陈嘉辉 周颖聪 李娟 许伟森

【摘要】 目的：探討与分析缩短更换石膏间歇时间改良Ponseti方法治疗先天性马蹄内翻足（CCF）的效果。方法：选择本院2019年9月-2020年3月收治的CCF患者48例作为改良组，2016年6月-2019年8月收治的CCF患者48例作为对照组。对照组采用传统Ponseti方法治疗，改良组采用缩短更换石膏间歇时间改良Ponseti方法治疗。比较两组临床疗效、并发症发生情况、Pirani评分以及运动神经传导情况变化。结果：治疗12个月后，改良组的优良率为97.9%，高于对照组的85.4%（P<0.05）。治疗期间，改良组不良事件（压疮、石膏松动、石膏脱落、静脉血栓）发生率为4.2%，低于对照组的20.8%（P<0.05）。治疗12个月后，两组Pirani评分均低于治疗前，且改良组低于对照组（P<0.05）。治疗12个月后，两组腓总神经与胫神经传导波幅正常率均高于治疗前，且改良组均高于对照组（P<0.05）。结论：缩短更换石膏间歇时间改良Ponseti方法治疗CCF能提高治疗效果，降低不良事件的发生，还能改善患儿的临床症状与神经肌肉功能。

【关键词】 缩短更换石膏间歇时间 改良Ponseti方法 先天性马蹄内翻足 神经肌肉功能 Pirani评分

Analysis of the Effect of Modified Ponseti Method Based on Shortening the Intermittent Time of Plaster Replacement in the Treatment of Congenital Clubfoot/CHEN Jiahui， ZHOU Yingcong， LI Juan， XU Weisen. //Medical Innovation of China， 2021， 18（34）： 00-005

[Abstract] Objective： To explore and analysis the effect of modified Ponseti method based on shortening the intermittent time of plaster replacement in the treatment of congenital clubfoot. Method： 48 cases of congenital clubfoot （CCF） patients admitted in our hospital from September 2019 to March 2020 were selected as the modified group， and the other 48 cases of CCF patients admitted from June 2016 to August 2019 were selected as the control group. The control group was treated with the traditional Ponseti method， and the modified group was treated with the modified Ponseti method based on shortening the intermittent time of plaster replacement. The clinical efficacy， complications， Pirani score and motor nerve conduction changes were compared between the two groups. Result： After 12 months of treatment， the excellent and good rate of the modified group was 97.9%， which was higher than 85.4% of the control group （P<0.05）. The incidence of adverse events （pressure sores， loosening of plaster， falling plaster and venous thrombosis） in the modified group during treatment was 4.2%， which was lower than 20.8% in the control group （P<0.05）. The Pirani scores of the two groups after 12 months of treatment were lower than those of the before treatment， and that of the modified group was lower than that of the control group （P<0.05）. After 12 months of treatment， the normal amplitude of conduction wave rates of common peroneal nerve and tibial nerve in the two groups were higher than those before treatment， and those in the modified group were higher than those in the control group （P<0.05）. Conclusion： The modified Ponseti method based on shortening the intermittent time of plaster replacement in the treatment of CCF can promote the overall curative effect， reduce the incidence of adverse events， and improve the clinical symptoms and neuromuscular function of children.

[Key words] Shortening the intermittent time of plaster replacement Modified Ponseti method Congenital clubfoot Neuromuscular function Pirani score

First-author’s address： 8th People’s Hospital of Dongguan （ Dongguan Children’s Hospital ）， Dongguan 523325， China

doi：10.3969/j.issn.1674-4985.2021.34.001

先天性馬蹄内翻足（congenital clubfoot，CCF）是小儿常见的一种严重影响足部功能的畸形，在小儿中的发病率为千分之一，男性发病率高于女性[1-2]。CCF多为单侧发病，在临床上多表现为踝关节马蹄、高弓足、前足内收、跟骨内翻等，可以造成严重的足部畸形和严重的功能障碍，严重影响患儿的身心健康[3]。CCF的病因与发病机制目前尚不明确，但是多伴随有神经肌肉电生理异常。肌电图检查可以较客观地反映患儿神经肌肉的功能状态，也是判断神经肌肉病变的良好检查方法之一[4-5]。……