g********m
发帖数: 956 | 1 国内亲戚的孩子，怀孕20周了，超声波检查孩子心肺脑子四肢长度发育都正常，唯一发
现脚有马蹄内翻足Clubfoot。现在都是独生子女，一家人很着急。目前医生怕有遗传，
基因，或是染色体问题，建议做羊水穿刺。版上有人知道这方面的知识吗？给科普一下
，clubfoot除了脚部畸形外，智力和精神方面会有什么更严重的问题？羊水穿刺主要能
诊断些什么问题，除了这个诊断外，还需要进行其他什么诊断？
谢谢，帮忙！ | l*****w
发帖数: 344 | | t*******f
发帖数: 795 | 3 Clubfoot is treated with manipulation by podiatrists, physiotherapists,
orthopedic surgeons, specialist Ponseti nurses, or orthotists by providing
braces to hold the feet in orthodox positions, serial casting, or splints
called knee ankle foot orthoses (KAFO). Other orthotic options include
Dennis-Brown bars with straight last boots, ankle foot orthoses and/or
custom foot orthoses (CFO). In North America, manipulation is followed by
serial casting, most often by the Ponseti Method. Foot manipulations usually
begin within two weeks of birth. Even with successful treatment, when only
one side is affected, that foot may be smaller than the other, and often
that calf, as well.
Extensive surgery of the soft tissue or bone is not usually necessary to
treat clubfoot; however, there are two minimal surgeries that may be
required:
Tenotomy (needed in 80% of cases) is a release (clipping) of the
Achilles tendon – minor surgery – local anesthesia
Anterior Tibial Tendon Transfer (needed in 20% of cases) – where the
tendon is moved from the first ray (toe) to the third ray in order to
release the inward traction on the foot.
Of course, each case is different, but in most cases extensive surgery is
not needed to treat clubfoot. Extensive surgery may lead to scar tissue
developing inside the child's foot. The scarring may result in functional,
growth and aesthetic problems in the foot because the scarred tissue will
interfere with the normal development of the appendage. A child who has
extensive surgery may require on average two additional surgeries to correct
the issues presented above.
In stretching and casting therapy the doctor changes the cast multiple times
over a few weeks, gradually stretching tendons until the foot is in the
correct position of external rotation. The heel cord is released (
percutaneous tenotomy) and another cast is put on, which is removed after
three weeks. To avoid relapse a corrective brace is worn for a gradually
reducing time until it is only at night up to four years of age.
Non-surgical treatment and the Ponseti Method
Main article: Ponseti Method
Treatment for clubfoot should begin almost immediately to have the best
chance for a successful outcome without the need for surgery. Over the past
10 to 15 years, more and more success has been achieved in correcting
clubfeet without the need for surgery. The clubfoot treatment method that is
becoming the standard in the U.S. and worldwide is known as the Ponseti
Method.[7] Foot manipulations differ subtly from the Kite casting method
which prevailed during the late 20th century. Although described by Dr.
Ignacio Ponseti in the 1950s, it did not reach a wider audience until it was
re-popularized around 2000 by Dr. John Herzenberg in the USA and in Europe
and Africa by NHS surgeon Steve Mannion while working in Africa. Parents of
children with clubfeet using the Internet[8] also helped the Ponseti gain
wider attention. The Ponseti method, if correctly done, is successful in >95
% of cases[9] in correcting clubfeet using non- or minimal-surgical
techniques. Typical clubfoot cases usually require 5 casts over 4 weeks.
Atypical clubfeet and complex clubfeet may require a larger number of casts.
Approximately 80% of infants require an Achilles tenotomy (microscopic
incision in the tendon requiring only local anesthetic and no stitches)
performed in a clinic toward the end of the serial casting.
Throughout the past decade, physicians at Texas Scottish Rite Hospital for
Children have been studying the effectiveness of both the Ponseti casting
method and the French functional (physical therapy) method of stretching,
massaging and taping and comparing the results with patients who have
undergone surgery. Results of these studies have been presented at national
and international conferences, such as the Pediatric Orthopaedic Society of
North America annual meeting, the International Clubfoot Symposium, Brandon
Carrell Visiting Professorship and the American Academy of Orthopaedic
Surgeons annual meeting, and have been published in the Journal of Pediatric
Orthopaedics.[10]
After correction has been achieved, maintenance of correction may require
the full-time (23 hours per day) use of a splint—also known as a foot
abduction brace (FAB)—on both feet, regardless of whether the TEV is on one
side or both, for several weeks after treatment. Part-time use of a brace (
generally at night, usually 12 hours per day) is frequently prescribed for
up to 4 years. Without the parents' participation, the clubfoot will almost
certainly recur, because the muscles around the foot can pull it back into
the abnormal position. Approximately 20% of infants successfully treated
with the Ponseti casting method may require a surgical tendon transfer after
two years of age. While this requires a general anesthetic, it is a
relatively minor surgery that corrects a persistent muscle imbalance while
avoiding disturbance to the joints of the foot.
The developer of the Ponseti Method, Dr Ignacio Ponseti, was still treating
children with clubfeet (including complex/atypical clubfeet and failed
treatment clubfeet) at the University of Iowa Hospitals and Clinics well
into his 90s. He was assisted by Dr Jose Morcuende, president of the Ponseti
International Association.
The long-term outlook[11] for children who experienced the Ponseti Method
treatment is comparable to that of non-affected children.
【在 g********m 的大作中提到】
: 国内亲戚的孩子，怀孕20周了，超声波检查孩子心肺脑子四肢长度发育都正常，唯一发
: 现脚有马蹄内翻足Clubfoot。现在都是独生子女，一家人很着急。目前医生怕有遗传，
: 基因，或是染色体问题，建议做羊水穿刺。版上有人知道这方面的知识吗？给科普一下
: ，clubfoot除了脚部畸形外，智力和精神方面会有什么更严重的问题？羊水穿刺主要能
: 诊断些什么问题，除了这个诊断外，还需要进行其他什么诊断？
: 谢谢，帮忙！
| s***m
发帖数: 30 | 4 非常感谢文章和专业知识的分享。
希望只是一个矫形的问题而非其他更严重的问题。
现在胎儿还在朋友肚中，也只能靠羊水穿刺来做诊断了。 |
|
