马蹄内翻足治疗中的26条注意事项

2020年10月14日【健康号】赵黎阅读 8449

（转自英华健步行）

近日有机会阅读由美国Iowa大学Thomas M. Cook教授主编的《Clubfoot/ The quest for a better Life for Millions of Children》(由Ice Cube Press于2019年出版，图示封面)，在238～239页有这样一段内容，我们认为对从事马蹄内翻足Ponseti方法治疗的医学同行和患者家长有帮助，摘录翻译如下，供参考：

Disclaimer: This information is adapted from www.clubfootcares.org and has been compiled from clubfoot family experience and the medical community. The opinion of some medical professionals may differ. This list is not a substitute for professional medical advice.

免责声明：此信息改编自www.clubfootcares.org并根据马蹄内翻足家庭的经验和医学界的经验编写而成。一些医学专业人士的意见可能不同。这份表单内容不能代替专业的医疗建议。

Parents/caregivers may want to seek more information or a second opinion for their child if:

出现下列情况时，患儿家长可以寻求进一步信息或其他专业人员的意见：

A. Someone other than a pediatric orthopaedic surgeon is doing the casting.

不是儿童骨科医生在打石膏。

B. The doctor cannot describe his or her training in the Ponseti method.

医生不能很好地介绍其潘塞缇（Ponseti）方法的相关培训

C. The doctor will not say how many clubfoot patients he or she has managed.

医生不愿透露其治疗过的马蹄内翻足患者的数量。

D. The doctor wants to delay the start of treatment. [Ask the reason(s).]

医生想推迟开始治疗的时间。[(需要与医生沟通)询问原因]

E. Casts slip or fall off.

石膏松脱。

F. Casts are only below the knee.

石膏只打到膝关节以下水平。

G. Casts are to be worn longer than a week.

每次石膏固定超过一周。

H. The foot does not improve or looks worse after 2-3 casts.

两、三次石膏治疗以后，足的形态没有改善甚至看起来更严重。

I. The doctor wants you to remove the cast the day before your appointment.

医生要求你在预约来诊的前一天拆除石膏

J. The doctor recommends Posterior-Medial Release (PMR) surgery.

医生建议做后内侧松解(PMR)手术。

K. The doctor says PMR surgery and the Ponseti method have the same longterm results.

医生说后内侧松解手术和Ponseti方法治疗远期效果一样好。

L. The doctor does not recognize “atypical/complex” clubfoot nor explain how treatment differs.

医生不能鉴别所诊治的马蹄内翻足是非典型性的还是复杂性的，也不解释治疗方法有何不同。

M. The doctor is unsure if a tenotomy is needed. [It is in 80% of cases.]

医生不确定是否需要做跟腱切断松解。[（目前看来）80%的病例需要做跟腱切断松解。]

N. A tenotomy is performed before achieving 60-70 degrees of external rotation.

在足外旋未达到60-70度的情况下实施跟腱切断松解。

O. The cast stays on for more than four weeks after the tenotomy.

跟腱切断松解后石膏固定已超过四周。

P. The clubfoot brace is applied before the foot is fully corrected.

足部畸形没有完全矫正的情况下，应用支具。

Q. There is a delay in starting bracing after the last cast is removed.

最后一次矫形石膏拆除后没有及时穿戴支具。

R. The doctor recommends a brace without a bar or just an Ankle-Foot Orthosis (AFO).

医生建议使用不带连杆的支具或者仅穿戴足踝支具(AFO)。

S. The clubfoot side(s) of the brace is not set at 60-70 degrees of external rotation; the non-clubfoot side is not set at 30-40 degrees.

支具的患侧未设置在外旋60-70度位；健侧未设置在外旋30-40度位。

T. The bar is not set to the width of the child’s shoulders.

支具的连杆未设置在与患者双肩同宽的宽度。

U. The doctor recommends something other than wearing the brace 23 hours for the first 3 months, then nights and naps, or later just nighttime, until the age of 4-5.

医生的支具穿戴建议与下列不同：最初的3个月里穿戴支具23小时，然后只是在晚上和午睡的时候穿戴支具，之后只是晚上穿戴，支具一直穿到患者4-5岁。

V. The doctor or orthoptist does not show you how to properly apply the brace.

医生或者矫形器师没有教给家长如何正确地穿戴支具。

W. The foot continues to slip out of the brace.

脚持续从支具中脱出。

X. The doctor wants to do Anterior Tibialis Tendon Transfer (ATT) surgery before first re-casting to correct a relapse.

对于畸形复发的情形，医生直接建议胫前肌腱转移(ATT)手术治疗，而不是再次通过手法+石膏矫正，。

Y. The doctor wants to do ATT surgery before the child is 4-5 years old.

医生建议在4-5岁之前做胫前肌腱转移(ATT)手术。

Z. Follow-up visits are not scheduled at regular intervals.

没有安排定期的门诊随访。

作者简介：

Thomas M. Cook, PT, PhD, is a physical therapist, bioengineer, global health specialist, and former Fulbright Scholar. He is currently Professor Emeritus in Physical Therapy & Rehabilitation Science and Public Health at the University of Iowa and Director of Global Operations for the Ponseti International Association.

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