先天性肌性斜颈手术 1～5岁最适宜

肌性斜颈,俗称歪脖儿,是指由于一侧胸锁乳突肌挛缩导致的颈部偏斜,头和颈不对称的畸形。先天性肌性斜颈80％发生于右侧,20％合并先天性髋关节脱位,是小儿矫行外科疾病中最常见的先天性畸形之一。     

小儿歪脖也是病

小儿先天性肌性斜颈是一种比较常见的小儿头颈部疾病．有时也叫小儿斜颈。其主要病因是一侧胸锁乳突肌的挛缩而引起患儿头部向患侧偏斜，有时可发生在臀位分娩过程中，由于分娩时损伤所致。但在剖宫产的新生儿中也可以出现。大多数患儿在出生后几天即可发现其一侧颈部出现一肿块，质地坚硬，不活动，一般无疼痛。随之发现患     

小儿先天性斜颈的诊治

小儿先天性斜颈是以一侧胸锁乳突肌挛缩而引起患儿头颈向一侧偏斜,又称肌性斜颈,原发性斜颈。1病因病机小儿肌性斜颈病因是胸锁乳突肌纤维挛缩与变短,引起本病的原因有以下几个方面:(1)分娩时胎儿头位不正,阻碍一侧胸锁乳突肌血运供给,引起该肌缺血性挛缩。(2)分娩时一侧胸锁乳     

小儿斜颈知多少

通常我们说的小儿斜颈,是指小儿先天性肌性斜颈,其病因是一侧胸锁乳突肌由于多种原因形成血肿,继而发生挛缩,引起患儿头部向患侧偏斜。常见病因有胎位不正、产伤或难产和胸锁乳突肌血管发育畸形等。大多数患儿在出生后几天即可发现其一侧颈部出现肿块,质地坚硬,不活动,一般无疼痛,随之发现患儿头偏向患侧。如果不进行治疗,颈部的肿块一般在3个月以后可消失,取而代之的是该肌的挛缩,并使头颈偏斜进一步加重。早期发现,及时诊断,正确治疗,是治愈该病的关键。小儿先天性肌性斜颈诊断并不困难。但应该与以下其他类型的斜颈相鉴别:小儿骨性斜颈由…     

高频超声诊断小儿先天性肌性斜颈

目的探讨高频超声诊断小儿先天性肌性斜颈的价值。方法对58例先天性肌性斜颈患儿进行回顾性分析。结果所有病例患儿志翎胸锁胸突肌均可发现异常声像改变。结论高频超声对小儿先天性斜颈有明确的诊断价值。     

高频超声诊断小儿先天性肌性斜颈

目的探讨高频超声诊断小儿先天性肌性斜颈的价值。方法对58例先天性肌性斜颈患儿进行回顾性分析。结果所有病例患儿患侧胸锁胸突肌均可发现异常声像改变。结论高频超声对小儿先天性斜颈有明确的诊断价值。     

小儿先天性肌性斜颈危险因素分析及RTE技术在其诊断和治疗效果评估中的应用价值

目的探究小儿先天性肌性斜颈(CMT)危险因素及实时组织弹性成像(RTE)技术在其诊断和治疗效果评估中的应用价值。方法选取2017年10月—2020年10月医院收治的76例CMT患儿作为研究组,纳入同期80例健康体检儿童作为对照组,均行RTE技术检查。记录CMT相关因素及RTE参数(弹性评分、弹性应变比值),绘制受试者工作特征(ROC)曲线分析RTE参数诊断价值,并根据治疗效果分组,对比不同治疗效果患者治疗后RTE参数,分析RTE参数与治疗效果关系。结果两组弹性评分、弹性应变比值、分娩方式、胎次、出生时面部不对称、孕期状况对比差异有统计学意义(P<0.05)。logistic回归分析显示,剖宫产、孕期用药(抗生素、激素、抗凝血药物等)、胎位不正、脐带绕颈、病毒感染是CMT发生的独立危险因素(P<0.05)。弹性评分、弹性应变比值及二者联合诊断CMT的AUC值分别为0.746(0.670~0.812)、0.777(0.704~0.840)、0.835(0.767~0.890),二者联合诊断AUC值最大;治疗有效患者弹性评分、弹性应变比值低于治疗无效患者,差异有统计学意义(P<0.05)。小儿CMT弹性评分、弹性应变比值与治疗效果相关(P<0.05)。结论小儿CMT发病与剖宫产、孕期用药等多种因素有关,弹性评分、弹性应变比值联合诊断小儿CMT具有较高诊断价值,且能为疗效评价提供客观依据,以便临床及时调整治疗方案。     

