儿童创伤性休克

据统计创伤是成人45岁以下死亡的第一位原因，在人类总死亡原因中位列第三。1875～2000年全世界发表有关创伤和休克的论文多达40000余篇。近年在小儿意外事故中创伤的发生率也在逐年上升。创伤的严重程度是极其重要的始动因素，严重创伤，尤其合并脏器损伤和大量出血的病例(如交通肇事、挤压伤、高处坠落伤和颅脑外伤等)，80％左右发生不同程度的创伤性休克。与其他类型的休克相比，创伤性休克是一个更为复杂、更难预测的病理生理过程，     

儿童创伤性窒息44例临床分析

创伤性窒息多见于胸部或胸腹部受强烈挤压而造成的闭合性损伤。现就我院 1999年 11月一次收治的 44例创伤性窒息予以分析。1　临床资料1 1　一般资料　本组 44例中 ,男 9例 ,女 35例 ,年龄 11～ 12岁 ,平均(11 5 3± 0 83)岁。1 2　受伤原因　某学校数百名中学生下课后拥挤在楼梯口 ,前方的几名学生不幸被挤倒在楼梯上 ,随后的学生重叠挤压在上面 ,时间长达十余分钟。1 3　临床表现1 3 1　皮肤粘膜改变　重度窒息 12例 ,均有上半身皮肤紫绀 ,且越向上紫绀越重 ,头面部皮肤有密集出血点并融合成片。轻度窒息 32例 ,上半身皮肤紫绀不明显 ,眼…     

儿童创伤性髋关节脱位的长期随访

儿童创伤性髋关节脱位 (ｔｒａｕｍａｔｉｃｄｉｓｌｏｃａｔｉｏｎｏｆｔｈｅｈｉｐｉｎｃｈｉｌｄｒｅｎ ,ＴＤＨＣ )较为少见 ,文献报道[1] 发生率在 5 %～10 % ,由于生长板强度小于关节囊及韧带的强度 ,所以产生成人脱位的外伤机制在儿童常导致骨骺损伤而非脱位 ,与成人不同的是儿童髋关节柔软性大 ,关节囊较松弛 ,轻微外伤可导致脱位 ,我院自 1990～ 2 0 0 1年共收治 8例ＴＤＨＣ患儿 ,根据临床诊治体会 ,结合文献进行讨论。临床资料本组 8例 ,男 6例 ,女 2例 ,年龄 5～14岁。致伤原因 :6例为高处坠落1例为踢球时扭伤 ,1例为车祸伤。新…     

儿童链球菌中毒休克综合征1例

患儿女,4岁2个月。以"咳嗽、发热5 d,加重伴呼吸困难、咳暗红色痰1 d"为主诉入院。患儿有青霉素及头孢菌素过敏史。曾在外院予大环内酯类治疗,疗效不佳。体检:体温38.9℃,呼吸55次/min,脉搏195次/min,血压127/72 mm Hg(1 mmHg=0.133 kPa,下同),血氧饱和度0.88。躯     

儿童链球菌中毒休克综合征临床分析

目的 增强儿科临床医生对链球菌中毒休克综合征（streptococcal toxic shock syndrome,STSS）的认识.方法 对我院收治的2例STSS患儿的临床特点及治疗经过进行分析.结果 2例STSS患儿既往体健,均有发热,1例以咳嗽、气促、呼吸费力为主要症状,另1例主要表现为皮疹、肢体肿胀.2例患儿病情均在数小时内迅速进展为多器官功能不全综合征、弥散性血管内凝血.经抗感染及其他综合治疗,2例患儿均好转出院.结论 本病临床上并不多见,且起病急骤,临床表现因个体差异而变化较大,只有早期识别、诊断本病,才能进行有效治疗.     

