treatment of rigid idiopathic congenital clubfoot[J].J Foot Ankle Surg,2019,58(6):1192-1196.DOI:10.1053/j.jfas.2019.04.003.
3 Carroll NC.Clubfoot in the twentieth century:where we were and where we may be going in the twenty-first century[J].J Pediatr Orthop B,2012,21(1):1-6.DOI:10.1097/BPB.0b013e32834a99f2.
4 Hosseinzadeh P,Kelly DM,Zionts LE.Management of the relapsed clubfoot following treatment using the Ponseti method[J].J Am Acad Orthop Surg,2017,25(3):195-203.DOI:10.5435/JAAOS-D-15-00624.
5 Dimeglio A,Bensahel H,Souchet P,et al.Classification of clubfoot[J].J Pediatr Orthop B,1995,4(2):129-136.DOI:10.1097/01202412-199504020-00002.
6 李敬春,荀福兴,刘远忠,等.X线在Ponseti方法治疗先天性马蹄内翻足后畸形复发预测中的意义[J].骨科临床与研究杂志,2018,3(3):167-171.DOI:10.19548/j.2096-269x.2018.03.007.Li JC,Xun FX,Liu YZ,et al.Value of X-ray in predicting the recurrence of congenital clubfoot after treatment with Ponseti’s method[J].J Clin Orthop Res,2018,3 (3):167-171.DOI:10.19548/j.2096-269x.2018.03.007.
7 Lykissas MG,Crawford AH,Eismann EA,et al.Ponseti me-thod compared with soft-tissue release for the management of clubfoot:A meta-analysis study[J].World J Orthop,2013,4(3):144-153.DOI:10.5312/wjo.v4.i3.144.
8 徐宏文,于凌佳,李敬春,等.步态分析对先天性马蹄内翻足治疗的功能评价[J].中华小儿外科杂志,2014,35(10):786-789.DOI:10.3760/cma.j.issn.0253-3006.2014.10.016.Xu HW,Yu LJ,Li JC,et al.Gait analysis after Ponseti treatment for clubfeet[J].Chin J Pediatr Surg,2014,35 (10):786-789.DOI:10.3760/cma.j.issn.0253-3006.2014.10.016.
9 McCahill J,Stebbins J,Koning B,et al.Repeatability of the Oxford Foot Model in children with foot deformity[J].Gait Posture,2018,61:86-89.DOI:10.1016/j.gaitpost.2017.12.023.
10 Cavanagh PR,Rodgers MM.The arch index:a useful measure from footprints[J].J Biomech,1987,20(5):547-551.DOI:10.1016/0021-9290(87)90255-7.
11 蒙雨,唐学阳,刘利君.儿童柔软型扁平足的治疗进展[J].临床小儿外科杂志,2018,17(5):390-393.DOI:10.3969/j.issn.1671-6353.2018.05.017.Meng Y,Tang XY,Liu LJ.Therapeutic advances of soft-type pediatric clubfoot[J].J Clin Ped Sur,2018,17(5):390-393.DOI:10.3969/j.issn.1671-6353.2018.05.017.
12 Bajaj V,Anshuman R,Verma N,et al.Correlation of foot bimalleolar angle and ultrasonography in assessing the severity of club foot in neonates treated by the ponseti method[J].Malays Orthop J,2018,12(3):14-18.DOI:10.5704/MOJ.1811.003.
13 Ganesan B,Luximon A,Al-Jumaily A,et al.Ponseti method in the management of clubfoot under 2 years of age:A systematic review[J].PLoS One,2017,12(6):e0178299.DOI:10.1371/journal.pone.0178299.
14 Pierz KA,Lloyd JR,Solomito MJ,et al.Lower extremity characteristics in recurrent clubfoot:Clinical and gait analysis findings that may influence decisions for additional surgery[J].Gait Posture,2020,75:85-92.DOI:10.1016/j.gaitpost.2019.10.002.
Memo
收稿日期:2020-04-18。
基金项目:国家临床重点专科建设项目(编号:国卫办医函[2013]544)
通讯作者:李明,Email:LM3180@163.com