自体骨髓注射治疗单纯性骨囊肿的影像学变化与临床意义

目的观测自体骨髓注射治疗单纯性骨囊肿的影像学改变，分析其临床意义。方法自体骨髓注射治疗单纯性骨囊肿患儿27例，获随访25例，随访平均3．3年。以CR摄影判定影像学上的疗效；观测术后不同时期X线骨囊肿面积、皮质厚度的变化情况；分术前合并病理骨折组及无病理骨折组，测算术前囊肿纵径／最小皮质厚度，行组间比较。通过三维CT结合X线观察骨囊肿的基本愈合形式。结果1次注射后愈合10例，缺损愈合5例，持续存在7例（含2例无反应），复发3例。除外无反应者，术后3个月病灶内均有不同程度的密度增高；X线骨囊肿面积基本稳定，主要发生在术后649个月（21／23）；X线骨囊肿皮质厚度基本稳定，主要发生在术后9个月～1年（19／23）。除外下肢持重管状骨病变，术前合并病理骨折组及无病理骨折组囊肿纵径与最小皮质厚度比值差异显著。结论自体骨髓注射治疗单纯性骨囊肿术后随访至少1年；该法通过骨皮质增厚，囊腔内骨嵴及骨小梁向心性增生，分割包绕填塞囊腔而逐步愈合。     

骨骼及肌肉系统疾病

032386儿童创伤性髓关节脱位/李增炎…//医师进修杂志一2003,26(l)一55 032387儿童股骨颈骨折的治疗分析/潘骏…//上海第二医科大学学报一2003,23(1)一61一63 032388骨折儿童微量元素动态监测及其临床意义/付友恒//遵义医学院学报一2002,25(3)一243~244 032389经皮囊内注射自体骨髓治疗小儿骨囊肿8例/杨威…//中国实用儿科杂志一2002,17(9)一549 术前常规骨髓穿刺,采集骨髓som工备用。借助X线片(机),用骨穿针破入骨囊肿腔内,抽出10~20ml黄色一血性液体。将无血凝块的骨髓液(30一soml)注入囊腔。结果:术后3d,7例囊腔完全或基本愈合.1例未显…     

儿童长骨骨折不愈合原因分析与治疗

目的 探讨引起儿童长骨骨折不愈合的相关因素,为临床规避相关风险提供借鉴.方法 回顾1996至2006年收治的儿童长骨骨折不愈合病例51例,从损伤原因、骨折部位、治疗方法等方面分析引起骨折不愈合的原因,并采用更换固定方式、植骨等手术方法对骨折不愈合病例进行重新治疗.结果 51例病例经更换内固定为髓内固定或采用外固定架加植骨等治疗方法均获得良好愈合, 在随访期内未发生再骨折.结论 儿童长骨骨折治疗不当是引起骨折不愈合的主要原因,高能量损伤也是引起骨折不愈合的原因之一;在骨折部位方面,本组病例中以股骨干骨折不愈合多见.对于儿童长骨骨折不愈合的治疗应该在诊断明确后尽早更换固定方式, 骨折端重新获得稳定是治疗的关键.     

单侧多功能外固定器治疗儿童急诊多发伤中长骨干骨折

为探讨单侧多功能外固定器在儿童长骨干骨折急诊多发伤治疗中的应用价值 ,回顾分析 1993年 1月～ 2 0 0 1年 4月 6 7例儿童多发伤长骨干骨折的临床资料 ,男 4 2例 ,女 2 5例 ,年龄 4～ 14岁 ,平均 8.6岁。术后随访观察骨折愈合情况及有无并发症 ,随访时间 1～ 4 4个月 (平均 16个月 )。结果本组骨折均愈合 ,术后 2～ 3周均出现骨痂 ,4～ 5周后骨痂生长良好。术后 8～ 12周均达到临床愈合 ,无延迟或不愈合、无严重并发症的发生。认为单侧多功能外固定器固定术是治疗儿童长骨干骨折的有效方法 ,对不稳定性骨折和多发伤病人可作为首选 ,值得推广单侧多功能外固定器治疗儿童急诊多发伤中长骨干骨折$北京儿童医院外科!100045@孙保胜 $北京儿童医院外科!100045@王强     

