Araştırma Makalesi
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Mid-Term Clinical Results of Patients with Congenital Talipes Equinovarus Deformity Treated with Ponseti Method

Yıl 2018, Cilt: 2 Sayı: 3, 193 - 198, 13.11.2018
https://doi.org/10.30565/medalanya.422996

Öz

Aim: We aimed to evaluate the mid-term clinical
results of manipulation and casting treatment method with Ponseti technique in
patients with Congenital Talipes Equinovarus (CTEV) deformity.

Patients and Methods:Thirty-five patients were treated by
Ponseti technique of manipulation and casting treatment method in the
Department of Orthopedics and Traumatology of Kartal Training and Research
Hospital between 2005-2009 and 22 of them were males and 13 of them were
females. Twenty-one of 56 feet with CTEV were 21 bilateral and 14 of them were
unilateral. Clinical results were assessed according to the Pirani clubfoot
severity scoring system. Treatments of all patients were initiated beginning
from the moment of their application. Ages of the patients ranged between 2
days and 2 months. The total number of casts applied per patient was average 7
± (5-11). Achillotomies of all patients were performed under conditions of the
operating room. The patients were followed up for 28 ± (20-36) months after
application of achillotomy and foot cast for 3 weeks and followed by Dennis
Brown splint.

Results: Improvement in forefoot and hindfoot scores
after treatment was significant (p<0.001). Age at onset of treatment was
observed to have no therapeutic effect (p>0.05). During follow-ups of
treatment with abduction brace, achillotomies of two patients were required to
be repeated particularly due to recurrence of equinus deformity. Achillotomy
was not performed in eight patients since ankle dorsiflexion was greater than
15 degrees after serial cast treatment.


























Conclusion:In patients with CTEV, when Ponseti
method is performed in accordance with its technique and when the patients are
followed up regularly, it can be used as a successful treatment method.

Kaynakça

  • 1. Herring JB. Congenital talipes equinovarus. In: Tachdjian MO, editor. Tachdjian: pediatric orthopaedics. Philadelphia: W.B.Saunders Company; 2001. p. 922-59.
  • 2. Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital clubfoot. J Bone Joint Surg Am. 2002 Feb;84-A(2):290-308.
  • 3. Parker SE, Mai CT, Strickland MJ, Multistate study of the epidemiology of clubfoot. Birth Defects Res A Clin Mol Teratol. 2009 Nov;85(11):897-904.
  • 4. Kite JH. The treatment of congenital clubfoot. JAMA. 1932;99:1156.
  • 5. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am. 1992;74:448-54.
  • 6. Souchet , Bensahel : Functional Treatment of Clubfoot : A new Series of 350 İdiopathic Clubfeet With Long-term Follow up J Pediatr Orthop B. 2004 May;13(3):189-96.
  • 7. Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146–53.
  • 8. Pirani S, Hodges D, Sekeramayi F. A reliable & valid method of assessing the amount of deformity in the congenital clubfoot deformity. J Bone Joint Surg Br 2008; 90-B (Suppl 1):53. 9. Ponseti IV, Smoley EN. Congenital clubfoot: the results of treatment. J Bone Joint Surg Am. 1963;45(2):261–344.
  • 10. Ponseti IV, Smoley EN. The classic: congenital club foot: the results of treatment. 1963. Clin Orthop Relat Res 2009; 467(5):1133-45.
  • 11. Faizan M, Jilani LZ, Abbas M, Zahid M, Asif N. Management of idiopathic clubfoot by Ponseti technique in children presenting after one year of age. J Foot Ankle Surg. 2015;54(5):967–72.
  • 12. Alves C, Escalda C, Fernandes P, Tavares D, Neves MC. Ponseti method:does age at the beginning of treatment make a difference? Clin Orthop Relat Res. 2009;467(5):1271–7.
  • 13. Bor N, Herzenberg JE, Frick SL. Ponseti management of club foot in older infants. Clin Orthop Relat Res. 2006;444:224–8.
  • 14. Napiontek M1, Jóźwiak M., Skew foot--etiology, clinical appearance, management Chir Narzadow Ruchu Ortop Pol. 1994;59(5):461-70.
  • 15. Koureas G1, Rampal V, Mascard E, Seringe R, Wicart P. The incidence and treatment of rocker bottom deformity as a complication of the conservative treatment of idiopathic congenital clubfoot. J Bone Joint Surg Br. 2008 Jan;90(1):57-60.
  • 16. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62:23-31.
  • 17. David M. Scher, MD, Predicting the Need for Tenotomy in the Ponseti Method for Correction of Clubfeet J Pediatr Orthop 2004;24:349–52.
  • 18. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004;113:376- 80.
  • 19. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002;22:517-21.
  • 20. Thacker MM, Scher DM, Sala DA, et al. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop 2005; 25:225-8.
  • 21. Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding Complications Following Percutaneous Tendoachilles Tenotomy in the Treatment of Clubfoot Deformity. J Pediatr Orthop 2004; 24: 353-7.
  • 22. Ponseti IV. Common errors in the treatment of congenital clubfoot. Int Orthop.1997;21:137-41.
  • 23. Wynne-Davies R. Family Studies and the Cause of Congenital Club Foot. Talipes Equinovarus, Talipes Calcaneo-Valgus and Metatarsus Varus. J Bone Joint Surg Br. 1964; 46:445–63.
  • 24. Ponseti IV. The ponseti technique for correction of congenital clubfoot. J Bone Joint Surg Am 2002;84-A:1889–90 author reply 90–1.

