小切口植骨加外固定支架治疗儿童胫骨骨折骨不连

目的探讨以小切口植骨配合双边外固定支架治疗儿童胫骨骨折后骨不连的可行性及优点。方法1999年1月-2004年1月治疗儿童胫骨骨折后骨不连28例，全部采用小切口植骨加外固定支架治疗。结果全部病例骨折愈合，未出现排斥反应和骨感染，平均需4．6个月拆除支架及内固定。结论小切口植骨加外固定支架治疗儿童胫骨骨折后骨不连是一种有效和安全的方法。     

儿童罕见的腹腔真菌性感染诊治分析

目的探讨儿童罕见的腹腔真菌性感染临床表现、放射影像学表现及治疗方法的选择。方法回顾性总结我院1985年～2002年收治的2例儿童腹腔真菌性感染的临床及影像学表现、治疗方法。结果术后诊断为腹腔孢子丝菌性腹膜炎的患儿，经抗真菌治疗后无效死亡；术后诊断为腹腔隐球菌性肉芽肿的患儿，经抗真菌治疗后痊愈。结论儿童腹腔真菌性感染应及早诊断和合理治疗，对降低腹腔真菌性感染的死亡率有重要的意义。     

儿童椎管内肠源性囊肿的诊治体会

目的 总结儿童椎管内肠源性囊肿的临床特点和治疗经验。方法 回顾性分析我院6例儿童椎管内肠源性囊肿的临床、影像学资料。结果 本组6例均有肢体活动障碍，4例伴有神经根性疼痛，5例感觉障碍。囊肿位于颈段4例，胸段2例。MRI检查表现为稍长T1、长T2均匀信号。5例作全切或大部切除术，1例行部分切除术。5例术后神经功能恢复良好。结论 儿童椎管内肠源性囊肿是少见的先天性疾患，多发生于颈段椎管硬膜下脊髓腹侧。MRI是有效的检查工具。早期诊断和显微手术是治疗的最佳方案。     

儿童肺部囊性病变的诊断和治疗

目的探讨儿童肺部囊性病变的诊断、手术治疗时机和方式。方法对23例儿童肺部囊性病变进行回顾性分析，其中支气管源性肺囊肿16例，肺隔离症4例，肺大疱3例。16例行肺叶切除术，7例行囊肿切除术。5例为急诊手术。结果无手术死亡病例，全部患儿术后恢复良好，无脓胸、气胸、支气管胸膜瘘等并发症。术后随访3月-2年，无复发病例。结论儿童先天性肺囊肿确诊后应尽早手术，合并囊肿或肺部感染者待感染控制后手术，压迫症状明显则应急诊手术。肺大疱如经抗感染治疗无好转或进行性增大及合并气胸、脓胸应行手术治疗。手术中应尽量保留正常肺组织。     

儿童陈旧性孟氏骨折的手术治疗

目的 了解儿童陈旧性孟氏骨折的分型、传统治疗方法以及治疗观念的改变，总结分析14例患者手术治疗的经验。方法 白1992年～1999年，采用手术切开复位，尺骨斜行截骨延长矫正成角及短缩畸形，环状韧带修补或关节囊及周围组织紧缩缝合或重建术治疗儿童陈旧性孟氏骨折14例。结果 经随访1～6年，平均3．5年。优5例，良6例，可2例，差1例，疗效满意。结论 对儿童陈旧性孟氏骨折行手术治疗是积极可取的。     

儿童消化性溃疡穿孔的临床处理探讨

目的 探讨儿童消化性溃疡穿孔的外科治疗。方法 回顾性分析11例胃、十二指肠溃疡穿孔患儿病例资料。结果 11例患儿均行单纯穿孔修补术，愈后良好。结论 单纯穿孔修补术具有操作简单、效果好、并发症少、不影响生长发育的优点，在治疗儿童的胃、十二指肠溃疡穿孔时为首选术式。     

儿童屈指肌腱陈旧性损伤的治疗

目的探讨儿童陈旧性屈指肌腱损伤的特点及治疗方法。方法采用显微外科技术修复儿童屈指肌腱陈旧性损伤12例12指，术后2d开始被动屈伸锻炼。结果经6～20月随访，功能恢复良好，按照TAM测定方法评定，优良率占91．7％。结论精细的手术操作、恰当的手术方式，早期被动屈伸锻炼，减少创面渗血、减少炎症反应和水肿是减少肌腱粘连的关键。     

儿童常见骨折的治疗进展

儿童骨折后愈合、生长再塑形能力强，与成人相比，儿童骨折需切开复位内固定者少，骨折延迟愈合、不愈合者少见。近年来，儿童骨折的治疗逐步放弃了既往需长时间住院、牵引制动、石膏固定的保守治疗；各种质地坚固、设计合理、材料优良的骨折内外固定器械不断涌现，如弹性髓内钉、单臂外固定器在儿童长骨骨折中的应用和推广；另外，选择治疗方法时也考虑到儿童年龄因素；儿童骨折的治疗已不再是简单地完成骨骼的长合，而是更加关注骨折对合的准确性、骨折治疗后功能状态的最大保持、后遗症的减少和治疗手段本身损伤性的降低等。而注重儿童心理、减少住院时间、降低治疗费用和方便家长护理等一系列新的治疗理念和方法，也在不断深入到儿童骨折治疗的实践之中。现就儿童常见骨折的治疗进展综述如下。     

