How The Age Fator Affects Limited Soft Tissue Release Combined With Ponseti Manipulation To Treat With Stiffed Clubfoot In Small Children

Conginital clubfoot is one of the most common malformations in the Pediatric Orthopaedics . Its incidence is about 1 % . There are not few cases which malformations are so severe and solid that it is called as the stiffed talipes equinovarus . In recent years , the latest development of the treatment with the conginital clubfoot in the world is the Ponseti Manipulation and its Serial Casting , a conservative method , which makes a big success in the surgical field . But in China , the patients who went to see the doctor and received a early treatment are so rare that most of them have becomed to be " the neglected cases " when they were tackled with . And the simple Ponseti method will not make it. Among the cases who go to the clinical early , a few of them will mitigate ther deformity by the Ponseti method ,but many of the stiffed cases must have to be treated by surgical operation . Thus , the surgical operation is a essential way to the treatment of the stiffed clubfoot insmall children.Selection of the surgical oportunity:At present , in our country or outside of the world , it is considered that thesurgical oportunity should to be after six-months-year-old . After X-rays studies in the treatment of the clubfoot with a muscle strength balance method early , Xu Longshun discovered that within six months the abnormities of the bone caused by surgery was more obvious that he advised when within six months the muscle strength balanced surgery should not be held . But in the clinical practice , we find that many of the parents are so depressed under the social and mentality pressure as to take their children to seek treatment anywhen and anywhere . For their disobeyance to the Ponseti method , the effect of the Manipulation turned to be poor . So , we think that in a early stage using the orthopaedical surgery to treat the stiffed clubfoot is correspondence to the clinical situations .Selection of the surgical method:There are many surgical methods to treat with the stiffed clubfoot . In the present time in clinical , the surgical methods are classified into three catagories . Such as (1) Soft tissue release surgery , for example , Turco release , Mackay release and Simons release . (2) Tendon transfer surgery . (3) Osteotomy .Because the malformations are so inclined to recur after surgery that some cases will have the soft tissue released for many times . So, Sobel E thought many times' release is essential for the clubfoot treatment , and should not be thought as recurrence .So far , the surgery opportunity of the stiffed clubfoot is not sure , operation methods are various , and the curative effect is not too high . It is reported that the total excellent rate is about 77-87% or so , the recurred rate is high , and the deformity rate of the talus and the navicular is not lower than that of more than 60% .Followed by the revealment of the blood circulation knowledge of the talus and the narvicular and the practice of microtraumatic therapy , we ameliorate the Turco posteo-interior release to be a much standard " limited soft tissue release " since 2000 year , and using this method combined with Poseti manipulation to treat the stiffed clubfoot in small children . In our study we measured the T-CA and C-M1A by X-ray imagings for the different age groups , adopted the Carcean's functional and morphological assessment standards to assess the curative effect, and compared thedeformities of the talus among two groups after operation 1 -2 years later . Clinical materials and methodsOne . Common material : From 2000.1 -2004.6 , there are 120 cases , 195 feetof stiffed clubfoot treated in our hospital . Among them , 78 cases is male , 42 cases female . We classified them into two group by the age : A-group ( 4-6 months year old ) , 54 cases , 88 feet; B-group (7-12 months year old ), 66 cases , 107 feet.Two . Treatment method : (1) . limited soft tissue release ( modified Turco release). (2). combined with Ponseti manipulation to guide the limited release . (3). serial plaster casting fixation .Three . The method of X-r...