Murgai Rajan R, Compton Edward, Patel Akash R, Ryan Deirdre, Kay Robert M
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Children's Bone and Spine Surgery, Las Vegas, NV.
J Pediatr Orthop. 2018 Sep;38(8):e470-e474. doi: 10.1097/BPO.0000000000001212.
Although postoperative cast immobilization is routinely used in children, it is not without complications. Few studies have focused on interventions to decrease their frequency. The purpose of this study was to determine if foam padding in postoperative lower extremity casts decreased the rate of cast complications.
A retrospective review of patients who underwent lower extremity casting after elective surgery at a tertiary pediatric hospital from 2006 to 2013 was conducted. Postoperative casts were classified by type (A-frame, short leg, long leg, spica) and the presence of foam. Charts were reviewed for skin complications, cast splits for apparent neurovascular deficits, cast splits for patient complaints, unplanned outpatient returns for cast-related issues, and compartment syndrome.
In total, 920 patients with 2,481 casts were included. In total, 612 (24.7%) casts had foam placed during casting. The incidence of skin complications was significantly lower in A-frame casts with foam (4.5%, 5/112) than without (13.4%, 11/82) (P=0.03) and long leg casts with foam (0.9%, 2/225) than without (4.3%, 19/444) (P=0.02). Patients with static encephalopathy casted with foam had a lower incidence of skin complications (0.7%, 2/279) than those without (3.6%, 22/615) (P=0.01). There was no difference in the overall incidence of skin complications in casts with and without foam (P=0.44), short leg casts (P=0.37), and spica casts (P=0.34). Patients with skin complications (20.3±7.1 kg/m) had a higher body mass index than those without (18.9±5.4 kg/m) (P=0.04). Postoperative A-frame casts with foam (0.0%, 0/112) were split less often for apparent neurovascular deficits than those without foam (4.5%, 3/67) (P=0.05). The cast split rates for apparent neurovascular deficits in casts with and without foam (P=0.58), long leg casts (P=0.67), short leg casts (P=0.63), and spica casts (P=1.0) were comparable.
The use of foam in postoperative lower extremity casting is an effective intervention to reduce the incidence of skin complications in patients with static encephalopathy, in an A-frame cast, or in a long leg cast.
Level III-retrospective comparative study.
尽管术后石膏固定在儿童中常规使用，但并非没有并发症。很少有研究关注降低其发生率的干预措施。本研究的目的是确定术后下肢石膏中使用泡沫垫是否能降低石膏并发症的发生率。
对2006年至2013年在一家三级儿科医院接受择期手术后进行下肢石膏固定的患者进行回顾性研究。术后石膏根据类型（A形、短腿、长腿、髋人字）和是否有泡沫进行分类。查阅病历以了解皮肤并发症、因明显神经血管缺损导致的石膏裂开、因患者主诉导致的石膏裂开、因石膏相关问题的计划外门诊复诊以及骨筋膜室综合征。
共纳入920例患者的2481个石膏。总共有612个（24.7%）石膏在打石膏时放置了泡沫。有泡沫的A形石膏的皮肤并发症发生率（4.5%，5/112）显著低于无泡沫的（13.4%，11/82）（P = 0.03），有泡沫的长腿石膏的皮肤并发症发生率（0.9%，2/225）低于无泡沫的（4.3%，19/444）（P = 0.02）。使用泡沫进行石膏固定的静态脑病患者的皮肤并发症发生率（0.7%，2/279）低于未使用泡沫的（3.6%，22/615）（P = 0.01）。有泡沫和无泡沫的石膏、短腿石膏以及髋人字石膏的皮肤并发症总体发生率无差异（P = 0.44、P = 0.37、P = 0.34）。有皮肤并发症的患者的体重指数（20.3±7.1kg/m）高于无皮肤并发症的患者（18.9±5.4kg/m）（P = 0.04）。有泡沫的术后A形石膏（0.0%，0/112）因明显神经血管缺损导致的裂开次数少于无泡沫的（4.5%，3/67）（P = 0.05）。有泡沫和无泡沫的石膏、长腿石膏、短腿石膏以及髋人字石膏因明显神经血管缺损导致的石膏裂开率相当（P = 0.58、P = 0.67、P = 0.63、P = 1.0）。
术后下肢石膏固定中使用泡沫是一种有效的干预措施，可降低静态脑病患者、A形石膏患者或长腿石膏患者的皮肤并发症发生率。
III级——回顾性比较研究。
