改良半硬化高分子绷带人类位固定治疗发育性髋关节脱位

Modified spica immobilization of semi-hardened polymer bandage for treatment of developmental dislocation of hips

目的评估传统石膏人类位固定与改良半硬化高分子绷带人类位固定治疗发育性髋关节脱位的疗效与并发症。方法随访重庆医科大学附属儿童医院采取闭石膏组合复位人类位石膏固定完整资料的患儿62例共75髋,其中石膏组采用传统石膏固定方法30例共35髋,改良组采用改良半硬化高分子绷带固定方法32例共40髋。纳入标准:首次确诊为发育性髋关节脱位;年龄≤24个月;采取人类位石膏固定术治疗。排除标准:复位年龄>24个月;闭合复位失败;外院已经接受过其他治疗;临床资料不全或随访时间低于24个月。对全部患儿进行影像学检查和髋关节功能评价,统计患儿拆除石膏时发生烦躁、焦虑以及皮肤压伤的情况。男女比例、优良率、患儿烦躁、焦虑、皮肤压伤发生率及股骨头坏死发生率采用卡方检验,两组患儿年龄、体重、随访时间及髋臼指数采用独立样本t检验,Tönnis分度采用非参数检验。结果石膏组平均随访时间(31.2±4.2)月,改良组平均随访时间(32.2±5.5)月,组间差异无明显统计学意义(t=0.87,P>0.05)。根据周永德发育性髋关节脱位疗效评价标准,石膏组优良率88.6%,改良组优良率为87.5%,组间优良率差异并无统计学意义(χ^2=0.02,P>0.05)。石膏组股骨头坏死发生率17.1%,改良组股骨头坏死发生率为12.5%,组间差异并无统计学意义(χ^2=0.32,P>0.05)。在石膏并发症皮肤压伤上,石膏组与改良组差异并无统计学意义(χ^2=1.40,P>0.05)。但在拆除石膏时引起患儿烦躁、焦虑的情绪上,改良组显著低于石膏组(χ^2=43.75,P<0.01)。结论改良半硬化高分子绷带人类位固定治疗发育性髋关节脱位与传统石膏固定具有相当的治疗效果及并发症发生率,但显著降低了患儿在拆除石膏时的烦躁、焦虑,同时完全避免了石膏锯的使用与相关风险。

Objective To evaluate the curative effect and complication of the developmental dislocation of the hips(DDH)in children with traditional spicacast immobilization and modified semi-hardened polymer bandage spica immobilization.Methods Sixty-two DDH children in Children's Hospital of Chongqing Medical University with a total of 75 hips were enrolled in this study.In the cast group,30 children with a total of 35 hips were treated with the traditional spica cast immobilization method.In the modified group,32 children with a total of 40 hips were treated with modified semi-hardened polymer bandage.Inclusion criteria:the first diagnosis of developmental dislocation of the hip,age≤24 months,treatment with human plaster fixation.Exclusion criteria:reduction age>24 months,closed reduction failure,other treatments have been adopted outside the hospital,clinical data are incomplete or follow-up time is less than 24 months.All the children underwent imaging and hip function evaluation.The irritability,anxiety,and crushing of the skin occurred when the patient was removed cast.Chi-square test was used for the ratio of male to female,the excellent and good rate,irritability,anxiety,skin pressure,and femoral head necrosis.The age,weight,follow-up time and acetabular index of the two groups of children were tested by independent t-test.The Tönnis scale was analyzed by non-parameter verification.Results The average follow-up time of the plaster group were(31.2±4.2)months,and the average follow-up time of the modified group were(32.2±5.5)months.There was no significant difference between the groups(t=0.87,P>0.05).According to Zhou Yongde evaluation criteria of developmental dislocation of hip joint,the rate of excellent and good rank was 88.6%in cast group and 87.5%in improved group.There was no significant difference between the two groups(χ^2=0.02,P>0.05).The incidence of avascular necrosis was 17.1%in the cast group and 12.5%in the modified group.There was no significant difference between the groups(χ^2=0.32,P>0.05).In the cast complications of skin crush,cast group and the improvement group no significant difference(χ^2=1.40,P>0.05).However,when removing cast caused irritability and anxiety in children,the modified group was significantly lower than the cast group(χ^2=43.75,P<0.01).Conclusions Modified semi-hardened polymer bandage immobilizations for the treatment of DDH has the same therapeutic effects and complications in the development of dislocation of the hip compared with traditional cast fixation,but significantly reduce irritability,anxiety and complete anxiety in children with cast removal.The use of plaster saws and related risks are completely avoided.