Yang Zheng,Lu Ming,Gao Lei,et al.Intraoperative observations of tenotomic efficacy for pediatric clubfoot[J].Journal of Clinical Pediatric Surgery,,19():779-784.[doi:10.3969/j.issn.1671-6353.2020.09.004]
Intraoperative observations of tenotomic efficacy for pediatric clubfoot
- Keywords:
- Equinus Deformity/SU; Achilles Tendon/SU; Surgical Procedures; Operative/MT; Treatment Outcome; Child
- CLC:
- R726.8;R681.8;R682.1+6
- Abstract:
- Objective Currently Ponseti method is a standard treatment for low-age children with talipes equinus.Deformity is mostly corrected through plaster casting and tenotomy and tenotomy of Achilles tendon (TAT) is focused upon plantar flexion.Our study was intended to clarify the corrective capacity of this operation and discuss its effective range (ER) by comparing different monthly ages and varying degrees of deformity. Methods Clinical data were collected for all cases of congenital talipes equinus undergoing tenotomy over the last two years.Patient profiles and related intraoperative data were collected.Two grouping methods were employed used for comparison.Based upon monthly age,the authors observed whether or not there was a correlation between different operative ages and ER and analyze the changing trend of ER with a higher age.Then according to severity of original deformity,whether or not there was a difference in corrective efficacy. Results A total of 173 children fulfilled the inclusion criteria.The operative sideness was bilateral (n=68) and unilateral (n=105).A total of 241 cases of percutaneous Achilles tenotomy were performed.One-way ANOVA was employed for comparing the differences among 9 monthly age groups (F=9.187,P<0.001).Statistical difference existed in perative ER among different groups.Through LSD multiple comparison,there was less variation between 3 to 6 months.However,statistical differences existed among other groups.By data analysis,early treatment yielded better outcomes.For the same operation,low-age children could obtain larger corrective ER.According to the degree of severity,the cases was classified by Pirani score (6 sub-system): ≥ 5 severe while <5 mild.The results of independent-samples T test were as follows:t value 0.395,p value 0.693 and p value >0.05.The severity of original deformity did not affect the value of operative ER.The ER of tenotomy was 35.32±8.283 degrees. Conclusion At approximately 35 degrees,ER of TAT is closely correlated with monthly age.Operative ER decreases with a higher monthly age while corrective capacity of TAT has nothing to do with the severity degree of original deformity.
References:
1 Radler C.The Ponseti method for the treatment of congenital club foot:review of the current literature and treatment recommendations[J].Int Orthop,2013,37(9):1747-1753.
2 Spiegel DA.CORR Insights(R):results of clubfoot management using the Ponseti method:do the details matter? A systematic review[J].Clin Orthop Relat Res,2014,472(5):1617-1618.DOI:10.1007/s11999-014-3522-0.
3 Shabtai L,Specht SC,Herzenberg JE.Worldwide spread of the Ponseti method for clubfoot[J].World J Orthop,2014,5(5):585-590.
4 O’Shea RM,Sabatini CS.What is new in idiopathic clubfoot?[J].Curr Rev Musculoskelet Med,2016,9(4):470-477.DOI:10.1007/s12178-016-9375-2.
5 Dobbs MB,Morcuende JA,Gurnett CA,et al.Treatment of idiopathic clubfoot:an historical review[J].Iowa Orthop J,2000,20:59-64.
6 Patwardhan S,Shyam A,Sancheti P.Prcutaneous needle tenotomy for tendo-achillis release in clubfoot-technical note[J].J Orthop Case Rep,2012,2(1):35-36.
7 Herzenberg JE,Radler C,Bor N.Ponseti versus traditional methods of casting for idiopathic clubfoot[J].J Pediatr Orthop,2002,22(4):517-521.
8 Morcuende JA,Abbasi D,Dolan LA,et al.Results of an accelerated Ponseti protocol for clubfoot[J].J Pediatr Orthop,2005,25(5):623-626.DOI:10.1097/01.bpo.0000162015.44865.5e.
