Results after spica cast immobilization following hip reconstruction in 95 cases: is there a need for alternative techniques?
Results after spica cast immobilization following hip reconstruction in 95 cases: is there a need for alternative techniques?
复制标题
DOI：
10.1007/s00402-020-03733-8
复制
发表时间：
2022-06
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
--
作者：
发育性髋关节发育不良 (DDH)、神经源性髋关节发育不良 (NDH) 和 Perthes 病通常需要手术治疗。角位石膏铸造是一种常见的术后固定。本研究的目的是评估与固定相关的并发症。在一项回顾性分析中，我们纳入了 2008 年至 2018 年间接受髋关节重建手术的 83 名患者（95 个髋关节）。其中 43 名女性患者和 40 名男性患者。年龄从 3 个月到 19 岁。所有患者术后均接受为期 6 周的人字形石膏治疗。使用完整的医疗文件对并发症进行分析，并根据 Clavien-Dindo 进行分类。 23 名患者 (27.7%) 出现并发症。浅表皮肤病变7例，深层皮肤病变3例，内收肌痉挛3例，半脱位2例，钢板感染1例，钢板断裂1例，顺应性问题1例，石膏脱位2例，再脱位1例，骨愈合延迟1例，膝屈肌痉挛1例。根据 Clavien-Dindo 分类，我们能够统计出 10 例 I 型不良事件、4 例 II 型不良事件、9 例 III 型不良事件、0 例 IV 型不良事件和 0 例 V 型不良事件。髋关节重建手术后使用人字形石膏仍然是最流行的后处理方式。它的并发症发生率较低，可以通过良好的石膏固定和泡沫填充来降低并发症发生率。应观察并避免脑瘫患者痉挛、皮肤损伤、压疮等已知并发症。使用泡沫垫和泡沫夹板缩短固定方案可减少并发症。证据级别 IV 级，病例系列
Developmental dysplasia of the hip (DDH), neurogenic dysplasia of the hip (NDH), and Perthes disease often require surgical treatment. Spica casting is a common postoperative immobilization. The purpose of this study was to evaluate the complications related to the immobilization. In a retrospective analysis, we included 83 patients (95 hips), who underwent hip reconstructive surgery between 2008 and 2018. We had 43 female and 40 male patients. Age reached from 3 months to 19 years. All patients were treated with a spica cast postoperatively for a 6-week protocol. Complications were analyzed using the full medical documentation and classified according to Clavien–Dindo. We had complications in 23 patients (27.7%). We counted superficial skin lesions in seven, deep skin lesions in three, spasticity of adductors in three, subluxation in two, infection of the plate in one, fracture of the plate in one, compliance problem in one, dislocations of the cast in two, reluxation in one, delayed bone healing in one and spasticity of knee flexors in one case. According to the classification of Clavien–Dindo, we were able to count ten type I, four type II, nine type III, zero type IV and zero type V adverse events. The usage of a spica cast after hip reconstructive surgery is still the most popular way of aftertreatment. It has a low complication rate, which may be lowered by well-applied casts and foam padding. Known complications such as spasticity in patients with cerebral palsy, skin lesions, and pressure sores should be observed and avoided. Shorter protocols for immobilization with the usage of foam padding and foam splints lead to less complications. Evidence level level IV, case series