tailieunhanh - Phẫu thuật bẩm sinh ở chân

Bởi vì quản lý không phẫu thuật WS tưởng không đến năng suất điều chỉnh đầy đủ và kết quả là bền vững, MOST trẻ em bị tật vẹo chân vô căn đã trải qua phẫu thuật với posteromedial và bên phát hành rộng rãi. Tuy nhiên, phẫu thuật quản lý gây ra biến dạng còn lại, độ cứng | Nonsurgical Management of Idiopathic Clubfoot Kenneth J. Noonan MD and B. Stephens Richards MD Abstract Because nonsurgical management was thought not to yield adequate correction and a durable result most children with idiopathic clubfoot have undergone surgery with extensive posteromedial and lateral release. However surgical management caused residual deformity stiffness and pain in some children thus the favorable longterm results with the Ponseti and French methods of nonsurgical management have garnered interest. The Ponseti method consists of manipulation and casting of idiopathic clubfeet the French method consists of physiotherapy taping and continuous passive motion. Careful evaluation of the techniques and results of these two approaches may increase their use and decrease or minimize the use of surgical management and thus the associated morbidity resulting from extensile releases. J Am Acad Orthop Surg 2003 11 392-402 The history of medicine is replete with cyclical trends of nonsurgical and surgical management approaches as well as reports of so-called new methods of treatment that were really modi cations of techniques used decades before. The treatment of idiopathic clubfoot is no exception. In 1939 J. Hiram Kite presented his management method of and experience with congenital clubfoot as a plea for conservative treatment. 1 However because some patients did not achieve full correction of the deformity with nonsurgical management interest in surgical approaches increased and nonoperative methods were largely ignored during subsequent decades. Surgical treatment predominated because it was thought to predictably obtain full and lasting correction. Some centers in Iowa and France continued using nonsurgical management but their results were viewed with skepticism. However long-term follow-up results of many children treated with extensive surgical release has revealed high rates of overcorrection stiffness and pain. As a result contemporary interest