Department of Urology, University of Iowa, Iowa City, IA, USA.
J Pediatr Urol. 2011 Aug;7(4):456-9. doi: 10.1016/j.jpurol.2010.06.005. Epub 2010 Jul 16.
Pelvic immobilization constitutes a necessary component of successful bladder exstrophy closure. The efficacy of spica cast immobilization has been reported as markedly inferior to external fixation, with success rates below 25%. We reviewed our experience with spica cast immobilization following bladder closure.
We retrospectively reviewed classic bladder exstrophy patients undergoing bladder closure with spica cast immobilization. Success of bladder closure and complications related to immobilization were noted, as were age, type of closure, use of osteotomy, duration of immobilization, and number of cast changes.
Fifteen patients underwent bladder closure (10 staged, 5 complete repair) at a median age of 4 days (range 1-6) and 14 were immobilized with spica casts. Initial closures were successful in 11 (73%). Success rates were higher in patients undergoing osteotomies (6/7, 86%) compared to those without osteotomies (5/8, 63%). No patients immobilized with spica casts developed serious complications related to their immobilization. Minor skin breakdown occurred in 3/14 patients (21%). Median time of immobilization was 39 days (range 22-48).
Spica casts are a safe, effective method of postoperative immobilization and are associated with a low risk of cast-related complications.
骨盆固定是成功进行膀胱外翻修补术的必要组成部分。报道称，环形石膏固定的效果明显不如外固定，成功率低于 25%。我们回顾了膀胱关闭后使用环形石膏固定的经验。
我们回顾性分析了接受环形石膏固定进行膀胱关闭的经典膀胱外翻患者。记录了膀胱关闭的成功率和与固定相关的并发症，以及患者年龄、关闭类型、是否行截骨术、固定时间和更换石膏的次数。
15 名患者在中位年龄为 4 天（范围 1-6 天）时接受了膀胱关闭（10 例分期，5 例完全修复），其中 14 例患者使用环形石膏固定。11 例（73%）初始关闭成功。行截骨术的患者成功率更高（6/7，86%），而未行截骨术的患者成功率较低（5/8，63%）。使用环形石膏固定的患者无一例发生与固定相关的严重并发症。3/14 例患者（21%）出现轻微皮肤破裂。固定时间的中位数为 39 天（范围 22-48 天）。
环形石膏是一种安全、有效的术后固定方法，与石膏相关并发症的风险较低。