儿童创伤性膈肌破裂并尿胸

儿童创伤性膈肌破裂少见 ,而合并肾脏损伤所致的胸腔积尿 (尿胸 )更罕见 ,因此常被误诊。回顾 1 981～ 2 0 0 2年收治的 2 1例儿童创伤性膈肌破裂 ,发现创伤性膈肌破裂并尿胸 3例 ,报告如下。例 1 :男 ,6岁。 2 2ｄ前被载重拖拉机轧伤右胸腰部。当时出现呼吸困难并出现血尿 ,外院诊断为“胸部外伤 ,右侧血胸 ,右肾挫伤”并保守治疗。 5ｄ后血尿消失 ,但呼吸困难无改善 ,并胸痛、发热 38℃～ 39℃。反复 5次胸腔穿刺 ,每次抽出血性胸水 30 0ｍｌ左右 ,胸水逐渐变淡至黄色。穿刺后呼吸困难减轻 ,不久又复加重。遂转我院。体检 :胸廓对称 ,气管…     

儿童创伤性颈静脉孔综合征八例报告

儿童创伤性颈静脉孔综合征八例报告李忠禹，汪志德，林景春男６例。女２例。年龄９～１２岁。致伤原因：交通事故伤６例，跌落伤２例。临床表现：昏迷８例，时间１５分钟至１人；吞咽困难、声嘶８例，轻重不同，重者进食从鼻孔返流；患侧软腭麻痹或下塌８例；喉反射迟钝或...     

儿童严重创伤性软组织损伤的负压封闭治疗

目的 探讨负压封闭引流技术(vacuum sealing drainage,VSD)治疗儿童严重创伤性软组织损伤的效果.方法 16例严重创伤性软组织损伤的患儿,共20个创面,创面范围约为10 cm× 15 cm～30 cm×50 cm,严格清创后采用负压封闭引流(VSD)技术,持续40～60 kPa负压引流,5～7d后再行Ⅱ期缝合、植皮、组织瓣转移闭合创面.同期13例采用传统换药或引流的患儿为对照组.结果 VSD治疗组中,15例经负压封闭引流治疗后均可见创面肉芽组织新鲜.Ⅱ期缝合、植皮或组织瓣转移全部成活,无局部和全身并发症,1例反取皮原位移植的患儿发生创面感染,多次引流后行游离植皮成功.VSD治疗组与对照组比较,在Ⅱ期缝合时间、换药次数、平均住院时间及植皮愈合率等方面均有统计学意义(P<0.05)结论负压封闭引流技术能充分引流、控制感染和刺激创面肉芽组织生长,为及早覆盖创面提供了良好的条件,而且可以免除换药和缩短治愈时间,是治疗儿童严重创伤性软组织损伤的一种简便、有效方法.     

Traumatic pseudomeningocele in children

Summary Two cases of traumatic leptomeningeal cysts in children are reported. The pathogenesis is described. The absence of neurological deficits may be due to the unusual frontal location of the lesion in these cases. From the Kurnoool Medical College, Kurnool (Andhra Pradesh).     

小儿颅脑外伤

1 病历摘要 患儿,男,3岁,因"从床上摔下2 h,反复呕吐数次"急诊入院.患儿2 h前从床上摔下(约0.5 m高),着地情况不详,当时即出现哭吵,无昏迷,无抽搐.半小时后患儿出现呕吐,非喷射性,为胃内容物,哭吵加剧,遂急诊就医.患儿在就医途中,反复呕吐数次.     

Traumatic diaphragmatic hernia in children

Background

Traumatic diaphragmatic hernia (TDH) is very rare in the pediatric age group. Because of its rarity and its coexistence with more serious injuries, the diagnosis is often missed or delayed.

Patients and methods

All children with the diagnosis of TDH were retrospectively reviewed for age at diagnosis, sex, mechanism of injury, site of diaphragmatic rupture, associated injuries, injury severity score, investigations, treatment and outcome.

