Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780, USA.
J Bone Joint Surg Am. 2012 Jul 18;94(14):1259-64. doi: 10.2106/JBJS.K.00966.
At many centers, double-leg spica casting is the treatment of choice for diaphyseal femoral fractures in children two to six years old. We hypothesized that such patients can be effectively treated with single-leg spica casting and that such treatment would result in easier care and better patient function during treatment.
In a prospective, randomized controlled study, fifty-two patients two to six years old with a diaphyseal femoral fracture were randomly assigned to be treated immediately (after consent was obtained) with a single-leg (twenty-four patients) or double-leg (twenty-eight patients) spica cast. Serial radiographs were evaluated for maintenance of fracture reduction with respect to limb length, varus/valgus angulation, and procurvatum/recurvatum angulation. After cast removal, the performance version of the Activities Scale for Kids questionnaire and a custom-written survey were administered to the parents so that they could evaluate the ease of care and function of the children during treatment. Means were compared between treatment groups with use of Student t tests. P values of <0.05 were considered significant.
All limbs healed in satisfactory alignment. The children treated with a single-leg spica cast were more likely to fit into car seats (p < 0.05) and fit more comfortably into chairs (p < 0.05). Caregivers of patients treated with a single-leg cast took less time off work (p < 0.05). There were no major complications.
Treatment of pediatric femoral fractures with a single-leg spica cast is effective and safe, and postfracture patient care is facilitated.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
在许多中心，双下肢长腿石膏固定是治疗 2 至 6 岁儿童股骨干骨折的首选方法。我们假设这种患者可以通过单下肢长腿石膏固定有效治疗，并且这种治疗方法在治疗过程中可以更容易护理和改善患者功能。
在一项前瞻性、随机对照研究中，52 例 2 至 6 岁股骨干骨折的患者随机分为立即接受单下肢（24 例）或双下肢（28 例）长腿石膏固定治疗。连续拍摄 X 线片，评估骨折复位对线情况，包括肢体长度、内翻/外翻角度和外旋/内旋角度。拆除石膏后，采用活动量表（Kids 问卷）的表现版本和自编调查问卷，让家长评估治疗过程中孩子的护理和功能情况。采用学生 t 检验比较两组治疗方法的平均值。P 值<0.05 被认为有统计学意义。
所有肢体均愈合良好。接受单下肢长腿石膏固定治疗的儿童更有可能适合汽车座椅（p < 0.05），更舒适地坐在椅子上（p < 0.05）。接受单下肢石膏固定治疗的患儿家长请的病假更少（p < 0.05）。没有出现主要并发症。
单下肢长腿石膏固定治疗儿童股骨干骨折是有效且安全的，并且可以促进骨折后的患者护理。
治疗性 I 级。请参见作者指南，以获取完整的证据水平描述。
