İdiopatik Pes Ekinovaruslu Hastalarda Ponseti Yöntemiyle Tedavi Sonuçlarımız
GİRİŞ ve AMAÇ: Congenital clubfoot(pesekinovarus) tedavisi, günümüzde modern tedavi yöntemi Ponseti tarafından tanımlanan yöntemle, seri manipulasyon ve alçılama ile yapılmaktadır. Ortopedi de alçılama materyali olarak sıklıkla klasik beyaz alcı (plaster of paris=POP) ve daha nadiren fiberglass (SRF) alçı kullanılmakatdır. Çalışmanın amacı ponseti yönteminin ve bu 2 materyalin etkinliğini değerlendirmek ve birbirlerine üstünlüklerini belirlemektir. YÖNTEM ve GEREÇLER: 2006-2008 yılları arasında 16 hastanın 27 ayağı değerlendirilmeye alındı(12 erkek 4 kız) hastalar 2 gruba ayrıldı. 1. gruptaki 9 hastanın 16 ayağına klasik beyaz alçı(Plaster of Paris) 2. gruptaki 7 hastanın 11 ayağına sentetik soft cast alçı(SRF) uygulandı. Yöntemin etkinliği alçı materyallerinin özelliği ve komplikasyonlar değerlendirildi. Pirani ve Dimeglio skorlarına bakıldı. BULGULAR: Tedavi öncesi 12.81 olan ortalama Dimeglio skoru tedavi sonrası 2.56 olarak tespit edildi. Pirani skoru tedavi öncesi 4.125 iken tedavi sonrası ortalama değer 0.531 bulundu. Ortalama takip süresi 18 ay. Her 2 grupta klinik skorlarda istatistiksel olarak anlamlı düzelme tespit edildi(p0.05). Fiberglass sentetik alçı ile daha az basınca bağlı cilt yaralanması görülebileceği tespit edilmiştir..
Treatment Results of the Ponseti Method in Patients with Idiopathic Pes Equinovarus
INTRODUCTION: Congenital clubfoot (pes equinovarus)treatment is currently applied with serial manipulation andplaster casting with the modern treatment method described byPonseti. In orthopaedics, the plaster cast material used isusually the classic white plaster (plaster of Paris; POP) andmore rarely semi-rigid, fibreglass (SRF). The aim of this studywas to evaluate the efficacy of these two materials in thePonseti method and to identify the advantages of each.METHODS: A total of 27 feet of 16 patients (12 male, 4female) treated between 2006 and 2008 were included forevaluation. The patients were separated into 2 groups, asGroup 1 with 16 feet of 9 patients applied with POP, andGroup 2 with 11 feet of 7 patients applied with SRF. Theefficacy of the two methods was evaluated in respect of theproperties of the cast materials and complications. The Piraniand Dimeglio scores were examined.RESULTS: The mean Dimeglio score was 12.81 beforetreatment and 2.56 after treatment. The mean Pirani score was4.125 before treatment and 0.531 after treatment. The meanfollow-up period was 18 months. A statistically significantimprovement in clinical scores was observed in both groups(p0.05). It wasdetermined that less skin pressure injury could be seen withfibreglass synthetic plaster cast.
___
- Herring JA, editor: Disorders of the foot. In:
Tachdjian’s pediatrics. Vol.2, 3rd.edm Philadelphia:
W. B. Saunders; 2002.p.942-59.
- DimeglioA, Bonnet F,MazeauP,De Rosa
V.Orthopaedic treatment and passive motion
machine: Consequences fort he surgical treatment of
clubfoot. J. Pediatr. Orthop B 1996;5:173-80.
- Halanski MA, Davison JE, Huang J-C, Walker
CG, Walsh SJ, Crawford HA. Ponseti method
compared with surgical treatment of clubfoot: a
prospective comparison. J Bone Joint Surg Am.
2010;92:270-8.
- Göksan SB. Dogustan çarpık ayagın ponseti
yöntemi ile tedavisi Acta Orthop Traumatol Turc
2002,36:281-7.
- Herzenberg JE, Radler C, Bor N. Ponseti versus
traditional methods of casting for idiopathic
clubfoot. J Pediatr Orthop. 2002;22:517–21.
- Morcuende JA, Dolan LA, Dietz FR, Ponseti
IV. Radical reduction in the rate of extensive
corrective surgery for clubfoot using the Ponseti
method. Pediatr. 2004;113:376–80.
