Albrektson Josh, Kay Robert M, Tolo Vernon T, Skaggs David L
Children's Hospital Los Angeles, 4650 Sunset Boulevard #69, Los Angeles, CA, 90027, USA.
J Child Orthop. 2007 Nov;1(5):299-305. doi: 10.1007/s11832-007-0054-0. Epub 2007 Oct 13.
Studies have shown that when using a spica cast following hip surgery in children , there are associated complications such as soiling, pressure sores, and osteopenic fractures.
Charts were retrospectively reviewed for all patients who had undergone hip surgeries by one surgeon at one institution between 1999 and 2005. The method of post-operative immobilization (spica cast or abduction pillow) and complications were recorded for each patient.
There was a total of 32 patients. Of these, 11-all of whom had a diagnosis of developmental dysplasia of the hip-were treated using a spica cast. In the 21 patients treated in an abduction pillow, 4 (19%) were switched to a spica cast for the following reasons: (1) distal femoral fracture as a result of vigorous resuscitation during a choking episode, (2) parental preference, (3) for added immobilization over concern of implant loss of fixation, and (4) concern of migration of the hip, which again migrated after being changed to a spica cast and eventually required a pelvic osteotomy.
It is our opinion that only one of these complications in the children treated with an abduction pillow (the case of possible implant migration) may have been avoided if the child had originally been placed in a spica cast. The child who was successfully resuscitated after a choking incident weeks after the surgery may have had a worse outcome if it had been in a spica cast. This incident occurred at home and the abduction pillow was easily and quickly removed to allow resuscitation. An abduction pillow is a welcome alternative to a spica cast following hip surgery for many patients with neuromuscular and syndromic conditions. However, in children with osteopenic bone at risk for implant failure and in children with unstable hip reductions, a spica cast may be preferable.
研究表明，儿童髋关节手术后使用髋人字石膏固定会出现诸如弄脏、压疮和骨质疏松性骨折等相关并发症。
回顾性分析1999年至2005年间在一家机构由一位外科医生进行髋关节手术的所有患者的病历。记录每位患者的术后固定方法（髋人字石膏或外展枕）及并发症情况。
共有32例患者。其中11例——均诊断为发育性髋关节发育不良——采用髋人字石膏固定治疗。在使用外展枕治疗的21例患者中，4例（19%）因以下原因改用髋人字石膏固定：（1）窒息发作时强力复苏导致股骨干远端骨折；（2）家长的偏好；（3）出于对植入物固定丢失的担忧而加强固定；（4）担心髋关节移位，改为髋人字石膏固定后髋关节再次移位，最终需要进行骨盆截骨术。
我们认为，对于使用外展枕治疗的儿童，只有其中一种并发症（可能的植入物移位情况）如果最初使用髋人字石膏固定或许可以避免。术后数周在家中发生窒息事件后成功复苏的患儿，如果当时使用髋人字石膏固定，可能预后更差。当时外展枕便于快速移除，利于进行复苏。对于许多患有神经肌肉疾病和综合征的患者，外展枕是髋关节手术后髋人字石膏的一个受欢迎的替代选择。然而，对于有植入物失败风险的骨质疏松患儿以及髋关节复位不稳定的患儿，髋人字石膏可能更可取。