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。     

大龄儿童距骨颈骨折的治疗分析

目的 总结大龄儿童距骨颈骨折的诊治经验,为正确治疗大龄儿童距骨颈骨折提供参考和依据.方法 回顾分析2001年6月至2009年11月收治的10例大龄儿童距骨颈骨折的临床资料,其中男7例,女3例;年龄8～16岁,平均13.4岁;左侧4例,右侧6例.骨折根据改良Hawkins分型:Ⅰ型骨折3例,Ⅱ型骨折5例,Ⅲ型骨折2例.HawkinsⅠ型骨折采取保守治疗,非负重石膏外固定6～8周,HawkinsⅡ、Ⅲ型骨折均采取切开复位内固定.结果 随访15～68个月,平均23.5个月,随访时骨折均获愈合,无延迟愈合及骨不连.采用Hawkins评分:优5例,良4例,中1例,优良率为90.0％.发生切口皮缘表浅坏死1例,距骨体缺血性坏死2例,采用保守治疗后症状缓解.结论 恢复距骨的解剖关系是治疗儿童距骨颈骨折的关键,可靠的固定有利于早期功能锻炼,从而获得良好的治疗效果.其治疗方式的选择应根据患儿的个体状况、骨折类型等综合考虑:Hawkins Ⅰ型骨折可采取保守治疗,HawkinsⅡ、Ⅲ型骨折宜行切开复位内固定.     

一期肱骨远端内翻截骨与植骨内固定治疗陈旧性肱骨外髁骨折合并肘外翻的临床疗效分析

目的探讨采用一期肱骨远端内翻截骨、陈旧性肱骨外髁骨折处自体骨植骨内固定治疗儿童陈旧性肱骨外髁骨折并肘外翻的疗效。方法 2013年1月至2018年1月湖南省儿童医院共收治10例肱骨外髁陈旧性骨折不愈合继发肘外翻畸形患儿,其中男8例,女2例;年龄5～14岁,平均10.5岁;右侧8例,左侧2例;患儿受伤时间为3～10年,平均6年;提携角20°～40°者8例,40°～50°者2例。所有病例肘关节功能有不同程度受限,其中3例有尺神经麻痹症状。术前测量患侧的外翻角及对侧的提携角。均采用一期肱骨远端内翻截骨克氏针内固定,陈旧性肱骨外髁骨折处自体骨植骨,采用空心拉力螺钉+克氏针内固定术治疗,术后随访观察临床疗效。结果 10例均获随访,平均随访时间22个月(12～60个月)。患儿原骨折不愈合处及肱骨远端截骨处均达到骨性愈合,肱骨截骨端骨性愈合时间5～12周,平均7周;肱骨外髁骨折端愈合时间7～24周,平均11.9周。9例患侧提携角恢复正常,1例患侧提携角20°,但肘关节功能正常。术前患侧肘关节活动度平均为(92.5±20.8)°,术后1年时平均为(129.0±12.2)°,二者差异有统计学意义(t=7.639,P 0.001)。3例尺神经麻痹症状消失,1例空心拉力螺钉断裂,予再次手术。结论采用一期肱骨远端内翻截骨、陈旧性肱骨外髁骨折处自体骨植骨、空心拉力螺钉+克氏针内固定手术方式治疗儿童陈旧性肱骨外髁骨折并肘外翻畸形,术后肘关节外观、功能、稳定性恢复好,可避免二期手术,是治疗该病的理想手术方法。     

小儿骨折后骨不连原因分析

儿童处于生长发育时期 ,成骨细胞和破骨细胞丰富而活跃 ,血液循环旺盛 ,骨折愈合迅速 ,骨痂形成早 ,骨不连极为少见。近些年来国内外文献报道治疗各种骨不连的方法很多 ,而对骨不连原因特别是小儿骨不连的原因分析很少。本文就我院治疗的 2 6例骨折后骨不连的病因进行综合分析 ,报告如下。临床资料1978年 1月～ 1999年 12月我科共收治 2 6例骨不连患儿 ,其中男 17例 ,女9例 ,年龄 2～ 18岁 ,平均 8.2岁。骨不连的原因 :车祸伤 15例 ,占 5 7.7% ,骨髓炎或骨囊肿并发病理骨折所致骨缺损 5例 ,占 19.2 % ,肢体延长术后发生骨不连3例 ,占 11.5 %…     

