矫形器
马蹄内翻足与Ponseti疗法：对关节的影响及支具的作用
Ponseti疗法无需大手术即可矫正90%以上的马蹄内翻足，但踝关节仍较弱且复发常见。本文汇总关于踝、膝、髋、跟腱及支具的证据。
Ponseti疗法是目前治疗婴儿马蹄内翻足的最佳方法，但治疗后踝关节仍比正常儿童弱，行走时膝和髋需要代偿。马蹄内翻足容易复发，因此佩戴支具阶段是关键。
以下为PubMed、PMC和Cochrane证据的摘要。含表格的完整文章提供越南语和英语版本。
要点
- Ponseti疗法（系列石膏、跟腱切断、Denis Browne支具）无需大手术即可矫正90%以上的足。
- 踝关节（强证据，荟萃分析）：蹬地力量较弱、活动范围较小，行走时足更易内旋。
- 膝和髋的变化主要是代偿性的；没有强证据表明石膏或支具会损伤这些关节。
- 最常见的复发类型是马蹄足：若支具不能将足保持在背屈位，跟腱会再次挛缩。
- 只把足保持在中立位的普通AFO不够：一项比较研究中，AFO组复发83%，Denis Browne支具组为31%。
科学证据
- 不遵从佩戴支具是复发的主要原因（一项研究中复发足的86%）；不同研究中风险增加5–183倍。
- 在Ponseti本人的数据中，正确佩戴支具的儿童复发7%，未正确佩戴者为78%。
- 晚期复发时，步态分析显示50–70%儿童有代偿性髋外旋，71%有胫骨内旋。
- 定制动态膝踝足矫形器：小型研究中4年内无复发（20名儿童），或2年后复发8%（DTKAFO）。
实用建议
- 前3个月几乎全天佩戴，之后在睡眠时佩戴至4–5岁。
- 扣带前先把足跟压到鞋底；足跟碰不到鞋底或足常滑出，是早期复发的信号。
- 连杆长度应与孩子肩宽相同，随生长更换尺寸。
- 复发或治疗较晚时，矫形器必须根据残余畸形个性化制作。
如果您的孩子正在治疗马蹄内翻足或已复发，请前来检查并进行步态评估：+84 985 211 888。本文仅供健康教育。
参考文献
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