Importância da idade da criança para se iniciar o tratamento do pé torto congênito pela técnica acelerada de Ponseti.

Abstract

Introduction: the child's ideal age to start treatment of congenital clubfoot is still a matter of controversy in the literature. Objectives: to assess whether age at the start of treatment influences the results obtained with the accelerated Ponseti technique. To investigate whether the sex, the laterality of involvement and the degree of deformity have different repercussions according to the age categories of the children treated. Casuistry and method: the sample included 33 children and 51 congenital clubfoot. The groups were composed according to the children's age: group 1, up to 30 days and group 2, over 30 days old. The treatment was carried out using the accelerated Ponseti technique, with manipulating the feet and immobilizing plaster twice a week until the equine was corrected. Feet were classified by two independent examiners by means of photographic record, at the beginning of treatment and after correction of the equine, according to the parameters proposed by Pirani. For the evaluation of inter-rater reliability, the following were used: the statistical comparison of means of the two evaluators, the comparison of minimum and maximum values of the evaluators, the percentage of weighted quadratic agreement, the statistical weighted Kappa of Cohen, the limits of agreement, as proposed by Bland and Altman and Pittman's statistics. In the descriptive analysis the continuous variables were expressed as mean + standard deviation, median + interqualitic range and the minimum and maximum values. Categorical variables were expressed in absolute and percentage values. Association analyzes were performed using Student's t test to compare means in the case of dependent and independent samples; median tests for dependent and independent samples; Fisher and Chi-square tests for comparisons of independent proportions; and Mann-Whitney to compare medians of independent samples. The level of significance adopted was 5% (p <0.05). Stata for Mac software (version 12.0) was used. Results: the two groups of children were considered similar in terms of sex, laterality, Pirani's initial score. In children in group 1, age up to 30 days, treatment time was shorter, median of 14 days (p <0.001)) and the number of cast change was lower, median of four (p <0.001), compared to group 2 (children older than 30 days of life). There was agreement between the both evaluators at the beginning of the treatment and after the correction of the equine and the evolution of the treatment in both groups, evaluated by the Pirani score, was similar and with good results (p> 0.05). Conclusion: the treatment of clubfoot by the accelerated Ponseti technique was positively influenced by the age of the children, because in those up to 30 days, the time was shorter and required fewer manipulations and plaster immobilizations, compared to children over 30 days of life, without changing the quality of the proposed treatment. The sex, the laterality of involvement and the initial Pirani score did not interfered in the results of the treatment, when comparing the two age categories of the children.