综合康复治疗对小儿先天性肌性斜颈的临床研究

目的 研究综合康复治疗对小儿先天性肌性斜颈的临床影响。方法 采用随机数字表法将105例符合纳入标准的先天性肌性斜颈患儿随机分为对照组和研究组。对照组患儿(52例)采用传统推拿治疗,研究组患儿(53例)采用综合康复治疗。对两组的临床表现和临床症状积分进行评估。结果 治疗后,研究组患儿头部偏斜角度、颈部侧屈活动度和旋转活动度改善均大于对照组,差异有统计学意义(P<0.05)。两组患儿临床症状积分比较,研究组少于对照组,差异有统计学意义(P<0.05)。结论 综合康复治疗可以有效改善先天性肌性斜颈患儿颈部歪斜的症状、颈部活动的功能障碍,疗效确切。     

先天性肌性斜颈要早治疗

先天性肌性斜颈要早治疗中国医科大学主任医师马瑞雪“歪脖”医学上称为先天性肌性斜颈，是胸锁乳突肌纤维化而引起。其发病原因尚不完全清楚，多见于臀位产的小儿，可能是局部供血不足，产伤出血所致。这种小孩在出生时并无异常，约在生后７—１０天，在颈部胸锁乳突肌中...     

先天性肌性斜颈的早期综合干预疗效观察

目的探讨美国斜颈指南综合干预模式对早期先天性肌性斜颈的治疗效果。方法将64例2月龄以内的先天性斜颈患儿随机分为研究组和对照组各32例。研究组采用美国斜颈指南综合干预方法,包括颈部被动活动度训练,加强颈部及周围肌群力量训练,促进患儿对称性运动发育,环境调适,家属的指导教育;对照组采用单一的传统推拿手法治疗。治疗3个疗程后对比治疗效果。结果研究组治疗30例,优良率90.00%;对照组治疗29例,优良率82.76%,两组优良率差异无统计学意义(P0.05)。研究组在颈部被动活动度改善、胸锁乳突肌肿块及肌肉紧张消退、颅面部对称均优于对照组,差异有统计学意义(P0.05)。结论美国斜颈指南综合干预方法治疗先天性肌性斜颈临床总体疗效优于传统推拿组,尤其对于改善颈部被动活动度、消退肿块、改善及预防颅面部畸形疗效显著,值得临床推广。     

Adolescent maternal weight gain and low birth weight: a multifactorial model

Maternal weight gain is one of the most important independent predictors of infant birth weight and interacts with other maternal characteristics, including age, so that infant birth weight reaches a plateau at a higher level of maternal weight gain for young adolescents than for adults. It has been suggested that encouraging young adolescents to gain larger amounts of weight during pregnancy may be one way to decrease their risk of low-birth-weight deliveries. This recommendation may be premature because the mechanisms underlying the interaction between maternal age and weight gain are incompletely understood and may include such diverse factors as incomplete maternal growth, reproductive immaturity, diminished maternal body size, nutritional deficiencies, socioeconomic and behavioral factors, and maternal emotional stress. This review summarizes the literature on adolescent maternal weight gain and infant birth weight and discusses the importance of considering a multifactorial model in reformulating the weight-gain recommendations for pregnant adolescents.     

Predicting intrauterine growth retardation in sibships while considering maternal and infant covariates

Data on 6,210 full-term sibships (gestational age greater than 36 weeks) reconstructed from birth certificates registered in Maryland between 1980 and 1984 were used to study sibship aggregation and recurrence risk of intrauterine growth retardation (IUGR) while considering maternal and infant covariates. In this study, IUGR was defined as being below the 10th percentile for race-, sex-, and gestational-age-specific birth weight based on all births registered in Maryland during 1984. Maternal factors (race, age at delivery, marital status, amount of prenatal care, concurrent illnesses, and complications during pregnancy) and infant factors (congenital malformations and first born child or not) were used as covariates in a modified logistic regression model which allowed correlation among sibs. First-time mothers who were under age 30 years, unmarried, received too little prenatal care, or had any reported pregnancy complications were at high risk of delivering an infant with IUGR. Even given the effects of these risk factors, however, there was a significant correlation in risk among full sibs (r = .237 +/- .028), which, combined with information on risk factors, can be used to estimate sibling recurrence risk for IUGR.     

