پديد آورندگان :
حلاج مقدم، محمد دانشگاه علوم پزشكي مشهد , پارسا، علي دانشگاه علوم پزشكي مشهد , حبيب زاده شجاعي، رضا دانشگاه علوم پزشكي مشهد
كليدواژه :
بدشكلي پا , مادرزادي , كف پاي صاف , روش هاي جراحي با حداقل تهاجم , تالوس عمودي
چكيده فارسي :
رايج ترين روش درمان براي تالوس عمودي جراحي گسترده بافت نرم است. يك روش با حداقل تهاجم بر پايه قالب گيري سريالي يا پشت سر هم «دوب» (پونستي معكوس) 15 سال پيش معرفي شد و نتايج قابل توجهي به دست آورد. هدف از اين مطالعه بررسي و مقايسۀ نتايج ميان مدت قالب گيري با روش گچگيري است.
مواد و روشها: 12 بيمار مبتلا به تالوس عمودي در يك مطالعه آيندهنگر قرار گرفتند، 6 بيمار با 10 فوت مبتلا به پونستي معكوس و 6 نفر ديگر با 10 فوت با جراحي بافت نرم خارجي تحت درمان قرار گرفتند. در يك پيگيري 18 تا 24 ماهه، نتايج با استفاده از محدوده حركت مچ پا، پرسشنامه اكسفورد و اندازهگيريهاي راديوگرافي مقايسه شدند. يافتهها: ميانگين حركات مچ پا در دو گروه قابل مقايسه بود (0.35 = p)؛ نمره پرسشنامه اكسفورد بين دو گروه به لحاظ آماري تفاوت معناداري نداشت (p = 0.876). نتيجهگيري: با توجه به نتايج قابل مقايسه بين جراحي گسترده و گچگيري «پونستي معكوس» در اين مطالعه ميان مدت، تكنيك قالبگيري به دليل ماهيت و طبيعت غيرتهاجمي اين روش درماني توصيه ميشود.
چكيده لاتين :
Background: The most common method of treatment for vertical talus is the extensive soft tissue release. A minimally-invasive method based on Dobb's serial casting (Reverse Ponseti) was introduced 15 years ago and has yielded significant results. The aim of this study was to investigate and compares the midterm results of Casting with the extensive soft tissue release method.
Methods:12 patients with vertical talus were included in a prospective study, 6 patients with 10 feet were treated with reverse ponseti, and 6 other patients with 10 feet with externsive soft tissue release. In an 18-24 months follow-up the results were compared together, using ankle range of motion, oxford questionnaire, and radiographic measurements.
Results: The mean range of ankle motion was comparable in the two groups (p=0.35), the oxford questionnaire score was not statistically different between the two groups (p=0.876).
Conclusion: With the comparable results between the ''reverse-ponseti'' casting land extensive surgical releases in this mid-term study, the casting technique is recommended because of its lower cost and non-invasive nature.
rtical talus (CVT) is an uncommon congenital foot deformity. Incidence rate of CVT is 1 out of 10,000 live birth. CVT is one of the main causes of rigid flatfoot in newborns (1). Rigid talonavicular joint dislocation is the hallmark (inflexible in the sole of the foot with no arch) of CVT, accompanied by non-flexible equinus. In this structural abnormality, in fact, the convex plantar surface of the foot creates a rocker-bottom appearance (2). It occurs as an isolated deformity in half of patients and is associated with neuromuscular and genetic disorders in others (1, 3, 4).
There is bilateral involvement in half of CVT patients, and there is no gender predilection (5). Although CVT is not painful for newborns and infants, if not diagnosed and left untreated, leads to major disabilities in the adulthood. Ambulation is not usually delayed; however, the gait is unbalanced. Patient`s shoes often show abnormal wear, and pain often develops in early adolescence (6). As the heels, do not touch the ground, push-off from the floor is poor and talar head acts as a weight-bearing structure, resulting in painful calluses in this region (7, 8).
