髓腔扩大回流再植小儿Ⅱ型末节断指

随着显微外科技术的发展和小血管吻合技术的提高，小儿断指再植的成活率也大大提高，但对于小儿末节断指再植的临床报道较少，我科自2004年7月～2005年5月，采用吻合指固有动脉供血，髓腔扩大回流再植小儿Ⅱ型末节断指21例，取得满意效果，报道如下。     

小儿拇指末节离断再植16例诊治分析

目的 探讨小儿拇指末节断指再植的手术要点及治疗经验.方法 对16例(17指)儿童拇指末节断指进行再植.根据离断末节手指血管损伤情况采用同时吻合动静脉、仅吻合动脉、静脉动脉化、直接缝合的方法进行再植.结果 再植17指中,成活15指,成活率为88.2%,术后随访3个月至6年,成活指血运良好,发育、外观及功能恢复好.结论 根据血管不同损伤情况采取正确的手术方法,确保高质量的血管吻合是小儿拇指末节断指再植成功的关键.     

小剂量氯胺酮、咪唑安定辅助臂丛用于小儿上肢手术体会

小儿上肢手术中，臂丛阻滞常因不易取得小儿配合被迫改为全麻。在临床实践中，我们将小剂量氯胺酮、咪唑安定辅助臂丛用于小儿上肢手术，效果满意，现总结资料报告如下。     

22例小儿末节断指的临床治疗

目的 探讨小儿末节断指临床分型对提高再植成活率的影响。方法 观察22例26指小儿末节手指离断伤，将其分为三型。Ⅰ型：离断部位自远节指间关节横纹至甲根部，此型吻合指动静脉进行再植。Ⅱ型：甲根部至指腹螺纹中心。Ⅲ型：指腹螺纹中心以远。Ⅲ型伤口清创后直接原位缝合。Ⅱ型中依据损伤程度再分为两种处理方法。结果 四种方法治疗的成活率分别为85．7％、66．7％、66．7％和75％，其中再植后的手指恢复满意的感觉和外形。结论 小儿末节断指应正确地予以处理，末节再植是最有效的治疗方法，有较高的成活率、满意的感觉和外形。     

我国小儿泌尿外科的发展要追求更高的目标

小儿泌尿外科近年来在国内取得了相当大的进步.如全国小儿泌尿外科的学术会议每年进行一次,并逐步增加影像报告和手术演示的比例,促进了同行的交流、技术推广;尿道下裂尿道成形术在主要大城市大型医院小儿泌尿外科都能达到比较高的成功率;一些单位相继开展了小儿泌尿系疾病的腹腔镜治疗如肾盂成形和膀胱输尿管再植等.     

小儿多指断指再植三例

我院从1991年8月至1998年12月间,对小儿一只手两个以上手指离断行再植手术,共3例10个手指全部存活。术后随访再植手指功能及生长良好,现报告如下。 资料和方法 1.临床资料 本组3例10个断指,均为完全性离断。年龄5～12岁。右手1例,左手2例。电锯伤1例,切草铡刀     

膀胱外输尿管隧道延长术治疗小儿巨输尿管10例

巨输尿管症是小儿泌尿外科常见疾病,其病因复杂,以输尿管迂曲、扩张为共同病理改变,常采用病变输尿管切除、输尿管裁剪整形及抗返流性输尿管膀胱再植手术。2002年6月￣2005年6月我院采用改良膀胱外输尿管隧道延长术治疗小儿巨输尿管症10例,疗效良好,现报告如下。1临床资料1.1一     

肩胸皮管在末节断指中的应用

肩胸皮管在末节断指中的应用山东济南儿童医院外科（２５００２２）张宗瑞小儿末节断指常见，入院时大部份断离指体不具备再植条件。１９８０年５月～１９９２年９月我们采用肩胸皮管治疗小儿末节断指１３例皆获得成功，术后随访疗效满意，报道如下。资料和方法一、临床资...     

