Učinkovitost serijskega mavčenja za zdravljenje otrok z ekvinovarusom – pregled literature : diplomsko delo

Kovačić, Andreja (author), Puh, Urška (mentor)

Uvod: Ekvinovarus je prirojena okvara stopala, ki lahko v odsotnosti zdravljenja vodi v dolgoročne funkcijske okvare, nezmožnost hoje, žulje in bolečino. Pojavi se pri enem do dveh otrocih na 1.000 novorojenčkov. Na radiološki sliki stopala z ekvinovarusom je viden nepravilen položaj kosti v stopalu, zunanji izgled stopala pa sestavljajo štiri komponente: ekvinus, adduktus, varus in kavus. Za zdravljenje ekvinovarusa je bila v preteklosti najpogosteje uporabljena metoda Kite. Pozneje je bila nekoliko spremenjena in izboljšana ter dobila ime metoda Ponseti. Obe metodi vključujeta raztezanje mehkih tkiv stopala, prilagoditev položaja kosti v stopalu, mavčenje, tenotomijo ahilove tetive in uporabo opornice po odstranitvi mavca. Razlikujeta se v načinu prilagoditve položaja kosti v stopalu, trajanju zdravljenja ter času uporabe opornice po mavčenju. Namen: Namen diplomskega dela je bil pregledati izsledke raziskav o učinkovitosti serijskega mavčenja pri idiopatskem prirojenem ekvinovarusu. Metode dela: Randomizirani kontrolirani poizkusi so bili iskani v podatkovnih zbirkah PEDro, PubMED in Cochrane Library z določenimi ključnimi besedami in s pregledom seznama literature preglednega članka. Rezultati: V pregled je bilo vključenih osem raziskav. V raziskavah, ki so primerjale metodi Kite in Ponseti, so avtorji zaključili, da je metoda Ponseti boljša izbira za zdravljenje ekvinovarusa (štiri raziskave). Primerjava dolgoročne in kratkoročne učinkovitosti metode Ponseti ter operativnega posega je pokazala boljše rezultate metode Ponseti (dve poročili iste raziskave). Primerjava standardne metode Ponseti s pospešeno ni pokazala razlik. Sklep: Najboljše rezultate zdravljenja ekvinovarusa kaže metoda Ponseti. Na podlagi kratkoročnih rezultatov je pospešena metoda Ponseti enako uspešna. Vse raziskave so bile opravljene pri otrocih do dveh let starosti, rojenih z idiopatskim ekvinovarusom in brez drugih zdravstvenih težav. Potrebne so nadaljnje raziskave o preprečevanju ponovitev okvare in povečanju uspešnosti metode Ponseti, predvsem pri otrocih s hujšo obliko ekvinovarusa. Primerjanje rezultatov med raziskavami je oteženo zaradi raznolikosti v uporabljenih ocenjevalnih sistemih, ki nimajo preverjenih merskih lastnosti. Smiselno bi bilo uveljaviti enoten ocenjevalni sistem

• Language: Slovenian
• Keywords: ekvinovarus, Ponseti, Kite, pospešena metoda Ponseti
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-106270
• COBISS.SI-ID: 5583211
• Publication date in RUL: 19.02.2019

Secondary language

• Language: English
• Title: Efficiency of serial casting as a treatment for children with clubfoot – literature review : diploma work

Abstract

Introduction: Clubfoot is a congenital deformity of the foot that left untreated can lead to long-term functional defects, inability to walk, blisters and pain. It occurs in one or two children per 1,000 new-borns. Radiograph of the foot with equinovarus shows incorrect position of the bones in the foot. The outer appearance of the foot consists of four components: equinus, adductus, varus and cavus. In the past the most common treatment of clubfoot was the Kite method. It was later on improved and renamed to the Ponseti method. Both methods include stretching of the foot, adjustments of the position of bones in the foot, casting, tenotomy of the Achilles tendon and use of braces after cast removal. The differences between two methods are the way the position of the bones is adjusted, duration of the treatment and duration of the use of braces. Purpose: The purpose of the thesis was to review the findings of researches about the efficiency of serial casting in idiopathic congenital clubfoot. Methods: We searched for randomised controlled tests in the databases PEDro, PubMED and Cochrane Library using certain key words and we looked for additional researches by reviewing the literature list of a review article. Results: The review included eight researches. Authors of those researches, which have compared the Kite and Ponseti method, concluded that the Ponseti method is the better choice for treating clubfoot (four researches). The comparison of the long-term and short-term efficiency of the Ponseti method and the operative procedure showed better results of the Ponseti method (two reports of the same research). The comparison between the standard and accelerated Ponseti method did not show any differences. Conclusion: The Ponseti method provides the best results in treating clubfoot. Based on short-term results the accelerated Ponseti method is equally successful. All researches were carried out on children of up to two years of age, born with idiopathic clubfoot and without other health issues. There is a need for additional researches on the prevention of the reoccurrence of the deformity and the increase of success of the Ponseti method, particularly in children with a more severe form of clubfoot. The diversity of evaluation systems without proven measuring options makes it difficult to compare results of different researches. It would be reasonable to enforce a single evaluation system.

• Keywords: clubfoot, Ponseti, Kite, accelerated Ponseti method