2026 年第 7 期 第 21 卷

改良Ponseti技术联合中药外敷防治马蹄内翻足石膏期皮肤并发症的对照研究

A controlled study of modified Ponseti technique combined with external application of Chinese herbs in preventing and treating skin complications during casting period for clubfoot

作者：卡德尔·依明张小群郭文涛

英文作者：Kadeer Yiming Zhang Xiaoqun Guo Wentao

单位：新疆医科大学第一附属医院关节外科，乌鲁木齐830054

英文单位：Department of Joint Surgery the First Affiliated Hospital of Xinjiang Medical University Urumqi 830054 China

关键词：马蹄内翻足；改良Ponseti技术；皮肤并发症；中药外敷；微循环；生物力学

英文关键词：Clubfoot;ModifiedPonsetitechnique;Skincomplications;ExternalapplicationofChineseherbs;Microcirculation;Biomechanics

• 摘要：

• 目的 探究改良Ponseti技术联合“活血化瘀、舒筋活络”中药外敷对马蹄内翻足石膏期皮肤并发症的影响。方法 选取2022年1月至2025年1月于新疆医科大学第一附属医院就诊的80例马蹄内翻足患儿作为研究对象。采用随机数字表法将患儿分为对照组与观察组，各40例。根据脱落标准，2组分别脱落3例，最终各入组37例。对照组采取传统Ponseti技术，并配合凡士林纱布实施皮肤保护；观察组采用改良Ponseti技术联合中药凝胶贴外敷。比较2组患者皮肤并发症发生率、皮肤状况、疼痛程度、转化生长因子β1（TGF-β1）、白细胞介素6（IL-6）、微循环评估、生物力学监测、疗效评价。结果 观察组皮肤并发症总发生率显著低于对照组［8.1%（3/37）比40.5%（15/37）］，差异有统计学意义（χ2=10.571，P=0.001）。治疗后，2组患儿Braden Q评分均高于治疗前，且观察组高于对照组；2组患儿儿童疼痛行为量表评分均低于治疗前，且观察组低于对照组（均P＜0.05）。2组治疗前、治疗4周、石膏拆除时TGF-β1均呈持续上升趋势，对照组IL-6呈先上升后下降趋势，而观察组呈持续下降趋势；治疗4周和石膏拆除时，观察组TGF-β1均高于对照组，IL-6均低于对照组，差异均有统计学意义（均P＜0.05）。治疗后，2组患儿血流灌注均高于治疗前，且观察组高于对照组；2组接触压、剪切力、压力-时间积分均低于治疗前，且观察组均低于对照组（均P＜0.05）。观察组总有效率显著高于对照组［94.6%（35/37）比75.7%（28/37）］，差异有统计学意义（χ2=5.234，P=0.022）。结论 改良Ponseti技术联合“活血化瘀、舒筋活络”中药凝胶贴外敷，可显著降低马蹄内翻足患儿石膏固定期皮肤并发症发生率，减轻皮肤疼痛，改善皮肤状态，显著提高总有效率，其机制涉及改善微循环、调节炎症修复平衡及优化生物力学环境。

• Objective To investigate the effect of modified Ponseti technique combined with external application of Chinese herbs for "promoting blood circulation and removing blood stasis, relaxing sinews and activating collaterals" on skin complications during the casting period in children with clubfoot. Methods A total of 80 children with clubfoot treated at the First Affiliated Hospital of Xinjiang Medical University from January 2022 to January 2025 were enrolled. The children were randomly divided into control group and observation group by random number table method, with 40 cases in each group. According to the dropout criteria, 3 cases dropped out in each group, and 37 cases were finally included in each group. The control group received traditional Ponseti technique with vaseline gauze for skin protection, and the observation group was treated with modified Ponseti technique combined with external application of traditional Chinese medicine gel patches. The incidence of skin complications, skin condition, pain level, transforming growth factor-β1 (TGF-β1), interleukin-6 (IL-6), microcirculation evaluation, biomechanical monitoring and curative effect were compared between the two groups. Results The total incidence of skin complications in the observation group was significantly lower than that in the control group ［8.1%(3/37) vs 40.5%(15/37)］(χ2=10.571, P=0.001). After treatment, the Braden Q scores in both groups were higher than those before treatment, and the score in the observation group was higher than that in the control group; the faces, legs, activity, cry, and consolability scale scores in both groups were lower than those before treatment, and the score in the observation group was lower than that in the control group (all P<0.05). TGF-β1 in both groups showed a continuous increasing trend before treatment, at 4 weeks of treatment and at cast removal; IL-6 in the control group showed a trend of first increasing and then decreasing, while that in the observation group showed a continuous decreasing trend; at 4 weeks of treatment and at cast removal, TGF-β1 in observation group were higher than those in the control group, and IL-6 were lower than those in the control group (all P<0.05). After treatment, the blood perfusion in both groups was higher than that before treatment, and that in the observation group was higher than that in the control group; the contact pressure, shear force and pressure-time integral in both groups were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). The total effective rate of the observation group was significantly higher than that of the control group ［94.6%(35/37) vs 75.7%(28/37)］(χ2=5.234, P=0.022). Conclusion Modified Ponseti technique combined with external application of traditional Chinese medicine gel patches for "promoting blood circulation and removing blood stasis, relaxing sinews and activating collaterals" can significantly reduce the incidence of skin complications during cast fixation in children with clubfoot, relieve skin pain, improve skin condition and significantly increase the total effective rate. Its mechanism is related to improving microcirculation, regulating inflammatory repair balance and optimizing biomechanical environment.