POUL, Jan. Výsledky Ponsetiho metody v odstupu 4 až 6 let od začátku terapie (Results of the Ponseti Treatment Evaluated at Four to Six Years after it Started). Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca. Praha: Galén, 2012, vol. 79, No 6, p. 524-528. ISSN 0001-5415.
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Basic information
Original name Výsledky Ponsetiho metody v odstupu 4 až 6 let od začátku terapie
Name (in English) Results of the Ponseti Treatment Evaluated at Four to Six Years after it Started
Authors POUL, Jan.
Edition Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca, Praha, Galén, 2012, 0001-5415.
Other information
Original language Czech
Type of outcome Article in a journal
Field of Study 30211 Orthopaedics
Country of publisher Czech Republic
Confidentiality degree is not subject to a state or trade secret
Impact factor Impact factor: 1.628 in 2009
Organization unit Faculty of Medicine
UT WoS 000313143300008
Keywords in English talipes equinovarus congenitus; Ponseti treatment; follow-up; critical analysis; failure of Ponseti treatment
Tags International impact, Reviewed
Changed by Changed by: Ing. Mgr. Věra Pospíšilíková, učo 9005. Changed: 22. 4. 2013 16:59.
Abstract
Ponsetiho koncept včasné léčby pes equinovarus congenitus platí bezpochyby ve světě v současné době za "zlatý standard" terapie. Je spíše pozoruhodné, že metoda kterou autor opakovaně publikoval sám nebo se svými spolupracovníky již od šedesetých let minulého století byla lékařskou veřejností akceptována na přelomu dalšího století. Genialita inaugurátora této metody tkví v tom, že odkryl vnitřní "zamčení" nohy při snaze korigovat deformitu převáděním do everze. Naopak pokud je přední noha převáděna do supinace tlakem na hlavičku I. MTT zespodu a následně se noha abdukuje dochází k repozici kalkaneo-pedálního bloku. Protitlak je vykonáván tlakem na zevní stranu hlavice talu (fulcrum). Podrobný popis této nové metody je dostupný i v českém písemnictví. Cílem této studie bylo zpracovat vlastní soubor pacientů s ohledem na frekvenci selhání metody při dostatečně dlouhé době sledování 4-6 let. Za kritérium selhání byla stanovena taková reziduální deformita, že splňovala indikační podmínky pro subtalární uvolnění nohy.
Abstract (in English)
PURPOSE OF THE STUDY To assess outcomes of the Ponseti method for treatment of talipes equinovarus in relation to patient age at its start. MATERIAL AND METHODS In the 2006-2010 period, 115 children (163 feet) with talipes equinovarus were treated using the principles of Ponseti. The right foot was affected in 44, the left foot in 23, and the bilateral form was treated in 48 patients. In order to obtain results for at least 3 years of follow-up, we included the patients treated by the Ponseti method between 2006 and 2008, in whom 83 affected feet were analysed (23 isolated right feet, 14 left feet, 23 bilateral forms). According to the Dimeglio scoring system used to assess the severity of clubfoot deformity, there were four feet in group II, 37 feet in group III and 42 feet in group IV. RESULTS Subtalar release was performed in 29 feet (34.9%), in two feet being only posterior. Moreover, foot deviations, e.g. adduction of the forefoot less than 100 (5 feet, 6%), varus deformity of the heel less than 50 (6 feet, 7.2%), and failure to complete the Ponseti treatment (3 feet, 3.6%) were recorded. For assessment of the effect of age at start of casting on the outcome, two patient subgroup were distinguished: group 1, the treatment stared and continued in the first 8 postnatal weeks; group 2, the treatment was initiated and carried out between 9 and 20 weeks postnatally. Subsequently, subtalar release was performed in 18 of 61 feet (29.5%) in group 1, and in 11 of 21 feet (52.4 %) in group 2. Using Fischer's exact test, the difference was found statistically significant. (p<0.05). Of the three patients with an unfinished course of initial treatment, two underwent subtalar release later and one was lost to follow-up. DISCUSSSION Contrary to many recent reports, the frequency of Ponseti treatment failure in this study is substantially higher. Nevertheless, we adhered strictly to the Ponseti protocol of treatment, tenotomy was performed under general anaesthesia and Ponseti splinting was maintained properly in all but seven patients (8.4%). CONCLUSIONS Irrespective of rather frequent failure of the initial Ponseti treatment, its contribution for the patient is beneficial as it can reduce the extent of subtalar release required. However, a modern family will hardly accept several years of applying splints every night, irrespective of maximally sophisticated bracing. This becomes critical usually at the age when the child starts walking. Nowadays, families cooperate quite well due to the fact that a new method with high mass-media coverage has been offered to them.
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