Results

Over a period of 15?years (1992–2007), we treated seven children with TDH. All were males except one. Their mean age was 7.4?years (3.75–14?years). The site of TDH was on the left in three, on the right in three and one had bilateral TDH. The mechanism of injury was blunt trauma in six and penetrating injury from a stab in one. Three had right TDH and in all three, the diagnosis of TDH was delayed. All sustained severe injuries as reflected by the ISS score (mean 38.6). The time from presentation to diagnosis was variable ranging from 3 to 240?h (mean 65.7?h). The three patients with left TDH were repaired trans-abdominally while the three with right TDH were repaired via a right thoracotomy. The patient with bilateral TDH required laparotomy and thoracotomy. All our patients survived and the hospital stay was variable ranging from 7 to 24?days (mean 17?days).

Conclusions

TDH is very rare in children and often associated with severe more serious injuries. These two factors contribute to the delay in diagnosis. This is specially so for right TDH. To obviate delay in diagnosis, it is important to have a high index of suspicion as well as careful interpretation of the initial and follow-up radiological investigations including CT-scan of the chest and abdomen. This is important to detect a slowly increasing TDH that may not be apparent initially.     

Traumatic atlanto-occipital disruption in children

Ten cases of traumatic atlanto-occipital disruption in pediatric patients are reported. All injuries resulted from motor vehicle accidents, the majority of which were pedestrian/automobile. Three patients survived their injury for a period greater than one year. The importance of recognizing atlanto-occipital disruption is stressed because of its relative frequency in severely traumatized pediatric patients, particularly pedestrian/vehicle incidents, and because of the potential for survival. Diagnosis, in most instances, is based on the lateral cervical spine radiograph. The most applicable diagnostic features in children, as demonstrated on the lateral cervical spine radiograph, are reviewed.     

Traumatic atlanto-occipital dislocation in children

Traumatic atlanto-occipital dislocation is seen in approximately 25% of fatal pediatric trauma. This was previously considered to be a rare and fatal entity, however with improvements in resuscitation in the field, many patients who previously might have died are now evaluated in the hospital. Treatment of atlanto-occipital instability is internal fixation. Many authors have advocated supplemental external immobilization with a halo vest. However, there are several circumstances where the application of a halo vest is undesirable. Thus a method of internal fixation and fusion that is rigid enough not to require supplemental external orthosis is necessary. We present 2 cases of atlanto-occipital dislocation which were treated with Locksley intersegmental tie bar occipital cervical fusion. Both patients achieved solid fusion without supplemental halo bracing, and made complete neurologic recoveries. Traumatic atlanto-occipital dislocation is a potentially survivable injury that requires aggressive resuscitation in the field, a high index of suspicion and early definitive surgical stabilization.     

Traumatic posterior dislocation of hip in children

Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury.     

Traumatic pelvic fractures in children and adolescents

Although traumatic pelvic fractures in children are relatively rare, these injuries are identified in about 5% of children admitted to level 1 trauma centers after blunt trauma.1, 2, 3, 4 Such injuries differ from adult pelvic fractures in important ways and require distinct strategies for management. While the associated mortality rate for children with pelvic fractures is much lower than that for adults, the patient may require urgent surgical intervention for associated life-threatening injuries such as head trauma and abdominal injury. Unstable pelvic ring fractures should be acutely managed using an initial approach similar to that used in adult orthopedic traumatology. Although very few pediatric pelvic fractures will ultimately need surgical treatment, patients with these injuries must be followed over time to confirm proper healing, ensure normal pelvic growth, and address any potential complications. The trauma team suspecting a pelvic fracture in a child must understand the implication of such a finding, identify fracture patterns that increase suspicion of associated injuries, and involve pediatric or adult orthopedic specialists as appropriate during the management of the patient.     

Staphylococcal toxic shock in children

Toxic shock syndrome (TSS) is reported in 2 children. TSS occurred 10 days after an accidental injury of the fore foot in one case and 5 days following surgery for severe uretero-vesical reflux in the other. The clinical illness was defined by the case definition formulated for epidemiologic studies (CDC, 1982). The diagnosis was confirmed by isolation of a Staphylococcus aureus strain producing TSST, at the infected site. Toxin-induced mediators such as interleukin I and Tumor Necrosis Factor have been incriminated in septic shock with multivisceral involvement. As in our 2 cases, the syndrome may be delayed or even absent.