Tisherman R T, Hoellwarth J S, Mendelson S A
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Division of Orthopaedic Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
J Child Orthop. 2018 Apr 1;12(2):136-144. doi: 10.1302/1863-2548.12.170201.
Paediatric femur fractures are commonly encountered and often successfully managed with spica casting. Despite spica casting's long history there is little formal guidance for optimal outcomes and no consolidation of existing literature. The purpose of this study is to review the available literature regarding the use of spica casting for the management of paediatric diaphyseal femur fractures.
The PubMed database was queried for all research articles including the phrase "spica". A total of 788 abstracts were reviewed for relevance to the current study. Data was extracted from all available research studies which specified tolerance for fracture angulation or shortening in the cast. Additionally, all articles describing alternative materials, methods for spica application, and complications of spica casting were reviewed.
In all, 106 articles were found relevant to the management of diaphyseal femur fractures in the paediatric population. The aggregated, accepted fracture shortening decreased from 16 mm to 18 mm before age ten years to 12 mm to 14 mm after puberty. Aggregated, accepted angulation decreased from 14° to 16° varus/valgus and 18° to 22° pro/recurvatum before age two years, to 6° to 8° and 10° to 12° by puberty, respectively. The overall reported complication rate was 19.6%, with the most common complication being skin compromise in 8.2% of patients, followed by unacceptable angulation at the fracture site in 4.2% of patients and excessive limb shortening in 1.9% of patients.
This article reviews the available spica casting literature and compiles the available data. Spica casting offers a safe, effective means for definitive management of paediatric diaphyseal femur fractures. Future research identifying the rate and pattern of remodelling as it relates to angulation and shortening at various patient ages, particularly beyond the aforementioned norms, would be valuable to identify true biological tolerances accepted expert opinion.
Review of level II evidence.
小儿股骨骨折很常见，通常采用髋人字石膏固定法能成功治疗。尽管髋人字石膏固定法历史悠久，但对于实现最佳治疗效果却几乎没有正式的指导意见，且现有文献也未进行整合。本研究的目的是回顾关于使用髋人字石膏固定法治疗小儿股骨干骨折的现有文献。
在PubMed数据库中查询所有包含“髋人字石膏”一词的研究文章。共审查了788篇摘要，以确定其与本研究的相关性。从所有可用的研究中提取数据，这些研究明确了石膏固定中骨折成角或缩短的可接受范围。此外，还审查了所有描述替代材料、髋人字石膏应用方法以及髋人字石膏固定并发症的文章。
总共发现106篇文章与小儿股骨干骨折的治疗相关。汇总的、可接受的骨折缩短量在10岁前从16毫米降至18毫米，青春期后降至12毫米至14毫米。汇总的、可接受的成角在2岁前内翻/外翻为14°至16°、前屈/后伸为18°至22°，到青春期分别降至6°至8°和10°至12°。总体报告的并发症发生率为19.6%，最常见的并发症是8.2%的患者出现皮肤问题，其次是4.2%的患者骨折部位出现不可接受的成角，1.9%的患者出现肢体过度缩短。
本文回顾了现有的髋人字石膏固定文献并汇总了可用数据。髋人字石膏固定法为小儿股骨干骨折的确定性治疗提供了一种安全、有效的方法。未来的研究确定与不同患者年龄的成角和缩短相关的重塑速率和模式，特别是超出上述标准的情况，对于确定真正的生物学耐受度和公认的专家意见将是有价值的。
二级证据综述。
