万明　郑晓明　韩海宁　吴薇　黄伟彦　王康振

[摘要]目的：探究Ponseti系列石膏联合中医手法按摩矫正小儿先天性马蹄内翻足的疗效及外观满意度情况。方法：回顾性分析笔者医院2018年2月-2020年5月接受单纯Ponseti系列石膏矫正疗法治疗（对照组）及Ponseti系列石膏联合中医手法按摩治疗（观察组）各40例先天性马蹄内翻足患儿的临床资料。比较两组患儿治疗过程中相关指标（石膏固定总时长、平均石膏固定次数、跟腱切断手术率），记录其治疗前、治疗6个月后的足踝功能（Pirani严重程度评分、Laaveg-Ponseti评分、正位片距跟角、侧位片距跟角）变化，并参考《足外科》及自拟问卷的形式评估治疗后1年的临床疗效及外观满意度。结果：观察组石膏固定总时长、平均石膏固定次数、跟腱切断手术率、跟腱延长手术率均明显低于对照组，差异有统计学意义（P<0.05）。治疗6个月后，两组患儿Pirani严重程度评分较治疗前均有显著下降，且观察组明显低于对照组，差异有统计学意义（P<0.05）;两组Laaveg-Ponseti评分、正位片距跟角、侧位片距跟角较治疗前均有显著上升，且观察组明显高于对照组，差异有统计学意义（P<0.05）。治疗后1年，观察组总有效率及满意度为96.49%、92.50%高于对照组的85.71%、75.00%，差异有统计学意义（P<0.05）。结论：联合中医手法按摩后，Ponseti系列石膏矫正疗法治疗总时长减少，跟腱松解后疗效能得到巩固，且按摩手法学习难度小，治疗后外观满意度高，适合广泛推广及应用。

[關键词]Ponseti技术;石膏矫正;中医手法按摩;先天性马蹄内翻足;疗效;外观满意度

[中图分类号]R682.1+6    [文献标志码]A    [文章编号]1008-6455（2021）09-0017-05

Efficacy of Ponseti Series Plaster Combined with Traditional Chinese Medicine Manual Massage in the Correction of Congenital Talipes Equinovarus

WAN Ming，ZHENG Xiao-ming，HAN Hai-ning，WU Wei，HUANG Wei-yan，WANG Kang-zhen

（Third Department of Orthopedics，Zhongshan Hospital of Traditional Chinese Medicine，Zhongshan 528400，Guangdong，China）

Abstract： Objective  To explore the efficacy and appearance satisfaction of Ponseti series plaster combined with Traditional Chinese Medicine manual massage in the correction treatment of congenital talipes equinovarus in children. Methods  A retrospective analysis was performed on clinical data of each 40 children patients with congenital talipes equinovarus who received Ponseti series plaster correction therapy （the control group） or received Ponseti series plaster combined with traditional Chinese medicine manual massage （the observation group） in the our hospital between February 2018 and May 2020.  The related indicators during treatment （total duration of plaster fixation， average frequency of plaster fixation， achillotomy rate） were compared between the two groups， and the changes of foot-ankle function （Pirani severity score， Laaveg-Ponseti score， talocalcaneal angle of anterioposterior film， talocalcaneal angle of lateral film） were recorded before treatment and after 6 months of treatment， and Podiatric Surgery reference and self-made questionnaire were used to evaluate the clinical efficacy and appearance satisfaction at 1 year after treatment. Results  The total duration of plaster fixation， average frequency of plaster fixation， achillotomy rate and achilles tendon lengthening rate in the observation group were significantly shorter or lower than those in the control group （P<0.05）. After 6 months of treatment， the Pirani severity score in the two groups was significantly decreased compared to before treatment （P<0.05）， and the score in the observation group was significantly lower than that in the control group （P<0.05）. The Laaveg-Ponseti score， talocalcaneal angle of anterioposterior film， and talocalcaneal angle of lateral film of the two groups were significantly increased compared with those before treatment （P<0.05）， and the indexes in the observation group were significantly higher than those in the control group （P<0.05）. At 1 year after treatment， the total effective rate and satisfaction were 96.49% and 92.50% in the observation group， which were higher than those in the control group （85.71% and 75.00%， P<0.05）. Conclusion  After combination of Traditional Chinese Medicine manual massage， Ponseti series plaster correction therapy can shorten total duration of plaster fixation and consolidate the efficacy after achillotomy， and it has low difficulty of learning the manipulation and high appearance satisfaction after treatment， thus it is suitable for widespread promotion and application.

Key words： Ponseti technique; plaster correction; Traditional Chinese Medicine manual massage; congenital talipes equinovarus; efficacy; appearance satisfaction

先天性马蹄内翻足是临床最为常见的小儿足部畸形疾病，其主要表现为后足内翻、内旋，前足内收、高弓等，主要由足下垂、内翻、内收3个畸形症状综合形成，严重影响其足部功能，且还可造成运动障碍[1]。目前，临床针对该病的治疗方案尚未形成统一规定，但早期保守治疗是大部分医师的共识[2]。20世纪90年代，潘塞缇教授在《骨与关节外科杂志》中首次提出Ponseti系列石膏矫正疗法的概念，在长期随访过程中发现有效率可达到89%，引起广泛重视[3]。近年来，该疗法已成为治疗先天性马蹄内翻足的主要方法，但随着研究的不断深入，部分学者发现，该技术需不断替换石膏，且整体治疗时间长达10～12周，存在一定局限性[4]。……