住院先天性肌性斜颈儿童的临床流行病学特征分析

目的:了解先天性肌性斜颈(Congenital Muscular Torticollis,CMT)住院儿童的流行病学临床特征,为预防儿童CMT提供一定的理论依据。方法:回顾性分析湖南省儿童医院2002年1月~2008年6月收治的525例0~16岁CMT住院儿童资料。结果:525例中男童324例,女童201例;右侧CMT病变306例,左侧219例;保守治疗组和手术治疗组的确诊年龄及从发现到就诊的时间间隔不同;以胎位异常及异常分娩方式发生率高,分别为19.8%、28.2%;13.5%的CMT患儿合并畸形;先天性髋关节发育不良部位多与CMT同侧;面部畸形程度与年龄相关。结论:遗传因素、胎位异常、异常分娩方式可能是儿童CMT的危险因素。加强孕产期保健有助于降低CMT的发病率。     

低出生体重儿的影响因素研究

目的:应用描述性研究的方法,找出低体重儿的危险因素,为避免低体重儿的发生即优生优育提供可靠的理论依据。方法:符合纳入和排除标准的5842例确立为分析和研究的对象。结果:①通过低出生体重儿的影响因素单因素非条件Logistic回归分析发现:产次、孕次、孕周、产前空腹血糖、产前血压、季节、脐带长度有统计学意义(P<0.05),其中产次、孕次、孕周(37～40周)、产前血压是危险因素;秋季、脐带长度(30～70cm)是保护因素。②影响低出生体重儿的计量资料分析,通过成组t检验发现:产妇的产前体重、产妇的身高、胎盘重量有统计学意义,都对低出生体重儿有影响。③通过低体重儿多因素非条件Logistic回归结果发现:孕周、产前血压、秋季有统计学意义(P<0.05),其中孕周、秋季是保护因素,可避免低出生体重儿的发生;产前血压是危险因素,易导致低出生体重儿的发生。结论:孕妇的身高、体重、胎盘重量、孕次、产次、秋季是低出生体重儿的影响因素,其中孕周、秋季、产前空腹血糖、脐带长度是低出生体重儿的保护因素;产前血压是低出生体重儿的危险因素。     

常州市高出生体重的危险因素分析

目的:了解江苏省常州市高出生体重的发生率,探讨高出生体重的危险因素。方法:采用现况研究方法,在常州市所属的城市、乡镇及农村分别整群随机抽取1个现场,以2006年1月1日～2008年12月31日出生的婴幼儿及其父母为研究对象。调查的主要内容有婴幼儿一般状况、婴幼儿父母一般情况、孕产期健康状况等。结果:高出生体重发生率为11.6%(722/6 225),高出生体重组与正常体重组相比较,婴幼儿的死亡率明显增高(OR=3.033,P=0.016)。在调整了婴幼儿的性别、出生地区、母亲的年龄及教育水平等因素后,经多因素非条件Logistic回归分析后发现,影响高出生体重的因素有胎儿过期产、性别为男孩、母亲年龄≥29岁、新生儿出生地区为乡镇(P<0.032～0.001),其OR(95%CI)分别为:1.857(1.149～3.004)、1.889(1.564～2.282)、1.355(1.026～1.790)、1.469(1.146～1.883)。对上述4个危险因素聚集的关联性进行分析,发现随着危险因素聚集个数的增加,发生高出生体重的危险性就更大(趋势性检验P<0.001)。结论:高出生体重是引起常州地区婴幼儿死亡的重要危险因素之一,胎儿过期产、性别、母亲年龄≥29岁、新生儿出生地区为乡镇是常州地区发生高出生体重的重要、独立的危险因素。     

