儿童臀肌挛缩致骨盆倾斜的手术治疗

目的探讨儿童臀肌挛缩致骨盆倾斜的发生机制、手术方法和治疗效果。方法对36例臀肌挛缩致骨盆倾斜患儿术前检查均发现有双下肢不等长,假性长肢侧髋关节内收明显受限,骨盆前后位X线片示骨盆倾斜角5°~28°,平均15.5°;术中除松解挛缩的臀大肌及其筋膜外,探查发现髋关节外展肌明显挛缩,予以彻底松解。结果36例臀肌挛缩致骨盆倾斜患儿术中发现除假性长肢侧髂胫束、臀大肌筋膜及前外侧肌纤维纤维化挛缩外,髋关节外展肌明显挛缩,其中仅臀中肌挛缩者5例(13.9%),仅臀小肌挛缩者21例(58.3%),臀中、小肌均有挛缩者10例(27.8%)。手术松解挛缩的臀中肌和/或臀小肌以及髂胫束、臀大肌筋膜及前外侧肌纤维,恢复假性长肢侧髋关节内收功能和双下肢等长。随访32例,平均随访3.5年。27例完全矫正;5例髋关节内收轻度受限,其中3例仍有轻度骨盆倾斜,患肢长0.5~1.5cm。无一例出现髋关节外展肌力减弱。骨盆前后位X线片显示29例术后骨盆倾斜完全消失,3例骨盆倾斜角残留5°~10°。结论儿童髋关节外展肌挛缩是臀肌挛缩导致骨盆倾斜的主要原因,尤以臀小肌挛缩发生率高,且位置隐蔽。对臀肌挛缩伴有骨盆倾斜者,手术中应注意探查髋关节外展肌,对挛缩明显的予以彻底松解。     

儿童臀肌挛缩症的骨关节X线变化

目的：探讨臀肌挛缩症致骨盆、髋关节方面变化，阐明手术时机和效果。方法：比较３８例臀肌挛缩症与３０例非臀肌挛缩症骨盆，髋关节平片，３８例臀肌挛缩症中，２０例术后６－７的随访。结果：臀肌挛缩症患儿的ＣＥ有增大，颈干角增大，有头指数下降。２０例臀煌缩症术后６－７年随访，ＣＥ角引起有盆、髋关节继发性改变，手术有助于髋关节开矿和功能恢复。     

儿童臀肌挛缩症所致骨盆倾斜

目的 探讨儿童臀肌挛缩症所致骨盆倾斜的病理解剖基础、诊断和手术方法。方法 对1990～2003年在我院手术治疗的541例儿童臀肌挛缩症进行系统回顾和分析研究,并对手术效果进行随访评估。结果 骨盆倾斜37例,占6．8％,主要原因是臀中、小肌严重挛缩,某些病例两侧都存在倾斜因素。适合本病的骨盆倾斜角测量方法,可帮助识别是否存在骨盆倾斜,根椐臀中、小肌的病理解剖特点和不同病情酌情选择手术方法。随访29例,随访时间2～12年,结果良好。结论 臀中、小肌的严重挛缩是儿童臀肌挛缩症所致骨盆倾斜的主要原因和影响其疗效的因素,获得良好疗效的关键是彻底松解、保存或重建其外展功能。     

婴幼儿期背部烫伤致青少年瘢痕挛缩性脊柱侧弯

目的 探讨婴幼儿期背部烫伤所致青少年瘢痕挛缩性脊柱侧弯的发病机制、临床表现和治疗方法。方法 1997年8月～2003年6月共诊治各类儿童及青少年脊柱侧弯7000余例，其中仅有2例为瘢痕挛缩性脊柱侧弯，均伴有不同程度的骨盆倾斜。1例先行皮肤扩张、背部瘢痕切除、皮瓣转移术，再行脊柱侧弯前路TSRH矫形内固定术。另1例先行背部瘢痕切除、脊柱侧弯前路松解手术，Halo-股骨牵引50d后再行后路TSRH矫形内固定加胸廓成形术。结果 2例患儿术后外观畸形明显改善，侧弯矫正率分别为91．0％和55．0％，躯干变直，骨盆水平，伤口愈合良好。经3～4个月随访，无明显矫正丢失。结论 婴幼儿期烫伤所致背部严重瘢痕，可在青少年生长发育期诱发瘢痕挛缩性脊柱侧弯，其发病机制、临床表现均与典型青少年特发性脊柱侧弯有所不同。这一类型脊柱侧弯手术方案的制定必须遵循个体化、特异性的治疗原则。     

