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

Güray Altun , Tuhan Kurtulmuş

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.

Anahtar Kelimeler

Pes eqinovarus, Ponseti method, Achillotomy

Ponseti Yöntemiyle Tedavi Edilen Konjenital Pes Ekinovaruslu Hastaların Orta Dönem Sonuçları

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.

Anahtar Kelimeler

Pes ekinovarus, Ponseti yöntemi, Aşilotomi

Kaynakça

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