儿童髋臼周围病变的诊断与治疗

目的 探讨儿童髋臼周围病变的性质和预后。方法 从1997年7月至2000年6月对一组11例儿童髋臼周围病变，采取经皮穿刺活检，根据病理诊断结果，分别选择不同的处理方法。对髋臼顶壁塌陷者还进行了髋臼重建性手术。结果 本组平均随访18个月．良性病变9例，其中单纯性骨囊肿4例、嗜酸性肉芽肿4例、亚急性骨髓炎1例；恶性病变2例(软骨肉瘤、尤文氏肉瘤各1例)。4例单纯性骨囊肿中，2例作刮除 植骨中l例复发，2例囊腔内注入甲基强的松龙而治愈：4例嗜酸性肉芽肿中2例自愈，2例因髋臼顶壁塌陷采取刮除和植骨重建髋臼手术，获得病变消失、恢复了髋臼的正常形态：2例恶性肿瘤中1例放弃治疗，另1例软骨肉瘤第二次手术中发生意外而死亡。结论 儿童髋臼周围病变多为单纯性骨囊肿和嗜酸性肉芽肿，恶性肿瘤只占18．2％；囊腔内注入甲基强的松龙治疗单纯性骨囊肿是乎比刮除 植骨效果更好。     

先天性桡骨头脱位的诊断与治疗

目的 探讨先天性桡骨头脱位临床及X线检查的特征。方法 通过回顾我院25年收治的8例确诊为先天性桡骨头脱位的手术治疗，包括切开复位、桡骨缩短或尺骨延长术、环状韧带重建术。结果 8例10侧肢体手术治疗后随访2年，桡骨头复位满意，前臂旋转功能获得明显改善。结论 先天性比外伤性桡骨头脱位少见。本组病例绝大多数伴有身体其他部位畸形。术中发现二者的组织病理改变有明显差异。前者诊断后需手术治疗。     

Effect of the adaptation of the food of the hospitalized child on the cover of the nutritional needs]

AIMS: Denutrition remains a major concern in hospitalized children. Daily experience suggests that the meals proposed by hospital dietetic service, although well-balanced and in accordance with the recommendations, may be poorly accepted and consumed by children. The aims of this study were to assess the effect of modification of foods offer on energy intakes as well as nutriments and minerals and trace elements in hospitalized children. PATIENTS AND METHODS: During a 1-month period, 25 consecutive children (range 4-17 years; 13 girls), hospitalized in our pediatric department were included in the study (reasons for hospitalisation comprised: medical reasons [n=7], orthopedic problem [n=16] or surgery [n=2]). They had no restricted diet and received the usual pediatric hospital feeding according to the French recommended dietary allowances (RDA) (D1). They were compared to 21 children--matched for age, sex, nutritional status and pathology, hospitalized during the following 1-month period--who received a modified diet (D2), elaborated by dieticians according to the child's preference and excluded or limited food usually nonconsumed by the children. Food consumption was prospectively measured for 24h by analysis of the nonconsumed foods, as well as browsing and extra food brought by the family. Analysis of energy, carbohydrate, lipid, protein, iron and calcium intake was made using Bilnut 3 software (Nutrisoft, France). RESULTS: D2 covered 119+/-37% of the median energy needs versus 89+/-37% for D1 (p<0.05). The median energy needs were more often reached with D2 as compared to D1 (62% versus 32%, p<0.05). Protein intake was high in both groups, more importantly with D2 (266+/-111% of RDA versus 193+/-77% with D1, p<0.05). We observed no difference between the 2 diets in regards of fat/carbohydrate balance and iron intake. Calcium intake was increased with the adapted diet: 68+/-26% of RDA with D2 versus 49+/-26% with D1 (p<0.01). CONCLUSION: Adapting food offers to preference influences food and caloric intakes in hospitalized children. This could be an efficient strategy to prevent acute undernutrition in hospital.     

Transition to the neonatal nurse practitioner role: making the change from the side to the head of the bed

Role transition is never easy, but is complicated by the experienced neonatal nurse's frustration with reverting to a student role and becoming a novice practitioner, sometimes after years of developing a reputation as an expert nurse. This article discusses this transition, focusing on the skills needed to move successfully from nurse to nurse practitioner. Common to all advanced practice transitions are stages similar to those Benner identifies in her novice-to-expert theory of nursing practice. Feelings of frustration and inadequacy are common during the first year as an NNP. Studies focusing on role transition and role development suggest that a strong nursing identity is important for success in the NNP practice environment. Strategies to enhance the transition are discussed.