臀肌挛缩症伴骨盆倾斜的处理

儿童臀肌挛缩症近年来已逐渐被广大临床工作者所认识，一般认为其病理变化局限在臀大肌前下部分和阔筋膜张肌后份，病变严重者还可有臀中、小肌变性、髂胫束或外展肌群挛缩，出现不同于一般臀肌挛缩症的临床表现，继发骨盆倾斜、跛行，甚至脊柱侧弯，成为臀肌挛缩症的另一种类型——臀肌挛缩症伴骨盆倾斜。     

臀肌挛缩对小儿身体发育的影响

为了探讨臀肌挛缩对小儿身体发育的影响。对１４例不对称臀肌挛缩和２４例８～９岁对称性臀肌挛缩患儿进行体检及骨盆和髋关节Ｘ线测量。不对称性臀肌挛缩组行自身对照研究（ｔ检验），对称性臀肌挛缩患儿按病程及病情分为４组，按析因试验的设计行方差分析。发现１４例不对称性臀肌挛缩患儿臀肌挛缩对股骨颈干角、股骨头骺商及髋臼商无影响（Ｐ＞０．２），而髂骨的高宽比值和双侧髋臼指数变小（Ｐ＜０．０５），２４名对称性臀肌挛缩患儿检查显示，病程及病情均为影响因素（Ｐ＜０．０５），但二者间无交互作用（Ｐ＜０．８）。此外，臀肌挛缩对脊柱等结构发育尚有影响。臀肌挛缩可影响小儿身体发育，尤其是髂骨及髋臼的发育，病情越重或病程越长影响越明显。     

关节镜监视下射频汽化治疗儿童臀肌挛缩症

目的探讨关节镜监视下射频汽化技术治疗儿童臀肌挛缩症的临床效果及有关适应证。方法2005年1月2006年5月，采用关节镜监视下射频汽化治疗儿童臀肌挛缩症58例，男33例，女25例；年龄6～13岁，平均9岁。侧卧位，术前标记坐骨神经走行，股骨大转子，臀肌挛缩带和手术人口，于大转子区顶点后方2cm切开5mm，骨膜剥离器插入皮下筋膜组织与臀肌挛缩带之间，钝性分离5cm×5cm的工作腔隙，生理盐水充盈后在关节镜监视下，汽化电极斜行切断并松解挛缩组织，直至无活动性出血，阳性体征消失。结果术后随访3～12个月，按照有关臀肌挛缩症的疗效标准进行综合评定，优45例，良9例，中3例，差1例。伤口Ⅰ期愈合，无血管神经损伤等严重并发症。结论关节镜监视下射频汽化治疗儿童轻中度臀肌挛缩症，操作安全，疗效满意，创伤小，外形美观，痛苦少，有利于早期功能锻炼和康复。     

臀小肌挛缩的临床研究

临床资料1.一般资料　本组臀肌筋膜挛缩症2 14例 ,2 0 0例臀肌筋膜挛缩患儿有反复接受臀肌注射史 ,14例仅有 1～ 4次臀肌注射史 ,其中 9例为同一村医疗站接受反复臀肌青霉素注射。臀小肌挛缩型2 2例 ,其中男 9例 ,女 13例 ;单侧 15例 ,双侧 7例 ;年龄 4～ 12岁 ,平均 7.5岁。2 0例为农村患儿 ,2例来自城镇。其中15例在多家医院就医都未能确诊。 8例通过平均 6个月推拿、按摩等保守治疗无效。全部伴有骨盆倾斜 ,即立正时双下肢不能同时着地。2 .术前检查　臀小肌挛缩患儿临床表现为走路跛行 ,立正时双下肢不能同时着地 ,但双下肢可以翘“二郎…     

臀肌挛缩报告1例

2004年6月8日我院收治1例“双侧臀肌挛缩”的患儿，经手术切除其挛缩臀肌，10天后切口一期愈合，功能恢复，现报告如下。     

臀肌挛缩症的诊治体会(附27例报告)

臀肌挛缩症是由多种原因所致的臀肌及其筋膜挛缩，导致髋关节功能受限，表现出特殊的症状、体征的临床综合征。国内区域性调查显示：儿童发病率1％—2．4％。我院从1994年1月～2001年1月共手术治疗臀肌挛缩症27例，效果良好，现报告如下。     