应用单臂多功能外固定器治疗儿童病理性骨折

目的探讨单臂多功能外固定器治疗儿童病理性骨折的特点及疗效。方法回顾性分析2012年1月至2015年12月本院收治的18例病理性骨折患儿的临床资料。对于继发于肿瘤性及瘤样病变的病理性骨折采用单臂外固定器合并病灶刮除植骨治疗,其他病理性骨折患儿仅采用单臂外固定器治疗。通过X线片评估骨折复位有无丢失及病灶愈合情况;采用肩、肘、髋、膝、踝等关节功能综合评价标准及随访患儿家长的满意度进行临床评估。结果 18例患儿平均随访时间21.9个月,18例(包括术中医源性骨折1例)X线片均提示病理性骨折愈合,愈合时间4～7个月,平均4.5个月。针道感染1例,无骨不连、畸形愈合等并发症。根据肩、肘、髋、膝、踝等关节功能综合评价,疗效均为优秀,患儿家长满意度100%。结论单臂多功能外固定器结合或者不结合病灶刮除植骨术可作为治疗儿童病理性骨折的有效方法。     

股骨近端外展截骨治疗儿童股骨颈骨折不愈合

目的:探讨股骨近端外展截骨治疗儿童股骨颈骨折不愈合的治疗效果。方法:回顾性分析北京积水潭医院小儿骨科2003年1月至2018年1月间收治的股骨颈骨折不愈合19例患儿的临床资料。其中,男13例,女6例;年龄(10.0±3.0)岁。术前已经过1～2次手术治疗15例;因多发创伤后漏诊2例;经长期牵引、外固定保守治疗后骨折仍不...     

96例小儿颞骨骨折的临床特点和处置体会

目的：探讨小儿颞骨骨折的临床特点和处置方法。方法：通过回顾性分析1988～2002年间所收治的96例109侧小儿颞骨骨折的临床资料(其中13例为双侧颞骨骨折)。96例患儿，发病年龄在3个月～14岁，平均8．9岁；(男66例，女30例，男女之比为2．2：1)。交通事故伤52例(54．17％)，打击伤18例(18．75％)，坠落伤14例(14．58％)，跌伤12例(12．5％)。纵向骨折41例(37．6％)，横向骨折17例(15．6％)，斜形骨折15例(13．8％)，凹陷性骨折12例(11．0％)，混合性骨折24例(22．0％)；其中，骨折线向颅底延伸65例(59．6％)。骨折合并耳道出血49例(45．0％)、脑脊液耳漏22例(20．2％)、脑脊液鼻漏17例(15．6％)、听力障碍50例(45．9％)、面神经麻痹13例(11．9％)、脑膜炎2例(1．8％)。并发硬膜外血肿20例(18．3％)，硬膜下血肿27例(24．8％)，骨折造成的脑挫裂伤35例(32．1％)，单纯蛛网膜下腔出血41例(37．6％)，颅内积气36例(33．0％)。结果脑脊液耳漏和脑脊液鼻漏经保守治疗均痊愈，听力障碍50例中，28例完全恢复(56．0％)，15例部分恢复(30．0％)，7例完全性失聪(14．0％)。13例面神经损伤患儿中，10例6个月内完全恢复，2例1年后完全恢复，1例部分恢复。结论：小儿颞骨骨折多发生于交通事故、打击、坠落、跌伤，面神经损伤发生率较小，且恢复良好。听力损害恢复较差。及时治疗可提高并发症的治愈率。     

儿童四肢长骨病理性骨折手术治疗60例

目的 总结儿童四肢长骨病理性骨折的手术治疗经验,探讨提高临床诊断和治疗水平的方法.方法 2005年1月至2010年3月作者收治长骨病理性骨折患儿74例,其中60例采用手术治疗,在确诊原发疾病的同时,给予病灶彻底清除及植骨,并对骨折进行一期内固定处理.患儿出现患肢疼痛等症状的时间为1 d至2年,出现病理性骨折的时间为2 ...     