青岛市黄岛区先天性心脏病非遗传危险因素调查

目的:探讨先天性心脏病的发生与患儿父母孕前、孕期非遗传因素暴露的相关性。方法:采用病例对照分析方法,以面对面访谈形式对先心病患儿父母(观察组)和同期正常儿童父母(对照组)孕前、孕期非遗传因素进行调查研究。采用二分类非条件Logistic回归分析,筛选出与先心病可能相关的危险因素。结果:对两组调查数据进行统计分析未发现与当地先心病发病相关的非遗传性因素。结论:黄岛区内近几年出生缺陷预防工作取得一定效果,仍需加强孕前优生宣教,减少和避免孕前、孕期先心病发病的风险。     

Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy—An Evidence Analysis Center Systematic Review

BackgroundWhile obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined.ObjectiveA systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy.DesignA comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included.Main outcome measuresOutcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores.ResultsThirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent.ConclusionsBariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.     

多胎妊娠106例临床分析

目的:了解多胎妊娠发生率、孕妇合并症及围生儿结局相关因素。方法;回顾分析2000年1月~2004年12月多胎妊娠106例,了解发生率、年龄、孕周、合并症、分娩方式、围产儿结局及相关因素。结果:本院2000年1月~2004年12月住院分娩总数12 155例,多胎妊娠106例,发生率8.72‰,(其中双胎妊娠103例,发生率8.47‰、3胎妊娠3例,发生率0.25‰),年龄20~37岁,平均27.85岁,初产妇83例,占78.30%,经产妇23例,占21.70%。流产史26例,占24.53%。孕周28~40周,平均35.48周,其中28~36周50例,占47.17%,为同期的8.2倍,(P<0.01)。合并症主要是早产、胎膜早破、妊高征及贫血。分娩方法剖宫产占85.85%。围生儿215个,体重900~3 350 g,平均2 301.75 g,低体重儿122个,占56.74%,围生儿死亡10例,纠正围生儿死亡率32.56‰。为同期的4倍(P<0.01)。结论:多胎妊娠时孕妇并发症多,早产发生率及围生儿死亡率高,属高危妊娠范畴。临床上应高度重视加强孕期监测和管理,积极防治早产,适时终止妊娠。放宽剖宫产指征,提高新生儿管理技术,确保母婴安全。     

Risk factors of sudden infant death syndrome and risk factors for sleep disturbances

Relationship between major risk factors of sudden infant death syndrome (SIDS) and sleep disorders in the infants is the subject of review and discussion. Improper micro‐environmental characteristics (especially poor environmental organisation and lack of developmental stimulation), pre‐term delivery and/or infant low birth weight, prone sleep position, maternal smoking during pregnancy, and infant–parent(s) bed‐sharing are among well‐established risk factors of SIDS. These factors may also be associated with sleep disorders in infants, principally with bedtime problems, abnormal night awakenings, and arrhythmic sleep. As an attempt to fix sleep problems, some inexperienced parents may try infant‐rearing practices that may only aggravate sleep troubles and lead to further increased risk of SIDS, thus giving start to a vicious circle. Health care providers need to be aware of such situations as an opportunity to provide parents with guidance with respect for individual infant and family characteristics.     

妊娠相关蛋白-A与胎儿生长发育的关系

目的:探讨孕早期母血清妊娠相关蛋白-A(pregnancy-associated plasma protein-A,PAPP-A)与胎儿生长发育的关系。方法:选择2007年8～12月在南京市妇幼保健院产前诊断中心接受孕早期唐氏综合征血清筛查的102例孕妇,随访其妊娠结局,排除双胎及各种先天畸形,分析PAPP-A与胎儿出生体重、胎龄的关系。结果:①小于胎龄儿组(small for ges-tational age infant,SGA组)、适于胎龄儿组(appropriate for gestational age infant,AGA组)和大于胎龄儿组(large for gestationalage infant,LGA组)之间PAPP-A水平(MoM值)差异无统计学意义(F=0.775,P>0.05)。②孕早期母血清PAPP-A水平(MoM值)与胎儿出生体重、胎龄呈正相关(相关系数r为0.375和0.215,P均<0.05)。结论:母孕早期血清PAPP-A水平(MoM值)与胎儿宫内生长发育有关,但尚不能作为预测SGA的客观指标。