小儿手部爆炸伤的分类与治疗

目的 总结小儿手部爆炸伤的损伤特点，探讨其诊治方法。方法 对1990－2000年收治的78例小儿手部爆炸伤伤情和治疗过程进行回顾性分析，根据损伤特点，将爆炸伤分为撕裂伤、离断伤和毁损伤三种类型，撕裂伤清创后予以原位缝合，离断伤清创后急诊再植，毁损伤清创后采取Ⅰ期修复和延期修复两种方法，对毁损肢（指）体截肢或行各种功能重建术。结果 38例撕裂伤伤口Ⅰ期愈合，功能恢复好。24例离断伤中，21例再植存活，功能恢复于撕裂伤组。16例毁损伤功能恢复最差，经延期修复者术后感染机会明显降低。结论 小儿手部爆炸伤严重妨碍其身体生长和心理发育，采取相应的防范措施，能有效预防此类损伤发生。     

小儿颅骨瓣腹壁皮下埋藏取出后与新骨瓣再生

小儿颅骨瓣腹壁皮下埋藏取出后与新骨瓣再生孙守波贺志刚逯德胜高东利李惠芝我院１８例小儿颅骨瓣腹壁皮下埋藏再植后，２例取出部位皮下出现新生骨瓣，特报告如下，并对新生骨瓣产生的原因作一探讨。病例介绍例１：男，１４岁，１９９５年４月行去颅骨瓣减压，３个月后行...     

Lymphatic regeneration following hind limb replantation: an experimental study in the dog.

Different types of trauma to the lymphatic system can often occur, but surgical intervention can be performed only in specific cases. We report on lymphatic regeneration following limb replantation in traumatic amputations and replantation of extremities. The aim of this study was to observe the progression and reaction after surgical trauma that is similar to other kinds of trauma, both in children or adults, and to monitor the possible lymphatic regeneration. Particular attention was paid to two parameters: firstly, the physical examination of the replanted limbs by checking the post-traumatic lymphoedema, and secondly, the study of the images taken from indirect lymphangiography of the replanted limbs. Histological specimens of the surgical trauma area were also examined to reconfirm or exclude lymphatic regeneration. The study population consisted of sixteen mongrel dogs, divided into two groups of eight animals each, who underwent hind limb elective amputation and replantation combined with (group A) or without (group B) sciatic nerve division. Lymphoedema formation was followed quantitatively by measurement of the circumference of the hind limb for 21 days after replantation. Indirect lymphography, never performed before in such cases, and histopathology, were performed to evaluate and confirm lymphatic regeneration. Lymphatic regeneration after replantation of the operated hind limbs was first confirmed between 7th and 11th postoperative day by indirect lymphangiography and clinical observation of the post-traumatic lymphoedema of these limbs. The mean time of visualisation of lymphatic regeneration through lymphography was 10.12 days for group A and 9.37 days for group B. However, nerve transection had no effect on lymphatic regeneration (p = 0.46). Histopathological examination showed first evidence of lymphatic regeneration on the ninth postoperative day and a network of newly formed capillary lymphatics on the 21st postoperative day. It is concluded that lymphatic regeneration following replantation of the extremities without anastomosing of the interrupted lymph vessels, is an unquestionable fact. To achieve the best lymphatic drainage and use of the replanted extremities it is important to resect all non-vital tissues of the replantation area. Local or general infections decelerate lymphatic regeneration. Indirect lymphography with iotrolan is a reliable, easy to perform technique without complications that may be used repeatedly for confirmation and evaluation of post-traumatic lymphoedema.     

负压封闭引流术治疗儿童肢体大面积软组织缺损的疗效

目的探讨负压封闭引流术(VSD)在儿童肢体大面积软组织缺损修复中的临床效果。方法回顾性分析15例肢体大面积软组织缺损患儿的临床特征和VSD的治疗效果。对大面积软组织缺损患儿创面进行彻底清创后,有活性脱套伤皮肤修整后回植,根据患者创面形状和大小合理设计VSD敷料覆盖,5～7 d根据情况决定是否继续使用VSD或进行植皮。结果 15例创面中,2例皮肤脱套伤,原位回植成活;1例部分坏死,点状植皮后愈合;4例1次使用VSD后,肉芽生长新鲜,植皮成活;3例仍有少量渗出,植皮后VSD覆盖成活;3例使用后仍有肌腱外露,再次安装VSD后,肌腱完全被新鲜肉芽组织覆盖,植皮存活;2例仍有骨外露,行二期皮瓣转移修复创面。所有病例随访2～18个月,成活皮肤弹性色泽良好,而且供区和受区的并发症、远期功能、外观等明显优于成人。结论 VSD用于治疗儿童肢体大面积软组织缺损,能明显缩短病程,有效控制感染,促进肉芽组织生长,治疗效果显著。     