Infiltrating lipoma of the buttock in a 21-month-old child

A case of infiltrating lipoma of the buttock in a 21-month-old child is reported. The tumor, measuring 9 x 12 cm, was situated between the gluteal muscles with a lobulation penetrating into the pelvis through the obturator foramen. It was adherent to, but not infiltrating the sciatic nerve.Few cases of infiltrating lipomas in pediatric patients have been reported in the literature. The diagnosis is based mainly on clinical examination and CT. Fine-needle aspiration may be useful preoperatively to exclude a liposarcoma.Recurrences are frequent when follow-up is adequately extended.For optimal therapeutic results the excision of the tumor should include a rim of adjacent muscle tissue.     

儿童臀部韧带样瘤的手术治疗

目的：报告１３例儿童臀部韧带样瘤的临床资料并讨论其手术治疗问题。方法：１３例均进行了手术处理。结果：肿瘤切除术后，９例随访１年至８年２个月（平均３年４个月），３例肿瘤复发。结论：韧带样瘤具有浸润性生长特点，局部切除后易复发，但不发生转移和恶变。应早期诊治。为防止肿瘤复发，应广泛切除受累的臀肌、韧带、骨膜、骨质、关节及周围健康组织     

Cystic lymphangioma with special reference to rare sites

A 10 year retrospective study of 45 cases of cystic lymphangioma (CL) in children is presented. There were 25 females and 20 males. Age ranged from 6 months to 8 years. Common sites were involved in 38 and rare sites in 7 patients. Rare sites were—gluteal region (1), pelvis (1), retroperitoneum (1), mesentery (2), inguinal region (1) and inguinoscrotal region (1). The clinical presentation included sudden increase in size (25), lump abdomen (3), gluteal abscess (1), abdominal distension (1) and inguinal swelling (2). Diagnosis was established preoperatively in 38 cases, and after surgery and histopathology in 7 cases. Near total or subtotal excision was carried out in all cases. Facial nerve palsy (1) and recurrence (2) were the complications of surgery. The study is presented to highlight the occurrence of the cystic lymphangioma at rare sites to avoid diagnostic errors and unnecessary mutilating surgery.     

Posterior sagittal approach for resection of sacrococcygeal teratomas

The aim is to evaluate the ease of access, surgical trauma and cosmetic results of posterior sagittal approach for sacrococygeal teratomas (SCTs). From January 2002 to June 2010, we operated 19 cases of SCT exclusively through posterior sagittal approach. Patients were placed in knee chest position. An elliptical incision was made for the excision of the tumor. Care was taken to preserve all the muscles and other vital tissue in this area. Coccygectomy was performed in all patients. Closure was performed in layers. It was possible to resect all tumors from this approach and none of the patients required revision of the incision. Complete resection was possible in 17 patients while two had residual disease due to local extension. Minimal wound dehiscence was noted in four patients that healed spontaneously. It was possible to perform excision even in very large masses. Wound scar was satisfactory in most patients with preservation of gluteal folds. It is therefore concluded that posterior sagittal approach for SCT is feasible, with good access and cosmetic results.     

Obliteration of a metameric spinal arteriovenous malformation (Cobb syndrome) using combined endovascular embolization and surgical excision

Cobb syndrome represents the concurrent findings of a metameric spinal vascular malformation and a cutaneous vascular malformation within several dermatomes of each other. This rare entity engenders many difficult decisions with respect to appropriate therapeutic management. Historically, surgical excision carried a high morbidity, and conservative management without intervention was preferred. More recently, several cases of endovascular embolization have been reported with good success. The authors describe the case of a 17-year-old boy who presented with a right gluteal angioma and was found to have a spinal arteriovenous malformation. Multiple embolizations failed to prevent neurological deterioration, and the patient eventually became wheelchair dependent. Surgical excision of the malformation led to partial recovery of neurological function, and at the latest follow-up, 52 months postoperatively, the patient was able to ambulate independently. This case demonstrates the successful treatment of a patient with Cobb syndrome with surgical excision after multiple refractory embolizations. A multidisciplinary approach, which balances the patient's current neurological function against the risks and potential gains from any interventional and surgical procedure, is recommended.     

