PDF(Pubmed)
Abstract：
UNASSIGNED: Paediatric femoral shaft fractures can be managed with single- or double-leg hip spica casting between ages six-months and six-years. The aim of this review was to determine if single-leg hip spicas reduce the impact on family life without compromising fracture stability.
UNASSIGNED: The study was registered on PROSPERO (CRD42023454309). MEDLINE, Embase, Web of Science, Cochrane Library, and clinical trial registers were searched to May 2023 for level I-III evidence. Primary outcomes were impact on family life and fracture stability. Where appropriate, Meta-analysis was completed using RevMan v5.4. Risk of bias was assessed using RoB 2.0 (RCTs) and ROBINS-I (non-RCTs). Certainty of evidence was measured with GRADE.
UNASSIGNED: From 234 identified papers, four met the inclusion criteria (two RCTs; two non-RCTs). A total of 339 children were included (single-leg spica: 176; double-leg spica: 163). Three studies were \'high risk\' and one study \'moderate risk\' of bias. Impact on family life parameters were too heterogenous for pooled meta-analysis. Non-pooled data identified significantly more missed work days in the double-leg spica group and the \'Impact on Family\' Scale significantly favoured single-leg spicas. For fracture stability, meta-analysis identified that (i) mal-union rates were significantly lower in single-leg spica: OR 0.08 (95 % CI 0.01 to 0.69; p = 0.02); (ii) MUA in theatre was not significantly different: OR 0.97 (95 % CI 0.19 to 4.86; p = 0.97); and (iii) wedge adjustment was not significantly different: OR 3.46 (95 % CI 0.48 to 24.92; p = 0.22). Certainty of evidence was assessed as \'very low\'.
UNASSIGNED: Single-leg hip spicas may be associated with reduced impact on family life without compromising fracture stability compared with double-leg hip spicas. However, the evidence is weak. Therefore, a propensity score matched observational study is required to understand if subgroups of patients (age, fracture pattern, mechanism of injury) would benefit from a single- or double-leg hip spica.
UNASSIGNED: The study was registered on PROSPERO (CRD42023454309). MEDLINE, Embase, Web of Science, Cochrane Library, and clinical trial registers were searched to May 2023 for level I-III evidence. Primary outcomes were impact on family life and fracture stability. Where appropriate, Meta-analysis was completed using RevMan v5.4. Risk of bias was assessed using RoB 2.0 (RCTs) and ROBINS-I (non-RCTs). Certainty of evidence was measured with GRADE.
UNASSIGNED: From 234 identified papers, four met the inclusion criteria (two RCTs; two non-RCTs). A total of 339 children were included (single-leg spica: 176; double-leg spica: 163). Three studies were \'high risk\' and one study \'moderate risk\' of bias. Impact on family life parameters were too heterogenous for pooled meta-analysis. Non-pooled data identified significantly more missed work days in the double-leg spica group and the \'Impact on Family\' Scale significantly favoured single-leg spicas. For fracture stability, meta-analysis identified that (i) mal-union rates were significantly lower in single-leg spica: OR 0.08 (95 % CI 0.01 to 0.69; p = 0.02); (ii) MUA in theatre was not significantly different: OR 0.97 (95 % CI 0.19 to 4.86; p = 0.97); and (iii) wedge adjustment was not significantly different: OR 3.46 (95 % CI 0.48 to 24.92; p = 0.22). Certainty of evidence was assessed as \'very low\'.
UNASSIGNED: Single-leg hip spicas may be associated with reduced impact on family life without compromising fracture stability compared with double-leg hip spicas. However, the evidence is weak. Therefore, a propensity score matched observational study is required to understand if subgroups of patients (age, fracture pattern, mechanism of injury) would benefit from a single- or double-leg hip spica.
摘要：
■儿童股骨干骨折可通过6个月至6岁的单腿或双腿髋部脊柱铸造治疗。这项审查的目的是确定单腿髋骨是否在不损害骨折稳定性的情况下减少对家庭生活的影响。
■该研究在PROSPERO（CRD42023454309）上注册。MEDLINE,Embase,WebofScience,科克伦图书馆,和临床试验登记册被搜索到2023年5月的I-III级证据.主要结果是对家庭生活和骨折稳定性的影响。在适当的情况下，使用RevManv5.4完成Meta分析。使用RoB2.0（RCTs）和ROBINS-I（非RCTs）评估偏倚风险。证据的确定性是用等级来衡量的。
■从234篇确定的论文中，4人符合纳入标准(2个RCT;2个非RCT).总共包括339名儿童（单腿意大利：176；双腿意大利：163）。三项研究为“高风险”，一项研究为“中等风险”。对家庭生活参数的影响过于异质性，无法进行汇总荟萃分析。非汇总数据发现，在双腿spica组中，错过的工作日明显增多，“对家庭的影响”量表显着有利于单腿spica。对于断裂稳定性，荟萃分析发现,(i)单腿脊柱畸形愈合率显著较低:OR0.08(95%CI0.01~0.69;p=0.02);(ii)手术室MUA无显著差异:OR0.97(95%CI0.19~4.86;p=0.97);(iii)楔形调整无显著差异:OR3.46(95%CI0.48~24.92;p=0.22)。证据的确定性被评估为“非常低”。
■与双腿髋骨相比，单腿髋骨可能与减少对家庭生活的影响有关，而不会损害骨折的稳定性。然而,证据不足。因此,需要进行倾向评分匹配的观察性研究，以了解患者亚组(年龄，断裂模式,损伤机制）将受益于单腿或双腿髋关节。
■该研究在PROSPERO（CRD42023454309）上注册。MEDLINE,Embase,WebofScience,科克伦图书馆,和临床试验登记册被搜索到2023年5月的I-III级证据.主要结果是对家庭生活和骨折稳定性的影响。在适当的情况下，使用RevManv5.4完成Meta分析。使用RoB2.0（RCTs）和ROBINS-I（非RCTs）评估偏倚风险。证据的确定性是用等级来衡量的。
■从234篇确定的论文中，4人符合纳入标准(2个RCT;2个非RCT).总共包括339名儿童（单腿意大利：176；双腿意大利：163）。三项研究为“高风险”，一项研究为“中等风险”。对家庭生活参数的影响过于异质性，无法进行汇总荟萃分析。非汇总数据发现，在双腿spica组中，错过的工作日明显增多，“对家庭的影响”量表显着有利于单腿spica。对于断裂稳定性，荟萃分析发现,(i)单腿脊柱畸形愈合率显著较低:OR0.08(95%CI0.01~0.69;p=0.02);(ii)手术室MUA无显著差异:OR0.97(95%CI0.19~4.86;p=0.97);(iii)楔形调整无显著差异:OR3.46(95%CI0.48~24.92;p=0.22)。证据的确定性被评估为“非常低”。
■与双腿髋骨相比，单腿髋骨可能与减少对家庭生活的影响有关，而不会损害骨折的稳定性。然而,证据不足。因此,需要进行倾向评分匹配的观察性研究，以了解患者亚组(年龄，断裂模式,损伤机制）将受益于单腿或双腿髋关节。
