A carregar...
Publicação
Resultados clínicos do tratamento do pé boto segundo a técnica de Ponseti
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.39 MB | Adobe PDF |
Orientador(es)
Resumo(s)
Introdução: O método de Ponseti é atualmente considerado um método de eleição no tratamento do pé boto congénito, dada a sua elevada taxa de sucesso. O tratamento visa obter um pé plantígrado, indolor e flexível. Porém, vários estudos têm demonstrado taxas importantes de recidiva. Neste trabalho, é nosso objetivo avaliar os resultados clínicos do método, o impacto da recidiva no resultado final e identificar parâmetros clínicos e radiográficos relacionados com a recidiva. Materiais e Métodos: Avaliámos 61 pés botos em 42 crianças, tratadas com o método de Ponseti. Os parâmetros clínicos avaliados foram: classificação de Pirani e grau de dorsiflexão. No estudo radiográfico, realizado em média aos 35 meses, avaliámos na incidência ântero-posterior, os ângulos talo-calcaneano e talo-1ºmetatarso, e na incidência lateral, o ângulo tibio-calcaneano e a inclinação do calcâneo. Os resultados finais foram classificados em “bons”, “satisfatórios” e “maus” de acordo com a necessidade de cirurgia ou não. Os dados foram tratados numa tabela de Excel e utilizou-se o programa SPSS-26 para a análise estatística, realizando-se testes t-student e regressões logísticas com nível de significância de 95%. Resultados: O seguimento médio das crianças foi de 147,1 meses (mín. 71; máx. 203). A avaliação de Pirani final foi 0.5, com dorsiflexão média final de 12, 31º. A taxa de recidiva foi de 36%, não tendo comprometido os resultados finais, com 67,2% de bons resultados e 32,8% de resultados satisfatórios. Encontrámos correlação significativa com a recidiva para as varáveis: classificação de Pirani inicial e no primeiro ano, grau de dorsiflexão aos três anos, ângulo TC (AP), ângulo T1Met (Lat) e índice TC, tendo o ângulo TC (AP) o maior valor preditivo (p=0,015, odds-ratio 0,876). Discussão: O método de Ponseti é fiável, reprodutível e proporciona bons resultados clínicos. A cirurgia extra-articular em caso de recidiva, não parece comprometer os resultados clínicos, podendo ser considerada como parte do tratamento em determinados pés. Um ângulo talo-calcaneano na incidência antero-posterior aos três anos de idade, inferior a 20º, correlaciona-se com recidiva.
Introduction: The Ponseti method is currently considered a method of choice in the treatment of the congenital clubfoot, given its high success rate. The treatment aims to obtain a plantigrade foot, painless and with good mobility. However, several studies have shown important recurrence rates. In this work, it is our goal to evaluate the clinical results of the method, the impact of relapse on the final result, and to identify clinical and radiographic parameters connected to relapse. Materials and Methods: We evaluated 61 clubfeet in 42 children treated with the Ponseti method. The clinical parameters analysed were Pirani classification and degree of dorsiflexion. In the radiographic study, performed on average at 35 months, we analysed in the anteroposterior incidence, the talo-calcanean and talo-1ºmetatarsal angles, and in the lateral incidence, the tibio-calcanean and the calcaneus inclination. The final results were classified as "good", "satisfactory" and "bad" according to the need for surgery or not. The data were treated in an Excel table and the SPSS-26 program was used for statistical analysis, performing t-student tests and logistic regressions with a 95% significance level. Results: The average follow-up was 147.1 months (min. 71; max. 203). The final Pirani evaluation was 0.5, with a final average dorsiflexion of 12.31º. The recurrence rate was 36%, not compromising the final results with 67.2% of good results and 32.8% of satisfactory results. We found a significant correlation with relapse for the variables: initial Pirani classification and in the first year, degree of dorsiflexion at three years, CT angle (AP), T1Met angle (Lat) and CT index, with the CT angle (AP) having the highest predictive value (p=0.015, odds-ratio 0.876). Discussion: The Ponseti method is reliable, reproducible and provides good clinical results. Extra-articular surgery in case of recurrence does not seem to compromise the clinical results and can be considered as part of the treatment on certain feet. A talocalcanean angle in the anteroposterior incidence, at three years of age, below 20º, correlates with recurrence.
Introduction: The Ponseti method is currently considered a method of choice in the treatment of the congenital clubfoot, given its high success rate. The treatment aims to obtain a plantigrade foot, painless and with good mobility. However, several studies have shown important recurrence rates. In this work, it is our goal to evaluate the clinical results of the method, the impact of relapse on the final result, and to identify clinical and radiographic parameters connected to relapse. Materials and Methods: We evaluated 61 clubfeet in 42 children treated with the Ponseti method. The clinical parameters analysed were Pirani classification and degree of dorsiflexion. In the radiographic study, performed on average at 35 months, we analysed in the anteroposterior incidence, the talo-calcanean and talo-1ºmetatarsal angles, and in the lateral incidence, the tibio-calcanean and the calcaneus inclination. The final results were classified as "good", "satisfactory" and "bad" according to the need for surgery or not. The data were treated in an Excel table and the SPSS-26 program was used for statistical analysis, performing t-student tests and logistic regressions with a 95% significance level. Results: The average follow-up was 147.1 months (min. 71; max. 203). The final Pirani evaluation was 0.5, with a final average dorsiflexion of 12.31º. The recurrence rate was 36%, not compromising the final results with 67.2% of good results and 32.8% of satisfactory results. We found a significant correlation with relapse for the variables: initial Pirani classification and in the first year, degree of dorsiflexion at three years, CT angle (AP), T1Met angle (Lat) and CT index, with the CT angle (AP) having the highest predictive value (p=0.015, odds-ratio 0.876). Discussion: The Ponseti method is reliable, reproducible and provides good clinical results. Extra-articular surgery in case of recurrence does not seem to compromise the clinical results and can be considered as part of the treatment on certain feet. A talocalcanean angle in the anteroposterior incidence, at three years of age, below 20º, correlates with recurrence.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Pé boto Ponseti Resultados clínicos Recidiva Ortopedia