- Mihalko WM, Beaudoin AJ, Krause WR.
Mechanical properties and material characteristics of
orthopaedic casting material. J Orthop Trauma
1989;3(1):57-63.
- Coss HS, Hennrikus WL. Parent satisfaction
comparing two ban¬dage materials used during serial casting in infants. Foot Ankle Int 1996;17:483-
6.
- Zmurko MG, Belkoff SM, Herzenberg JE.
Mechanical evaluation of a soft cast material.
Orthopedics 1997;20:693-8.
- Hui C, Joughin E, Nettel-Aguirre A,
Goldstein S, Harder J, Kiefer G, Parsons D, Brauer
C, Howard J.Comparison of cast materials for the
treatment of congenital idiopathic clubfoot using the
Ponseti method: a prospective randomized
controlled trial.Can J Surg. 2014 Aug;57(4):247-53.
- Pitnerr DE, Kingele KE,Beebe AC
.Treatment of clubfoot with the ponseti
method:Acomparison of casting materilas.J pediatric
Orthop 2008 mar 28(2):250-3.
- 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.
- Radler C, Suda R,Manner HM,Gril F.Early
results of the Ponseti method fort he treatment of
idiopathic clubfoot.Z Orthop Ihre Grenzgeb.2006
Jan-Feb;144(1):80-6.
- Bor N, Herzenberg JE,Frick SL.Ponseti
management of clubfoot in older infants.Clin Orthop
Relat.Res.2006 Mar;444:224-8.
- Ponseti IV, Zhivkov M,Davis N,Sinlair
M,Dobbs MB,Morcuende JA.Treatment of the
complex idiopathic clubfoot.Clin OrthopRealat
Res.2006 Oct;451:171-6.
- Ponseti IV. Treatment of congenital club
foot. J Bone Joint Surg [Am] 1992;74:448-54.
- Dimeglio A, Bensahel H, Souchet P, Mazeau
P, Bonnet F. Classification of clubfoot. J Pediatr
Orthop B 1995;4:129- 36.
- Laaveg SJ, Ponseti IV.Long-term results of
treatment of congenitel clubfoot .J Bone Joint Surg
(Am) 1980;10:109-1.
- Göksan SB, Bursali A, Bilgili F, Sivacioglu
S, Ayanoglu S. Ponseti technique fort he correction
of idiopathic clubfeet presenting up to 1 year of age.
A preliminary study in children with untreated or
complex deformities. Arch Orthop Trauma
Surg.2006 Jan;126 (1):15-21.
- Van Mulken JM, Bulstra SK, Haefnagel NH.
Evaluation of the treatment of clubfeet with the
Dimeglio score. J Pediatr Orthop 2001 Sept-
Oct;21(5):642-7.
- Cantel T, Bagatur AE, Ogut T, Aksu T.
Comparison of the soft-tissue release methods in
idiopathic clubfoot. J Pediatr Orthop 2000:20:648-
51.
- Eberhardt O, Schelling K,Parsch K,Writh T.
Treatment of congenitel clubfoot with the Ponseti
method.Zortop Ihre Grenzgeb,2006 Sep-
Oct;144(5):497-501.
- Bursalı A. Pes ekinovarus(PEV) tedavisinde
Ponseti metodunun erken sonuçları.In: Alpaslan
AM,editör.XVII. Ulusal Ortopedi ve Travamatoloji
Kongresi Kongre Kitabı.24-29 Ekim 2001;Antalya,
Türkiye, İstanbul: Turgut Yayıncılık;2001.s.338-9.
- Changulani M, Garg NK, Rajagopal TS,
Bass A, Nayagam SN, Sampath J, Bruce CE.
Treatment of idiopathic club foot using the Ponseti
method. Initial experience.J Bone Joint Surg Br.
2006 Oct;88(10):1385-7.
- Abdelgawad AA, Lehman WB, van Bosse
HJ, Scher DM, Sala DA. Treatment of idiopathic
clubfoot using the Ponseti method: minimum 2-year
follow-upJ Pediatr Orthop B. 2007 Mar;16(2):98-
105.
- Terrazas –Lafargue G, Morcuende JA.
Effect of cast removal timing in the correction of
idiopathic clubfoot by the ponseti method. Iowa
Orthop J.2007;27:24-7.