9 Segev E,Keret D,Lokiec F,et al.Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot[J].Isr Med Assoc J,2005,7(5):307-310.
10 Zhao D,Li H,Zhao L,et al.Results of clubfoot management using the Ponseti method:do the detailsmatter? A systematic review[J].Clin Orthop Relat Res,2014,472(4):1329-1336.DOI:10.1007/s11999-014-3463-7.
11 Smith PA,Kuo KN,Graf AN,et al.Long-term results of comprehensive clubfoot release versus the Ponseti method:which is better?[J].Clin Orthop Relat Res,2014,472(4):1281-1290.DOI:10.1007/s11999-013-3386-8.
12 Radler C,Manner HM,Suda R,et al.Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment[J].J Bone Joint Surg Am,2007,89(6):1177-1183.DOI:10.2106/JBJS.F.00438.
13 Bashi RH,Baghdadi T,Shirazi MR,et al.Modified Ponseti method of treatment for correction of neglected clubfoot in older children and adolescents-a preliminary report[J].J Pediatr Orthop B,2016,25(2):99-103.DOI:10.1097/BPB.0000000000000266.
14 Banskota B,Banskota AK,Regmi R,et al.The Ponseti method in the treatment of children with idiopathic clubfoot presenting between five and ten years of age[J].Bone Joint J,2013,95-B (12):1721-1725.DOI:10.1302/0301-620X.95B12.32173.
15 Faizan M,Jilani LZ,Abbas M,et al.Management of idiopathic clubfoot by Ponseti technique in children presenting after one year of age[J].J Foot Ankle Surg,2015,54(5):967-972.DOI:10.1053/j.jfas.2014.05.009.
16 Bor N,Coplan JA,Herzenberg JE.Ponseti treatment for idiopathic clubfoot:minimum 5-year followup[J].Clin Orthop Relat Res,2009,467(5):1263-1270.DOI:10.1007/s11999-008-0683-8.
17 Ponseti IV.Treatment of congenital club foot[J].J Bone Joint Surg Am,1992,74(3):448-454.DOI:10.1136/bmj.1.3362.1031.
18 Dobbs MB,Gordon JE,Walton T,et al.Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity[J].J Pediatr Orthop,2004,24(4):353-357.DOI:10.1097/00004694-200407000-00002.
19 Minkowitz B,Finkelstein BI,Bleicher M.Percutaneous tendo-Achilles lengthening with a large-gauge needle:a modification of the Ponseti technique for correction of idiopathic clubfoot[J].J Foot Ankle Surg,2004,43(4):263-265.DOI:10.1053/j.jfas.2004.05.012.
20 ElTayeby HM.Multiple tenotomies after Ponseti method for management of severe rigid clubfoot[J].J Foot Ankle Surg,2012,51(2):156-160.DOI:10.1053/j.jfas.2011.10.038.
21 Mahan ST,Spencer SA,Kasser JR.Satisfactory patient based outcomes after surgical treatment for idiopathic clubfoot:includes surgeon’s individualized technique[J].J Pediatr Orthop,2014,34(6):631-638.DOI:10.1097/BPO.0000000000000197.
22 Park SS,Lee HS,Han SH,et al.Gastrocsoleus fascial release for correction of equinus deformity in residual or relapsed clubfoot[J].Foot Ankle Int,2012,33(12):1075-1078.DOI:10.3113/FAI.2012.1075.
23 Mary P,Damsin JP,Carlioz H.Correction of equinus in clubfoot:the contribution of arthrography[J].J Pediatr Orthop,2004,24(3):312-316.
24 De Langh R,Mulier JC,Fabry G,et al.Treatment of clubfoot by posterior capsulectomy[J].Clin Orthop Relat Res,1975,(106):248-253.DOI:10.1097/00003086-197501000-00037.
25 Nomura S,Kondo M,Maekawa M,et al.Limited plantar flexion of the ankle in the surgically treated congenital clubfoot[J].Fukuoka Igaku Zasshi,1982,73(8):476-487.
Memo
收稿日期:2020-04-10。
作者简介:杨征,Email:yzhg816@126.com