Ponseti Yöntemi ile Tedavi Edilen Doğuştan Çarpık Ayaklı Olguların Erken Dönem Sonuçları

Amaç: Ponseti yöntemi ile tedavi edilen doğuştan çarpık ayaklı (DÇA) olguların erken dönem sonuçlarını değerlendirmek. Gereç ve Yöntem: Çalışmaya 2009-2010 yıllarında Ponseti yöntemi ile tedavi edilmiş 27 (17 erkek, 10 kız ortalama yaş 12 gün ; dağılım 0- 35 gün) hastanın 38 ayağı alındı. Hastalardan 11’inde çift 16’sında tek taraflı deformite vardı. Tek taraflı olguların 9’unda sol 7’sinde sağ ayak etkilenmişti. Başka bir merkezde Doğuştan çarpık ayak(DÇA) tedavi gören, eşlik eden hastalıkları olan olgular çalışmaya dahil edilmedi. DÇA tanısı ile alçılamaya başlanıp devam edilemeyen yada ortez kullanmayan olgular çalışma dışında tutuldu. Ortalama takip süresi 14ay(12-17 ay) idi. Hastaların tamamına perkütan aşil tenotomisi uygulandı. Bulgular: Bir yıllık takip sonrasında yöntemin tam olarak uygulandığı ve çalışmaya dahil edilen 27 olgunun tamamında klinik olarak düzelme elde edildi. Bu olguların radyolojik değerlendirmesinde de normal sınırlarda değerler elde edilmiştir. Uygulamadaki en önemli sorun otez kullanımına uyum sağlanması ve uygun ortez yapımının sağlanamaması olduğu gözlenmiştir. Sonuç: Ponseti yöntemi ile DÇA tedavisinde başarılı bir sonuç için yöntemin kurallarına uygun şekilde titizlikle uygulanması, olguların sık ve yakından takibi ve ailelerin eğitiminin yanında ortotist eğitimininde önemli olduğu düşünülmektedir.

Early Results of Congenital Clubfoot Treatment With Ponseti Method

Objective: The purpose of this study is to evaluate early results of ponseti method for the treatment of congenital club foot. Materials and Methods: A total of 27 patients’ (38 clubfeet,17 boys, 10 girls; mean age 12 day) were treated by Ponseti method during the periot of 2009 to 2010 years. Eleven patients had bilateral and 16 pateints had unilateral clubfoot. Patients,which were treated by another medical center or had any concomitant illness ,were not included into this study. Some patients were excluded from this study, because they left the treatment or they did not use their splint. Mean follow up period was 14 months (12-17 months). We have performed percutenous achilles tenotomy in all patients. Results: Clinically we achieved exellent results in the patients whose method was performed properly.The radiological evaluation of these patients were also satisfactory. Poor compliance with the splint and or improper method of surgery were the main problems in these patients. Conclusion: Correct applying the Ponseti method, carefully following up the patients with frequent periods, education problems of patients' parents and orthotists, lack of understanding and poor compliance of patients' parents can all affect a successful outcome.

Kaynakça

1. Matthew BD, Christina AG. update on clubfoot: etiology and treatment. Clin Orthop Relat Res 2009; 467: 1146–53.

2. Herring JA, Karol LA, Richards SB, Johnston CE. Disorders of the Foot. Herring JA (Editors). Tachdjian's Pediatric Orthopaedics, 3.Baskı, Philedelphia, Elsevier Saunders 2002; 922-58.

3. McKay DW. New concept of and approach to clubfoot treatment:section II-correction of the clubfoot. J Pediatr Orthop 1983; 3: 10-21.

4. Napiontek M. Clinical and radiographic appearance of congenital talipes equinovarus after successful nonoperative treatment. J Pediatr Orthop 1996; 16: 67-72.

5. Uglow MG, Clarke NM. The functional outcome of staged surgery for the correction of talipes equinovarus. J Pediatr Orthop 2000; 20: 517-23.

6. Simons GW. Complete subtalar release in club feet. Part II Comparison with less extensive procedures. J Bone Joint Surg 1985; 67: 1056-65.

7. Centel T, Bagatur AE, Ogut T, Aksu T. Comparison of the soft-tissue release methods in idiopathic clubfoot. J Pediatr Orthop 2000; 20:648-51.

8. Ankur G, Saurabh S, Pankaj P, Jyotish P, Manish KV. Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation International Orthopaedics 2008; 32: 75–9.

9. Noam B, Julie AC, John EH. Ponseti Treatment for Idiopathic Clubfoot Clin Orthop Relat Res 2009; 467: 1263–70

10. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B 1995; 4: 129-36.

11. Ponseti IV. Common errors in the treatment of congenital clubfoot. Int Orthop 1997; 21: 137-41.

12. Turco VJ. Surgical correction of the resistant club foot. Onestage posteromedial release with internal fixation: a preliminary report. J Bone Joint Surg 1971; 53: 477-97.

13. Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am 2003; 85: 1286-94.

14. Catterall A, Early assessment and management of the club foot. Benson MK, Fixsen JA, Macnicol MF, Parsch K (Editors). Childrens orthopaedics and fractures. 2. Baskı, London: Churchill Livingstone, 2002: 464-77.

15. Ernst BZ, Tanja K, Claudia M, Gerhardt S, Wolfgang EL. Comparison of Ponseti versus surgical treatment for idiopathic clubfoot. Clin Orthop Relat Res 2009; 467: 2668–76.

16. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg 1980; 62: 23-31.

17. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg 1995; 77: 1477-89.

18. Dimeglio A, Bonnet F, Mazeau P, De Rosa V. Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot. J Pediatr Orthop B 1996; 5: 173-80.

19. Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 2001; 21: 719-26.

20. Willis RB, Mazen AH, Luis G, Ken K. what proportion of patients need extensive surgery afterfailure of the ponseti technique for clubfoot? Clin Orthop Relat Res 2009; 467: 1294–7.

21. Milind MP, Dipak SP, Hiral RC. Mid-term results of ponseti methıd for the treatment of congenital idiopathic clubfoot. J Orthop Surg Res 2011, 6: 3.

22. Bursalı A. Pes ekino varus tedavisinde Ponseti metodunun erken sonuçları. In: Alpaslan AM (Editör). XVII. Ulusal Ortopedi ve Travmatoloji Kongresi Kongre Kitabı; İstanbul: Turgut Yayıncılık, 2001: 338-9.

23. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 2002; 22: 517-21.

24. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004; 113: 376-80.

25. Tindall AJ, Steinlechner CW, Lavy CB, Mannion S, Mkandawire N. Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world? J Pediatr Orthop 2005; 25: 627-9.

Kaynak Göster