Peroneal nerve palsy: a complication of umbilical artery catheterization in the full-term newborn of a mother with diabetes

Umbilical artery catheters are an essential aid in the treatment of newborn infants who have cardiopulmonary disease. However, it is well-known that umbilical artery catheterization is associated with complications. The most frequent visible problem in an umbilical line is blanching or cyanosis of part or all of a distal extremity or the buttock area resulting from either vasospasm or a thrombotic or embolic incidence. Ischemic necrosis of the gluteal region is a rare complication of umbilical artery catheterization. We report the case of a full-term infant of an insulin-dependent diabetic mother with poor blood glucose control who developed a left peroneal nerve palsy after ischemic necrosis of the gluteal region after umbilical artery catheterization. The infant was born weighing 5050 g. The mother of the infant had preexisting diabetes mellitus that was treated with insulin from the age of 14 years. The metabolic control of the mother had been unstable both before and during the pregnancy. The neonate developed respiratory distress syndrome soon after birth and was immediately transferred to the neonatal intensive care unit. Mechanical ventilation via endotracheal tube was quickly considered necessary after rapid pulmonary deterioration. Her blood glucose levels were 13 mg/dL. A 3.5-gauge umbilical catheter was inserted into the left umbilical artery for blood sampling without difficulty when the infant required 100% oxygen to maintain satisfactory arterial oxygen pressure. Femoral pulses and circulation in the lower limbs were normal immediately before and after catheterization. A radiograph, which was taken immediately, showed the tip of the catheter to be at a level between the fourth and fifth sacral vertebrae. The catheter was removed immediately. Circulation and femoral pulses were normal and no blanching of the skin was observed. Another catheter was repositioned and the tip was confirmed radiologically to be in the thoracic aorta between the sixth and seventh thoracic vertebrae. The catheter was continuously flushed with heparinized solution. Three days after umbilical arterial catheterization, bruising was observed over the left gluteal region. The catheter was immediately removed despite its correct position. Over the next few days, the bruised skin and underlying tissues became necrotic. The area affected was 3 x 4 cm in diameter, with central necrosis surrounded by a rim of dark, red skin, which, in turn, was sharply demarcated from normal skin by a narrow, pale zone. Surgical excision of the gluteal necrosis was performed, but a deep ulcer 3 cm in diameter was left. The gluteal ulcer required 1 month to heal completely with extensive scar tissue formation. Throughout this period, the infant showed active movements in all of her limbs. At 4 weeks of age deterioration of all movement below the left knee with a dropping foot was observed. Severe peroneal nerve palsy was confirmed through nerve conduction studies, and there was electromyographic evidence of degeneration of the muscles supplied by the peroneal branch of the sciatic nerve. A Doppler study, which was also conducted, revealed no vascular damage. Treatment with physiotherapy and night-splinting of the left ankle was instituted. Repeated examination and nerve conduction tests at 3 months showed slow improvement with the left peroneal nerve remaining nonexcitable. At the time of this writing, the infant is 6 months old, and muscular strength below the left knee is still weak and atrophic changes in the form of muscle-wasting are already present. The rest of her motor development is normal. In our case, gangrene of the buttocks and sciatic nerve palsy followed displacement of the tip of the catheter into the inferior gluteal artery, a main branch of the internal iliac artery supplying the gluteus maximus, the overlying skin, and the sciatic nerve. The gangrenous changes were probably caused by vascular occlusion resulting from catheter-induced vasospasm of the inferior gluteal artery. Sciatic nerve palsy associated with umbilical artery catheterization has been postulated to be caused by vascular occlusion of the inferior gluteal artery. Infants of diabetic mothers may exhibit changes in coagulation factors and be at increased risk of thrombotic complications in utero and postnatally. In addition, maternal diabetes mellitus is associated with an increased incidence of congenital abnormalities, the incidence of which is 3 to 5 times higher than that among nondiabetic mothers. Although no particular or specific abnormalities have been associated with maternal disabilities, abnormalities of the cardiovascular system, including the development of umbilical vessels, frequently occur. This complication of umbilical artery catheterization has not been widely reported. We describe the first case that refers to gluteal gangrene and peroneal nerve palsy after umbilical artery catheterization of a newborn infant of a diabetic mother with poor blood glucose control. It should be noted that there were no contributing factors except that of the displacement of the catheter into the inferior gluteal artery. We speculate that the displacement of the tip of the catheter, with no difficulty in the present case, was associated with the maldevelopment of normal branching patterns of arteries after exposure of the fetus to hyperglycemia. In conclusion, umbilical artery catheterization is possibly associated with vascular occlusion, particularly in infants of diabetic mothers. Frequent inspection after the procedure has been performed is of the utmost importance especially in these neonates who often suffer from cardiopulmonary disease and require catheterization of their umbilical artery.     

