Objective:To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months. Methods:Ponseti method was used to treat 157 cases (227 feet) of CTE ...Objective:To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months. Methods:Ponseti method was used to treat 157 cases (227 feet) of CTE in children older than 6 months. All cases were classified by age and by the degree of deformity severity. The age group classification was:(1)ⅠGroup (6 months to 12 months),113 feet in 81 cases; (2)Ⅱ Group (1 to 3 years old),78 feet in 52 cases; (3) Ⅲ Group (>3 years old),36 feet in 24 cases. The degree of deformity of CTE was evaluated with Pirani scoring system. The cases were classified into three groups according to the deformity degree:(1) Mild Group (scoring 1-2.5),85 feet in 56 cases; (2) Moderate Group (scoring 3-4.5),104 feet in 71 cases; (3) Severe Group (scoring 5-6),38 feet in 30 cases. A Pirani score of 0-0.5 is regarded as an excellent result. For each group,we evaluated the number of casts used,the percentage of excellent result according to the Pirani score,and the percentage of percutaneous achillotenotomy. The result was compared among different groups. Results:The overall percentage of excellent result among all cases was 96.92%. Among the age groups,the percentage of excellence was not statistically different betweenⅠGroup andⅡGroup (P>0.05). The percentage of excellence was lower in the Ⅲ group than the other groups (P>0.01). Among the groups classified by deformity degree,the percentage of excellence was the lowest in severe group (P<0.05),and the difference between the mild group and moderate group was not statistically different (P>0.05). The number of casts used among different groups were different (P<0.01). Among different groups,the percentages of percutaneous achillotenotomy were significantly different (P<0.01). 209 feet in 148 cases were followed up for average time duration of 3 years and 11 months. Relapse was observed in 40 feet in 29 cases. The percentages of relapse were not statistically different among different groups (P>0.05). Conclusion:Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.展开更多
目的提出坐骨重叠征(ischium overlap sign,IOS)的概念,并分析其与发育性髋关节脱位(developmental dysplasia of the hip,DDH)手术后再脱位的关系。方法回顾性分析2013年9月至2017年5月山东大学附属省立医院治疗的88例(105髋)DDH患儿...目的提出坐骨重叠征(ischium overlap sign,IOS)的概念,并分析其与发育性髋关节脱位(developmental dysplasia of the hip,DDH)手术后再脱位的关系。方法回顾性分析2013年9月至2017年5月山东大学附属省立医院治疗的88例(105髋)DDH患儿病例资料,其中男童16例、女童72例;平均年龄12(5~24)个月,平均随访时间34(15~59)个月;双侧17例,左侧63髋,右侧42髋;1髋为髋臼发育不良,11髋半脱位,93髋全脱位。术中行髋关节造影检查,按照Bowen标准选择闭合或切开复位石膏固定术。IOS是指在人类位髋关节造影平片上股骨头软骨内缘与坐骨外缘的重叠关系,二者重叠为Ⅰ度,相接为Ⅱ度,分离为Ⅲ度。将93髋全脱位按照IOS分度进行分组,比较组间再脱位发生率。结果 1髋髋臼发育不良和11髋半脱位者IOS均为Ⅰ度。93髋全脱位中IOSⅠ度14髋,Ⅱ度39髋,此两组均行闭合复位石膏固定,无再脱位病例;Ⅲ度40髋中,闭合复位石膏固定17髋,6髋再脱位;切开复位石膏固定23髋,1髋再脱位。本研究发现Ⅲ度组的再脱位发生率(7/40,17.5%)高于其他两组(P=0.006)。IOS为Ⅲ度的40髋中,闭合复位的再脱位发生率(6/17,35.3%)高于切开复位(1/23,4.4%),差异有统计学意义(X^2=4.518,P=0.034)。结论 IOS与DDH术后再脱位有一定的关系,IOS为Ⅲ度的髋关节如行闭合复位,再脱位的风险较高。展开更多
文摘Objective:To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months. Methods:Ponseti method was used to treat 157 cases (227 feet) of CTE in children older than 6 months. All cases were classified by age and by the degree of deformity severity. The age group classification was:(1)ⅠGroup (6 months to 12 months),113 feet in 81 cases; (2)Ⅱ Group (1 to 3 years old),78 feet in 52 cases; (3) Ⅲ Group (>3 years old),36 feet in 24 cases. The degree of deformity of CTE was evaluated with Pirani scoring system. The cases were classified into three groups according to the deformity degree:(1) Mild Group (scoring 1-2.5),85 feet in 56 cases; (2) Moderate Group (scoring 3-4.5),104 feet in 71 cases; (3) Severe Group (scoring 5-6),38 feet in 30 cases. A Pirani score of 0-0.5 is regarded as an excellent result. For each group,we evaluated the number of casts used,the percentage of excellent result according to the Pirani score,and the percentage of percutaneous achillotenotomy. The result was compared among different groups. Results:The overall percentage of excellent result among all cases was 96.92%. Among the age groups,the percentage of excellence was not statistically different betweenⅠGroup andⅡGroup (P>0.05). The percentage of excellence was lower in the Ⅲ group than the other groups (P>0.01). Among the groups classified by deformity degree,the percentage of excellence was the lowest in severe group (P<0.05),and the difference between the mild group and moderate group was not statistically different (P>0.05). The number of casts used among different groups were different (P<0.01). Among different groups,the percentages of percutaneous achillotenotomy were significantly different (P<0.01). 209 feet in 148 cases were followed up for average time duration of 3 years and 11 months. Relapse was observed in 40 feet in 29 cases. The percentages of relapse were not statistically different among different groups (P>0.05). Conclusion:Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.
文摘目的提出坐骨重叠征(ischium overlap sign,IOS)的概念,并分析其与发育性髋关节脱位(developmental dysplasia of the hip,DDH)手术后再脱位的关系。方法回顾性分析2013年9月至2017年5月山东大学附属省立医院治疗的88例(105髋)DDH患儿病例资料,其中男童16例、女童72例;平均年龄12(5~24)个月,平均随访时间34(15~59)个月;双侧17例,左侧63髋,右侧42髋;1髋为髋臼发育不良,11髋半脱位,93髋全脱位。术中行髋关节造影检查,按照Bowen标准选择闭合或切开复位石膏固定术。IOS是指在人类位髋关节造影平片上股骨头软骨内缘与坐骨外缘的重叠关系,二者重叠为Ⅰ度,相接为Ⅱ度,分离为Ⅲ度。将93髋全脱位按照IOS分度进行分组,比较组间再脱位发生率。结果 1髋髋臼发育不良和11髋半脱位者IOS均为Ⅰ度。93髋全脱位中IOSⅠ度14髋,Ⅱ度39髋,此两组均行闭合复位石膏固定,无再脱位病例;Ⅲ度40髋中,闭合复位石膏固定17髋,6髋再脱位;切开复位石膏固定23髋,1髋再脱位。本研究发现Ⅲ度组的再脱位发生率(7/40,17.5%)高于其他两组(P=0.006)。IOS为Ⅲ度的40髋中,闭合复位的再脱位发生率(6/17,35.3%)高于切开复位(1/23,4.4%),差异有统计学意义(X^2=4.518,P=0.034)。结论 IOS与DDH术后再脱位有一定的关系,IOS为Ⅲ度的髋关节如行闭合复位,再脱位的风险较高。