Ponseti Yöntemiyle Tedavi Edilen Konjenital Pes Ekinovaruslu Hastaların Orta Dönem Sonuçları

Yıl 2018, Cilt: 2 Sayı: 3, 193 - 198, 13.11.2018
https://doi.org/10.30565/medalanya.422996

Öz

Amaç:Konjenital Pes Ekinovarus (KPEV)
deformiteli hastalarda Ponseti tekniğiyle manipulasyon ve alçı tedavi
yönteminin orta dönem klinik sonuçlarını değerlendirmeyi amaçladık.

Hastalar ve Yöntemler:Kartal Eğitim ve Araştırma Hastanesi
Ortopedi ve Travmatoloji Kliniğinde 2005 - 2009 yılları arasında Ponseti
tekniğiyle manipulasyon ve alçı yöntemiyle tedavi edilen 35 hastanın, 22’si erkek
13’ü kızdı. KPEV’li 56 ayağın 21’i bilateral, 14’ü tek taraflıydı. Klinik
sonuçlar Pirani skorlama sistemine göre değerlendirildi. Tüm hastaların
tedavisine hastanemize başvurduğu andan itibaren başlandı. Hastaların yaşı 2
günle 2 ay arasındaydı. Hasta başına ortalama 7 (5-11) adet alçı yapıldı. Tüm
hastaların aşilotomileri ameliyathane koşullarında yapıldı. Aşilotomi ve 3
hafta alçı uygulamasını takiben tüm hastalar Dennis Brown ateliyle ortalama 28
(20-36) ay takip edildi.

Bulgular:Ön ve arka ayak skorlarında tedavi
sonrası düzelme anlamlı derecedeydi (p<0.001). Tedaviye başlama yaşının tedaviye
etkisi olmadığı görüldü (p>0.05). Abduksiyon breysi tedavisinin takibi
sırasında iki hastanın aşilotomisinin, özellikle ekin deformitesinin nüks
etmesi sebebiyle, tekrarlanması gerekti. Sekiz hastaya seri alçılama
tedavisinden sonra ayak bileği dorsifleksiyonunun 15 dereceden fazla olması
nedeniyle aşilotomi yapılmadı.


























Sonuç: KPEV’li hastalarda Ponseti yöntemi, tekniğine
uygun yapıldığında ve hastaların takipleri düzenli gerçekleştirildiğinde başarılı
bir tedavi yöntemi olarak uygulanabilir.