位点加穴位药物注射与功能训练治疗脑性瘫痪的对比研究

目的　研究位点加穴位药物注射与功能训练治疗脑性瘫痪 (脑瘫 )的疗效对比。方法　设研究组 1 4 4例 ,对照组 76例 ,两组年龄均为 6个月～ 7岁 ,病残程度为中、重度。研究组应用小量VitB1 、VitB1 2 ,按照脑解剖及神经生理功能在头部的投射区 (位点 ) ,结合临床表现选择部位 ,四肢按照局部肌肉功能选择注射位点。下肢瘫痪较重患儿 ,可加选L4 、L5椎间隙 ,轻度刺激神经根。对照组应用功能训练。两组均为 4个疗程 ,每疗程 2 3d。结果　两组经 1 8个月的随访观察 ,研究组总有效率96 .52 % ,对照组总有效率 73 .63 %。结论　药物注射疗法疗效好 ,见效快 ,无不良反应。     

腓骨肌萎缩症1型患儿肌电图和遗传学研究

目的：探讨腓骨肌萎缩症1型（CMT1）儿童的肌电图和遗传学特点。方法：对24例CMT1型患儿进行常规肌电图检测,同时联合应用PCR-双酶切分析检测17p11.2-12上的基因重复,对照组为10名健康儿童。结果：24例患儿运动或感觉神经传导速度存在不同程度的减慢或消失,且感觉神经病变重于运动神经,下肢受累程度重于上肢。所检24例患儿72块肌肉中,40块呈神经源性损害（56%）;患儿年龄越大,肌肉受累程度越严重。24例患儿中,PCR-双酶切法在13例患儿中检测出1760 bp片段,占54%。正常对照组未检测到此片段。结论：CMT1患儿肌电图改变特征明显,以周围神经传导速度减慢为主,肌肉病变多呈神经源性损害。PCR-双酶切可作为一种简单有效的CMT1型基因诊断方法。     

婴儿型脊肌萎缩症的临床及电生理分析

目的 分析婴儿型脊肌萎缩症患儿的临床及电生理表现，探讨本病的电生理特点及早期诊断要点。方法回顾性分析25例婴儿型脊肌萎缩症临床资料，肌电电生理按常规方法进行，针极肌电图按汤氏正常计算，神经传导速度按本室正常计算。结果患儿大多在1岁内起病，四肢呈对称性、迟缓性瘫痪，下肢重于上肢，近端重于远端；血清CK、LDH正常。肌电图表现为3个肢体在肌肉安静时出现广泛的失神经电位，轻用力时出现长时限、高波幅的运动单位电位，大力募集时电位数减少；神经传导速度正常，肌肉复合动作电位降低；肌肉活检为典型的神经源性肌萎缩。结论本病确诊应依据临床特点、肌电电生理、肌肉活检的改变。     

正常儿童下肢旋转解剖轴线发育的研究

目的绘制出6个月至15岁儿童正常下肢旋转解剖轴线的发育曲线，为诊断儿童股骨和胫骨旋转畸形提供理论依据。方法随机抽取门诊体检的正常儿童149例，排除骨骼、肌肉及神经疾病和双侧下肢其他疾病引起的畸形，对每例儿童分别进行双侧下肢股骨旋转轴线角度（包括内旋角度、外旋角度）和胫骨旋转轴线角度测量，并根据年龄进行分组统计：6个月至2周岁21例；25个月至4周岁43例；5～12岁38例；12～15岁47例。将测量结果进行统计学处理。结果婴儿时期股骨的内旋平均在40°（10°～60°），外旋平均在70°（45°～90°），直到12岁左右，髋关节内旋平均50°（25°～65°），外旋平均45°（25°～65°），随着年龄的增加，股骨内旋渐增大，而外旋不断减小；在婴儿期，大腿-足中轴角内旋平均5°（-30°～＋20°），8岁时，大腿-足中轴角平均外旋10°（-5°～ ＋30°），大腿-踝横轴角的测量结果与小腿-足中轴角的测量结果基本相似。结论儿童下肢旋转解剖轴线具有随着年龄，普加而变化的特点，但在12岁左右不再有明显的改变。因此，在12岁以前诊断下肢旋转解剖轴线异常，应该考虑可能是发育中的正常现象。     

