Uticaj rane tenotomije Ahilove tetive na trajanje i rezultate lečenja teških oblika urođenog krivog stopala
Sažetak
Apstrakt
Uvod/Cilj. U radu prikazujemo našu modifikaciju Ponseti metode koju koristimo za lečenje teških oblika urođenog krivog stopala od 2007. godine. Modifikacija se sastoji u ranoj tenotomiji Ahilove tetive. Tenotomiju smo radili odmah nakon korekcije metatarzalnog dela stopala. Cilj rada bio je da na osnovu analize rezultata između dve grupe ispitanika utvrdimo uticaj rane tenotomije Ahilove tetive na dužinu i rezultate lečenja teških oblika urođenog krivog stopala. Metode. Istraživanje je bilo prospektivno i trajalo je od 2007. do 2016. godine. Sprovedeno je u Klinici za dečiju hirurgiju u Banjaluci. Grupu 1 činili su ispitanici lečeni u periodu 2007–2016. godina modifikovanom Ponseti metodom (n = 30; 52 stopala). Zastupljenost muškog pola bila je 67%, a ženskog pola 33%. Grupu 2 činili su ispitanici lečeni u istom periodu klasičnom Ponseti metodom (n = 32; 52 stopala). Zastupljenost muškog pola u ovoj grupi bila je 81%, a ženskog pola 19%. Piraniev skor koristili smo za: klasifikaciju deformiteta prema težini, praćenje uspeha korekcije, postavljanje indikacija za tenotomiju Ahilove tetive i za analizu rezultata liječenja. Rezultati. Ukupno trajanje lečenja u Grupi 1 kretalo se od 6 do 9 nedelja (prosečno 6,71 ± 0,871 nedelja). U Grupi 2 lečenje je trajalo od 9 do 12 nedelja (prosečno 9,92 ± 0,882 nedelja). Trajanje lečenja u Grupi 1 bilo je značajno kraće nego u Grupi 2 (r = 0,86, p = 0,001). Nije bilo razlike između grupa u rezlutatima lečenja (χ2 = 2,372; df = 2; n = 52; p = 0,936). Zaključak. Primena rane tenotomije Ahilove tetive u lečenju teških oblika urođenog krivog stopala značajno skraćuje trajanje lečenja i nema negativan uticaj na rezultate lečenja.
Reference
REFERENCES
Dimeglio A, Bensahel H. Classificationof clubfoot. J Pediatr Or¬thop B 1995; 1995; 4(2): 129–36.
Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 2001; 21(6): 719–26.
Ponseti IV. Congenital Clubfoot: Fundalmentas of Treatment. Oxford: Oxford University Press; 1996.
Carroll NC. Clubfoot in zhe twentieth centry: Where we were and where we may be going in the twenty century. J Pediatr Orthop B 2010; 21(1): 1–6.
Catherine M, Salazar JJ, Lee H. Surgical Versus Ponseti Ap-proach for the Management of CTEV: A Comparative Study Duffy. J Pediatr Orthop 2013; 33(3): 326–32.
Chaweerat R, Kaewpornsawan K, Wongsiridej P, Payakkaraung S, Sin¬noi S,Meesamanpong S. The effectiveness of parent manipula-tion on newborns with postural clubfoot: a randomized con-trolled trial. J Med Assoc Thai 2014; 97Suppl 9: S68–72.
Chen RC, Gordon EJ, Luhmann SJ, Schoenecker PL, Dobbs MB. New Dynamic Foot Abduction Orthosis for Clubfoot Treat-ment. J Pediactr Orthop 2007; 27(5): 522–8.
Chong DY, Finberg NS, Conklin MJ, Doyle JS, Khoury JG, Gilbert SR. Prospective evaluation of the use of Mitchell shoes and dynamic abduction brace for idiopathic clubfeet. J Pediatr Or-thop B 2014; 23(6): 501–4.
Desail S, Aroojis A, Mehta R. Ultrasoud Evaluation of Club-foot Correction During Ponseti Treatment: A Preliminary Re-port. J Pediactr Orthop 2008; 28(1): 53–9.
George HL, Umikrishman PN, Garg NK, Sampath J, Bruce CE. Uni¬lateral foot abduction orthosis is it substitutie for Denis Browne boots following Ponseti technique. J Pediatr Orthop 2011; 22(1): 22–5.
George P, Robin W. Preoperative Equinus Angle and Prognosis in Congenital Talipes Equinovarus: A Preliminary Report Tse-lentakis. J Pediatr Orthop B 2000; 9(3): 201–6.
Laaveg SJ, Ponseti IV. Long-term results of treatment of conge-ni¬tal club foot. J Bone Joint Surg Am 1980; 62(1): 23–31.
Limpaphayom N, Kerr SJ, Prasongchin P. Idiopathic clubfoot: ten year follow-up after a soft tissue release procedure. Int Orthop 2015; 39(1): 81–6.
Morcuende A, Abbasi D, Dolan L, Ponseti I. Results of an Acceler¬ated Ponseti Protocol for Clubfoot. J Pediatr Orthop 2009; 25(5): 623–6.
Nasr P, Berman L, Rehm A. Ultrasonographic findings after Achilles tenotomy during Ponseti treatment for clubfeet: Is ul-trasound a reliable tool to assess tendon healing? J Child Or-thop 2014; 8(5): 405–11.
Ramírez N, Flynn JM, Fernández S, Seda W, Macchiavelli RE. Ortho¬sis noncompliance after the Ponseti method for the treatment of idiopathic clubfeet: A relevant problem that needs reevaluation. J Pediatr Orthop 2011; 31(6): 710–5.
Stephan C, Herzenberg JE, Araujo FF. Accurate determination of cast weight for neonates with clubfoot. J Pediatr Orthop 2000; 20(2): 230–3.
Thacker MM, Scher DM, Sala DA, van Bosse HJ, Feldman DS, Leh¬man WB. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop 2005; 25(2): 225–8.
Zionts LE, Dietz FR. Bracing following correction of idio-pathic clubfoot using the Ponseti method. J Am Acad Orthop Surg 2010; 18(8): 486–93.
Ponseti IV, Smoley EN. Congenital Clubfoot: The Results of Treatment. Iowa Orthop J 1984; 4: 24–33.
Abdelgawad AA, Lehman WB, Bosse HJP, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: Minimum 2-year follow-up. J Pediatr Orthop B 2007; 16(2): 98–105.