Tahir VAROL, Lokman KARAKURT, Oktay BELHAN, H. Bayram TOSUN

Doğuştan Çarpık Ayaklı Olgularda Ponseti Yöntemi ile Tedavi Sonuçlarımız

Amaç: Ponseti yöntemi ile tedavi ettiğimiz doğuştan çarpık ayaklı (DÇA) olguların sonuçlarını değerlendirmek. Gereç ve Yöntem: Çalışmada, DÇA'lı 12 hastanın 18 ayağı değerlendirildi (8 erkek, 4 kız; ortalama yaş 5 gün). Dimeglio sınıflamasına göre, 10 ayak (%55.5) tip 2, 8 ayak (%44.5) tip 3 idi. Olgulara Ponseti yöntemi ile manipülasyon ve alçılama yapıldı. Ekin deformitesi için tüm olgulara perkütan Aşil tenotomisi yapıldı. Redüksiyonun korunması için ayak abdüksiyon cihazı kullanıldı. Ortalama takip süresi 21 ay (6-48 ay) idi. Bulgular: Son kontrolde 17 ayak (%94.4) Dimeglio tip 1, 1 ayak (%5.6) Dimeglio tip 2 idi. On hastanın 13 ayağında nüks görüldü. Nüks saptanan bu 10 hastanın 7'sinin ayak abdüksiyon ortezini düzenli kullanmadığı, hatta bir süre sonra kullanmayı bıraktıkları öğrenildi. Revizyon oranımız %11.1 idi ve bir ayağa komplet subtalar gevşetme, diğerine posteromedial gevşetme yapıldı. Bu iki hasta da ortezini düzenli kullanmamıştı. Sonuç: Ponseti yöntemi, idiyopatik tip DÇA deformitesini düzeltmede oldukça etkili bir yöntemdir. Başarılı sonuç alabilmek için yöntem tam olarak uygulanmalı ve ayak abdüksiyon ortezinin uygun şekil ve süre kullanılması amacı ile aileler eğitilmelidir. ©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler:

Doğuştan çarpık ayak, Ponseti, tedavi

Our Treatment Results of Congenital Clubfoot with the Ponseti Method

Objectives: We evaluated results of the Ponseti method in patients with congenital clubfoot deformity. Material and Methods: The study included 18 feet of 12 patients (8 boys, 4 girls; mean age was 5 days) with idiopathic clubfoot deformities. According to the Dimeglio classification, 10 feet (55.5%) were type 2, 8 feet (44.5%) were type 3. We did manipulation and casting with the Ponseti technique in all the patients. All of the patients underwent a percutaneous Achilles tenotomy for equinus deformity. Foot abduction brace was prescribed for maintenance of reduction. The mean follow-up period was 21 months (range 6-48 months). Results: At latest follow-up, 17 feet (94.4%) were Dimeglio type 1, 1 foot (5.6%) was Dimeglio type 2. We determined relapses in 13 feet of 10 patients. Seven of the 10 patients that we determined relapses had problems of using the abduction brace. Our revision rate was 11.1%; a foot required posteromedial release and another foot required complet subtalar release. These two patients were noncompliant with foot abduction brace. Conclusion: The Ponseti method is an effective method of treating congenital idiopathic clubfoot. The technique must be applied completely to obtain successful result and families must be educated to enhance the compliance to foot abduction brace.©2008, Firat University, Medical Faculty.

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Kabul Tarihi:10.08.2007