小儿肱骨髁上骨折的保守治疗

目的分析小儿肱骨髁上骨折的治疗方法，从审美观点要求选择最佳治疗方法。方法皮牵引治疗42例手法整复＋肘部可旋转活动的外固定托。结果随访1个月～1年，肘功能正常，无肘内翻。结论牵引治疗肱骨髁上骨折仍是治疗此种骨折的首选方法。     

血管瘤患儿雌激素升高因素及其与瘤体增生的关系

目的探讨血管瘤患儿血清雌二醇（E2）水平升高原因及其与血管瘤瘤体增生的关系。方法应用化学发光酶免疫法检测25例增生期血管瘤患儿（病例组）及15例同龄腹股沟斜疝患儿术前1d、术后3d（对照组）血清E2水平;用免疫组织化学法检测皮肤组织雌激素受体（ER）的表达。结果病例组术前血清E2水平明显高于术后及对照组（Pa〈0.05）;对照组手术前、后及与病例组术后血清E2水平比较无显著差异（Pa〉0.05）;瘤体组织ER的表达显著高于正常皮肤组织（P〈0.001）。结论血管瘤患儿血清E2升高可能与瘤体自身分泌E有关;血清E与瘤体ER结合,促进内皮细胞增殖,引起瘤体增生。     

肾盂输尿管成形术后再狭窄的原因分析及处理

目的 探讨小儿肾盂输尿管成形术后再狭窄的原因及防治。方法 对50例先天性肾盂输尿管连接部狭窄（UPJO）所致肾积水的治疗进行分析。记录肾积水程度、UPJO段长度、肾造瘘管及支架管情况、肾周引流管（膜）放置时间及引流量、有无再狭窄，病理检查UPJO段及再狭窄段。结果中度积水肾16例。重度积水肾35例。手术中见狭窄段长度〈1cm6例，〉2cm9例，余为1．5cm左右。手术后输尿管支架管拔除时间为7～15d（平均11．7d）。放置肾周胶管引流30例、橡皮膜引流7例，引流量7～300mL（平均30．5mL）。病理组织检查可见UPJO段黏膜层变薄或脱失，黏膜下层呈慢性炎表现，45例标本可见黏膜下层纤维组织成分增多，2例还可见黏膜下和肌层内腺样增生改变。手术后再狭窄3例（Anderson-Hynes于术后2例，Y-V成形术后1例），二次手术后治愈。结论 肾积水程度、UPJO段K度、尿引流情况对手术后肾盂输尿管连接部愈合均有影响。术中完整切除狭窄段、术后充分引流尿液、防止尿外渗是避免再狭窄的关键。     

Cyclofusion in normal and superior oblique palsy subjects.

PURPOSE: To evaluate the cyclofusional status in normal and acquired superior oblique palsy subjects. To know the extent to which cyclodeviations can be tolerated asymptomatically. METHOD: Incyclovergence and excyclovergence break points and recovery points were evaluated in 40 normal subjects and 17 cases of acquired superior oblique palsy. A Polaroid dissociation stereoprojector was used with special torsional slides at fixation distances of 1 meter and 6 meters. In addition, maximum intorsion tolerated (MIT) and maximum extorsion tolerated (MET), ie, the torsion that allowed baseline horizontal fusion, were studied. The evaluation was repeated in the palsy group 1 month after recovery, which was spontaneous in 8 cases, and after surgery in 9 cases. RESULT: The normal values for incyclovergence and excyclovergence were in the range of 12 degrees (break point) and 8 degrees (recovery point). In the case of superior oblique palsy, only the incyclovergence recovery point was significantly diminished (p=.004), which improved after recovery to near normal values. The intorsion tolerance (MIT) and extorsion tolerance (MET) also showed deterioration in the palsy group. After recovery, the MIT normalized but the MET did not recover at 1-meter distance fixation. The maximum torsional tolerance values appear to be more critical. CONCLUSION: The cyclofusional vergence under physiological conditions are better than reported earlier. But MIT and MET are better indicators of cyclofusional potential. These low values demand more precise alignment of the torsion in weakening or strengthening surgery of the oblique muscles.