Yasin Mohamad S, Alisi Mohammed S, Hammad Yazan S, Samarah Omar Q, Abu Hassan Freih O
Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan.
Orthop Res Rev. 2022 Mar 24;14:71-76. doi: 10.2147/ORR.S353279. eCollection 2022.
Closed reduction (CR) is a standard treatment for developmental dysplasia of the hip (DDH) after failed conservative treatment. After CR, the affected hip is held in the reduced position by a spica cast that typically extends below the knee (long). Above knee (short) spica cast is an alternative technique utilized by some pediatric orthopedic surgeons. We aimed to compare short versus long spica cast after CR in terms of success rate and complications.
Patients who underwent CR with short or long hip spica cast over a 3-year period (2016-2019) were evaluated for the success (sustainability of the reduction) and complications. The acute and long-term success were recorded retrospectively. Acute success was defined as concentric reduction of the hip confirmed by intraoperative arthrogram and immediate postoperative CT scan. Long-term success was defined as maintained reduction at 12 months' post reduction.
Forty-seven patients were included in our study. Long spica casts were used in 24 patients and short ones in the remaining 23. The overall acute and long-term success rates were 83% and 66%, respectively. The acute success rate of long spica was 87.5%, while short spica achieved 78.2%. On the long term, the success rate of short spica was higher than long one (73.9% vs 58.3%). Cox regression analysis showed that the type of cast (short vs long spica) was not correlated with acute success ( = 0.405), long-term success ( = 0.263), residual dysplasia ( = 0.405), or avascular necrosis ( = 0.053).
CR in DDH is an important line of management in the younger patient population and can save them an invasive open surgery later in life. A short leg spica could represent an easier and likely as successful alternative to the traditional long spica. More prospective future research is needed to validate our observational findings.
III.
闭合复位（CR）是发育性髋关节发育不良（DDH）保守治疗失败后的标准治疗方法。CR后，患侧髋关节通过通常延伸至膝关节以下的髋人字石膏（长腿）固定于复位位置。膝上（短腿）髋人字石膏是一些小儿骨科医生采用的替代技术。我们旨在比较CR后短腿与长腿髋人字石膏在成功率和并发症方面的差异。
对在3年期间（2016 - 2019年）接受CR并使用短腿或长腿髋人字石膏的患者进行复位成功（复位的可持续性）和并发症评估。回顾性记录急性和长期成功率。急性成功定义为术中关节造影和术后即刻CT扫描证实髋关节同心复位。长期成功定义为复位后12个月时维持复位。
我们的研究纳入了47例患者。24例患者使用长腿髋人字石膏，其余23例使用短腿石膏。总体急性和长期成功率分别为83%和66%。长腿髋人字石膏的急性成功率为87.5%，而短腿石膏为78.2%。从长期来看，短腿石膏的成功率高于长腿石膏（73.9%对58.3%）。Cox回归分析表明，石膏类型（短腿与长腿髋人字石膏）与急性成功（P = 0.405）、长期成功（P = 0.263）、残余发育不良（P = 0.405）或缺血性坏死（P = 0.053）均无相关性。
DDH的CR是年轻患者群体重要的治疗方法，可避免其日后进行侵入性开放手术。短腿髋人字石膏可能是传统长腿髋人字石膏更简便且可能同样成功的替代方法。需要更多前瞻性研究来验证我们的观察结果。
III级