Kaynakça

  • 1. Herring JB. Congenital talipes equinovarus. In: Tachdjian MO, editor. Tachdjian: pediatric orthopaedics. Philadelphia: W.B.Saunders Company; 2001. p. 922-59.
  • 2. Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital clubfoot. J Bone Joint Surg Am. 2002 Feb;84-A(2):290-308.
  • 3. Parker SE, Mai CT, Strickland MJ, Multistate study of the epidemiology of clubfoot. Birth Defects Res A Clin Mol Teratol. 2009 Nov;85(11):897-904.
  • 4. Kite JH. The treatment of congenital clubfoot. JAMA. 1932;99:1156.
  • 5. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am. 1992;74:448-54.
  • 6. Souchet , Bensahel : Functional Treatment of Clubfoot : A new Series of 350 İdiopathic Clubfeet With Long-term Follow up J Pediatr Orthop B. 2004 May;13(3):189-96.
  • 7. Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146–53.
  • 8. Pirani S, Hodges D, Sekeramayi F. A reliable & valid method of assessing the amount of deformity in the congenital clubfoot deformity. J Bone Joint Surg Br 2008; 90-B (Suppl 1):53. 9. Ponseti IV, Smoley EN. Congenital clubfoot: the results of treatment. J Bone Joint Surg Am. 1963;45(2):261–344.
  • 10. Ponseti IV, Smoley EN. The classic: congenital club foot: the results of treatment. 1963. Clin Orthop Relat Res 2009; 467(5):1133-45.
  • 11. Faizan M, Jilani LZ, Abbas M, Zahid M, Asif N. Management of idiopathic clubfoot by Ponseti technique in children presenting after one year of age. J Foot Ankle Surg. 2015;54(5):967–72.
  • 12. Alves C, Escalda C, Fernandes P, Tavares D, Neves MC. Ponseti method:does age at the beginning of treatment make a difference? Clin Orthop Relat Res. 2009;467(5):1271–7.
  • 13. Bor N, Herzenberg JE, Frick SL. Ponseti management of club foot in older infants. Clin Orthop Relat Res. 2006;444:224–8.
  • 14. Napiontek M1, Jóźwiak M., Skew foot--etiology, clinical appearance, management Chir Narzadow Ruchu Ortop Pol. 1994;59(5):461-70.
  • 15. Koureas G1, Rampal V, Mascard E, Seringe R, Wicart P. The incidence and treatment of rocker bottom deformity as a complication of the conservative treatment of idiopathic congenital clubfoot. J Bone Joint Surg Br. 2008 Jan;90(1):57-60.
  • 16. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62:23-31.
  • 17. David M. Scher, MD, Predicting the Need for Tenotomy in the Ponseti Method for Correction of Clubfeet J Pediatr Orthop 2004;24:349–52.
  • 18. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004;113:376- 80.
  • 19. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002;22:517-21.
  • 20. Thacker MM, Scher DM, Sala DA, et al. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop 2005; 25:225-8.
  • 21. Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding Complications Following Percutaneous Tendoachilles Tenotomy in the Treatment of Clubfoot Deformity. J Pediatr Orthop 2004; 24: 353-7.
  • 22. Ponseti IV. Common errors in the treatment of congenital clubfoot. Int Orthop.1997;21:137-41.
  • 23. Wynne-Davies R. Family Studies and the Cause of Congenital Club Foot. Talipes Equinovarus, Talipes Calcaneo-Valgus and Metatarsus Varus. J Bone Joint Surg Br. 1964; 46:445–63.
  • 24. Ponseti IV. The ponseti technique for correction of congenital clubfoot. J Bone Joint Surg Am 2002;84-A:1889–90 author reply 90–1.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Güray Altun 0000-0002-0669-8070

Tuhan Kurtulmuş

Yayımlanma Tarihi 13 Kasım 2018
Gönderilme Tarihi 11 Mayıs 2018
Kabul Tarihi 17 Eylül 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 2 Sayı: 3

Kaynak Göster

Vancouver Altun G, Kurtulmuş T. Ponseti Yöntemiyle Tedavi Edilen Konjenital Pes Ekinovaruslu Hastaların Orta Dönem Sonuçları. Acta Med. Alanya. 2018;2(3):193-8.

9705 

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