男性幼儿双下肢无力1周伴眼睑下垂3d北大核心CSCD

患儿1岁7个月,以双下肢无力、眼睑下垂起病,呈进行性加重并出现呼吸不规则。神经系统体格检查:嗜睡状,双眼睑下垂,双上肢肌力4级,双下肢肌力3级,腱反射消失。实验室检查提示脑脊液蛋白细胞分离,H反射消失,血清抗GD1b抗体IgG阳性。最终该患儿诊断为吉兰-巴雷综合征(Guillain-Barrésyndrome,GBS)、Miller-Fisher综合征与Bickerstaff脑干脑炎重叠综合征,治疗上予免疫球蛋白、血浆置换、呼吸支持等治疗后患儿恢复出院。儿童GBS、Miller-Fisher综合征与Bickerstaff脑干脑炎重叠综合征可同时出现周围神经及脑干损害,临床异质性强,其中抗GD1b抗体相关的GBS、Miller-Fisher综合征与Bickerstaff脑干脑炎重叠综合征有特殊临床表现及复杂神经电生理变化,诊断较困难。因此对有双下肢乏力、眼睑下垂患儿尽早完善神经传导速度检查,重点关注H反射。     

Nerve conduction and autonomic nerve function in diabetic children. A 10-year follow-up study

In order to study the long-term development of diabetic neuropathy in children with newly diagnosed diabetes mellitus, 144 children were entered in a prospective study of nerve conduction and autonomic nervous function. Neurophysiological recordings of nerve conduction and parasympathetic function (R-R variations) were made at onset of diabetes and after 2, 5 and 10 years. Low sensory nerve conduction and autonomic dysfunction were found in approximately 25% of the children at onset of diabetes when the patients were not yet in complete remission. During years 0–2, an initial improvement of sensory conduction velocities was found. After 2 years, deteriorations in sensory and motor nerve conduction and autonomic nerve function were common and further deterioration was seen over time. A correlation was found between nerve conduction and glycaemic control.     

运动神经传导阻滞与儿童吉兰-巴雷综合征不同亚型间的关系

目的 探讨运动神经传导阻滞（CB）与儿童吉兰-巴雷综合征（GBS）不同亚型间的关系。方法 回顾性分析50例GBS患儿的临床资料和神经电生理资料,根据神经电生理结果分为2型：急性炎症性脱髓鞘性多发性神经根神经病（AIDP,n=29）和急性运动轴索型神经病（AMAN,n=21）。根据有无运动神经CB分为伴有运动神经CB的AMAN（n=10）、不伴有运动神经CB的AMAN（n=11）、伴有运动神经CB的AIDP（n=19）和不伴有运动神经CB的AIDP（n=10）。比较各组间患儿起病年龄、性别、疾病高峰期休斯功能分级量表（HFGS）评分、短期预后（起病1个月后HFGS评分）。结果 AMAN中,运动神经CB均为可逆性。伴有运动神经CB的AMAN的起病1个月后HFGS评分低于不伴有运动神经CB的AMAN（P < 0.05）,伴有运动神经CB的AIDP的起病1个月后HFGS评分高于伴有运动神经CB的AMAN（P < 0.05）。结论 伴有可逆性运动神经CB的AMAN提示神经纤维病变轻微,短期预后较不伴有运动神经CB的AMAN和AIDP恢复快。     

Health-related quality of life and ambulation in children with myelomeningocele in a Swedish population

Aim: The aim was to study health‐related quality of life (HRQL) in Swedish children with myelomeningocele (MMC) with respect to ambulatory function. Methods: A physical examination of the lower limbs was performed, and occurrence of orthopaedic deformities and shunted hydrocephalus was documented. A questionnaire on general health‐related quality of life Child Health Questionnaire‐50 Parent Form (CHQ‐PF50) was answered by the parents of 62 children, mean age 12.5 (3.1) years. Results: The non‐ambulatory children had significantly more frequent spasticity in the lower limbs, more often joint contractures as well as hip dislocation or spine deformity compared with ambulating patients. Thirty‐two per cent of the ambulators managed without wheelchair use. All non‐ambulators were wheelchair users, of which 60% used both a manual and a powered wheelchair. The children with MMC perceived significantly lower HRQL of all subscales of CHQ compared with the healthy control group. Physical function was significantly higher in ambulatory patients, PF = 57.1 compared with 22.2 for non‐ambulatory patients. Conclusion: A Swedish population of children with MMC perceived lower HRQL compared with healthy children, but similar HRQL irrespective of ambulatory function except for the physical domain was reported.