Tesis

Korelasi antara skor Dimeglio dan antropometri kaki pasien clubfoot unilateral pasca Ponseti di RSCM th 2008-2013 = Correlation between Dimeglio score and foot anthropometry on unilateral clubfoot after Ponseti method at RSCM 2008-2013.

Clubfoot merupakan salah satu kelainan kaki bawaan yang paling sering ditemui
di dunia. Jika tidak ditangani,clubfoot akan mempengaruhi kualitas hidup secara
signifikan. Teknik Ponseti telah diterima secara universal sebagai metode terapi
dengan hasil yang sangat memuaskan . Terlepas dari keberhasilan teknik Ponseti,
kaki clubfoot pasca terapi tetap kecil secara antropometri. Penelitian ini bertujuan
untuk mengetahui korelasi antara parameter antropometri kaki dengan skor
Dimeglio pasca Ponseti.
Penelitian ini adalah penelitian analitik observasional dengan desain cross
sectional. Sampel adalah semua pasien clubfoot unilateral yang datang ke RSCM
2008-2013. Pasien di identifikasi jenis kelamin, berat badan, umur pertama kali
berobat, sisi yang sakit, jumlah gips, perlu pemanjangan tendon achiles atau tidak.
Selanjutnya dilakukan pemeriksaan panjang kaki, lebar kaki dan lingkar betis
pada kaki ctev dan kaki kontralateral dan dilakukan penilaian outcome
menggunakan skor Dimeglio. Uji t digunakan untuk menganalisis perbedaan
rerata panjang kaki, lebar kaki dan lingkar betis kaki ctev dengan kaki normal.
Sedangkan Uji korelasi Pearson digunakan untuk menganalisis korelasi antara
selisih antropometri dengan derajat Skor Dimeglio.
Penelitian ini merupakan evaluasi jangka menengah (3.16 tahun) dengan follow
up terpanjang 6.3 tahun dan terpendek 10 bulan. Rerata jumlah gips yang
dilakukan 6.4 seri. Rerata skor Dimeglio pasca terapi 4.8. Pasien dengan kriteria
benign 12 orang, moderate 5 orang. Tidak ada pasien dengan kriteria severe dan
very severe. Rerata panjang kaki ctev 14.71 cm, lebar kaki ctev 6.60 cm, lingkar
betis ctev 15.41 cm, sedangkan rerata panjang kaki normal 15.50 cm, lebar kaki
normal 6.99 cm, lingkar betis normal 16.68 cm. Uji t satu arah ditemukan panjang
kaki, lebar kaki dan lingkar betis kaki CTEV lebih kecil signifikan dari kaki
normal (t
> t, CI 95%). Korelasi selisih panjang kaki dengan Skor Dimeglio
0.694. Korelasi selisih lebar kaki dengan skor Dimeglio 0.367. Korelasi selisih
lingkar betis dengan skor Dimeglio 0.305. Uji Korelasi Pearson ditemukan
korelasi bermakna antara selisih panjang kaki dengan skor Dimeglio (P0.01).
0
Luaran metoda Ponseti dengan skor Dimeglio pada clubfoot unilateral di RSCM
baik. Rata-rata panjang kaki, lebar kaki dan lingkar betis kaki ctev lebih rendah
dari kaki normal. Terdapat korelasi antara selisih panjang kaki dengan skor
Dimeglio pasca terapi.Tidak terdapat korelasi antara lebar kaki dan lingkar betis
denganskor Dimeglio pasca terapi.


Clubfoot is one of the most common congenital foot deformity in the world. If left
untreated, clubfoot will affect significantly to the quality of life. Ponseti technique
has been universaly accepted as the method with a very satisfactory result.
Despite the fact of Ponseti successfulness, there is a concern that the foot being
treated still in a smaller dimension anthropomethically. This study aims to find
any correlation between Dimeglio score post Ponseti-treated clubfoot with
anthropometric parameter of the foot.
This is an observational analytic study with cross sectional design. The samples
were unilateral clubfoot patients who came to Cipto Mangunkusumo Hospital
from 2008 until 2013. Every patient was recorded for gender, body weight, age on
first visit, age at the time study conducted, side of foot affected, number of serial
casts, and requirement of tendon lengthening. Afterwards, we measure foot length,
foot width, and calf circumference of the clubfoot and normal one. Then, we
assessed the post Ponseti correction score by using Dimeglio T-test was used to
analyze the differences of foot length, foot width, and calf circumference between
clubfoot and normal foot. While Pearson correlation test was used to analyze the
correlation between anthropometric differences and severity of clubfoot
(Dimeglio Score).
This is mid term follow up study (mean 3.16 years ) with maximum follow up 6.3
years and minimum 10 month. The mean of serial casts that has been done was
6.4 series. The mean of post-treatment Dimeglio score was 4.8. Patients who were
included in benign criteria were 12 subjects, moderate were 5 subjects. No patient
were included in severe and very severe criteria. The mean of clubfoot length was
14.71 cm, the mean of clubfoot width was 6.60 cm, and the mean of calf
circumference of clubfoot side is 15.41 cm. On the other hand, the mean of
normal foot length was 15.50 cm, the mean of normal foot width was 6.99 cm,
and the mean of calf circumference of normal foot side was 16.68 cm. One-way ttest
found that the foot length,foot width and calf circumference of clubfeet were significantly smaller than the normal feet (t> t, CI 95%). The correlation of difference in foot length with Dimeglio score is 0.694. The correlation of
difference in foot width with Dimeglio score is 0.367. The correlation of
difference in calf circumference with Dimeglio score is 0.305. Pearson correlation
test found that there is a significant correlation between the difference in foot
length and Dimeglio score (p0.01).
The outcome of Ponsetti technique for unilateral clubfoot in Cipto
Mangunkusumo Hospital using Dimeglio score is good. The means of foot length,
foot width, and calf circumference for clubfoot were found to be less than normal
foot. There were correlation between differences of foot length and post treatment
Dimeglio score.There were no correlation between differences of foot length and
foot width with post treatment Dimeglio score.