Minimally invasive surgical treatment of the congenital clubfoot

Urođeno krivo stopalo i dalje predstavlja ozbiljan problem u patologiji koštano-zglobnog sistema kod djece Mnoga pitanja iz oblasti urođenog krivog stopala i danas su predmet istraživanja i dilema. Najčešća pitanja koja su predmet rasprave odnose se na:etiologiju, kliničku klasifikaciju i načine liječenja. Pes equinovarus congenitus (PEVC) je deformitet stopala koji se liječi neoperativnim procedurama i operativno. U literaturi postoje različiti pristupi problemu liječenja PEVC , što zavisi od specijalnosti, ustanove koja se bavi ovim problemom i regije. Minimalno invazivni hirurški tretman (MIHT) je novi, savremeni, način liječenja urođenog krivog stopala. Cilj rada bio je da se upoređivanjem rezultata liječenja ispitati i dokaže da je minimalno invazivan hirurški tretman urođenog krivog stropala bolji način liječenja, sa kojim se dobijaju bolji rezultati, u odnosu na radikalni hirurški tretman. Metod. Klinička studija sprovedna u Klinici za dečiju hirurgija Banjaluka i UDK Beograd. Ispitivanje je provedno kod dve grupe ispitanika, grupa A (kontrolna grupa) -deca lečena radikalnom hirurkom korekcijom i grupa B (eksperimentalna grupa)- deca lečena sa MIHT-om. Ukupan broj ispitanika u grupi A bio je 50, muškog pola 35 (70%) i ženskog pola 15 (30%). Obostranih deformiteta bilo je kod 38 (76%), jednostranih kod 12 (24%) ispitanika. Uzrast dece bio je od 5 do 15 godina. Ukupan broj ispitivanih stopala je 88. Ukupan broj ispitanika u grupi B bio je 48, muškog pola 35 (73%) i ženskog pola 13 (27%). Obostranih deformiteta bilo je kod 38 (79%), jednostranih kod 10 (21%) ispitanika. Uzrast djece bio je od 3 do 7 godina. Ukupan broj ispitivanih stopala je 84. Za analizu rezultata korišten je upitnik. Za svako ispitivano stopalo praćeno 15 parametara i to po pet kliničkih, radiografskih i funkcionalnih parametara. Za praćenje kliničkih parametara korišten je McKay protokal, za radiografsku evaluaciju korišten je G.W.Simons protokol i za funkionalone paremetre Laaveg-Ponseti protokol. Indikacija za tenotomiju Ahilove tetive kod ispitanika lečenih MIHT-om postavljena je na osnovu Piranijevog skora...Congenial clubfoot continues to represent a serious problem in pathology of the bone-joint system of children. Many questions from the field of congenial clubfoot are a subject of research and dilemmas even today. The most frequent questions which are the subject of discussion are related to: aetiology, clinical classification and manners of treatment. Pes equinovarus congenitus (PEVC) is a deformity of feet treated by non operative procedures and operationally. In literature, there are different approaches to the problem of the treatment of PEVC, what depends from the speciality, the institution that deals with this problem and the region. Minimally invasive surgical treatment (MIST) is a new, modern, manner of treatment of the congenial clubfoot. The aim of this paper was that by comparison of the results of treatment is to question and proven that the minimally invasive surgical treatment of the congenial clubfoot is a better manner of treatment, by which are obtained a better results, in comparison with the radical surgical treatment. Method. Clinical study was conducted at the Clinic for Pediatric Surgery of Banja Luka and University Children's Hospital Belgrade. The testing was conducted in two groups of subjects, group A (control group) - children treated with the radical surgical correction and group B (experimental group) -children treated with MIST. The total number of subjects in group A was 50, males 35 (70%) and females 15 (30%). Bilateral deformities was at 38 (76%) and unilateral at 12 (24%) subjects. The age of the children was from 3 to 7 years. The total number of the tested feet is 84. For the analysis of the results a questionnaire was used. For each tested foot were monitored 15 parameters and that means five clinical, radiographic and functional parameters. For monitoring of the clinical parameters, it was used a McKay protocol, for the radiographic evaluation was used G.W.Simons protocol and for the functional parameters Laaveg-Ponseti protocol. Indication for tenotomy of the Achilles tendon at the subjects treated with MIST was set on the basis of Pirani score..