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.
■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。