LYMPHOKINES POST AUTOLOGOUS PERIPHERAL BLOOD STEM CELL TRANSPLANTATION IN CHILDREN

Malignant ectomesenchymoma (MEM) is a rare soft tissue tumor believed to arise from a pluripotent migratory neural crest cell and composed of both a mesenchymal element and a neuroectodermal element. The authors report the case of an 11-month-old male who presented with a local abdominal MEM and systemic metastases into lungs, liver, bones, and bone marrow. This is the first reported case of an MEM with initial bone marrow dissemination. The tumor consisted of a neuroblastoma component and a mesenchymal component with sarcomatous features. Diagnosis and therapy were complicated by the histological heterogeneity of the tumor, which also influenced the clinical appearance and course in this case. A literature search revealed 15 other evaluated cases that arose in soft tissue and had adequate clinicopathologic data. Complete surgical resection was the mainstay of treatment, and chemotherapy also appeared to be important. In all reported patients ( n = 3) with initial metastases or bone marrow dissemination, as in this case, no cure could be achieved. In patients with disseminated MEM, new therapeutic approaches such as high-dose chemotherapy followed by stem cell rescue should be considered, similar to the current strategy in patients with stage IV neuroblastoma or soft tissue sarcoma.     

Chediak-Higashi syndrome: four cases from Northern Finland

Chediak-Higashi syndrome (CHS) is a rare multiorgan disease entity with autosomal recessive inheritance characterized by oculocutaneous albinism, bleeding tendency, recurrent bacterial infections and various neurological symptoms. Intracellular vesicle formation is deficient, resulting in giant granules in many cells, e.g. giant melanosomes in the melanocytes. Diagnosis has been based on morphological examination of peripheral blood and bone marrow, with giant granules seen in cells of the myeloid lineage and in lymphocytes. The ultimate diagnostic test is to look for a mutated LYST gene. Most patients develop an accelerated phase of the disease with deposition of lymphohistiocytes in the liver, spleen, lymph nodes and bone marrow, resulting in hepatosplenomegaly, bone marrow infiltration and haemophagocytosis. Peripheral blood neutropenia becomes more profound as anaemia and thrombocytopenia develop. Most patients succumb before the age of 10 years. Four patients with CHS are described, one of whom is a long-term survivor after successful allogeneic bone marrow transplantation, two succumbed during the accelerated phase and one is living with a chronic form of the disease.

Conclusion: Allogeneic bone marrow transplantation from an HLA-matched sibling is the therapy of choice and should be performed early. If there is no matched family donor, an unrelated donor or a placental blood graft is a good alternative. The clinical picture of CHS is heterogeneous and therapeutic decisions need to be made on an individual basis.     

Juvenile osteoporosis: recognizing the risk

Osteoporosis in children is often an undiagnosed condition. Diagnosis is usually made after several fractures occur with minimal trauma or radiographs demonstrate hypodense bones. The relationship of bone mineral density (BMD) to fracture risk in children is controversial. In our study, we were referred 16 patients between the ages of 5 and 15 years who had had two or more fractures without serious trauma. Dual-energy X-ray absorptiometry (DEXA) scans were performed to determine each patient's BMD. The mean bone density of the hip for these 16 patients assessed by z-score was -2.78 +/- 1.4 (SD); the mean BMD of the spine assessed by z-score was -3.08 +/- 1.2 (SD). Fifteen of 16 patients were osteoporotic or osteopenic in either the hip or the spine; 12 patients were osteoporotic in both the hip and the spine; one patient was osteoporotic only in the spine. These data strongly suggest that children with multiple fractures should be screened for osteoporosis.     

65例中国非亲缘性脐血造血干细胞移植的回顾研究

目的1998—2004年,广州脐血库向国内25家移植中心提供非亲缘性脐血治疗恶性及非恶性肿瘤性疾病患者65例,对其进行回顾性分析,探讨与非亲缘性脐血移植密切相关的影响因素。方法脐带血均采自广州市妇婴医院正常分娩的足月顺产产妇,脐血分离、冻存、复温方法参照纽约脐血库的标准及相关文献;选择脐血的依据是HLA相合程度及有核细胞数量。结果65例接受非亲缘性脐血移植的病例中,白血病49例,遗传缺陷性疾病16例;男性42例,女性23例;受者中位年龄10岁(1~33岁);中位体重27kg(10~67kg);HLA-A、B,DRB1匹配全相合9例,1个位点不合43例,2个位点不合13例;总有核细胞(TNC)中位输入量5.7×107/kg[(1.84~20.00)×107/kg]。移植后植入50例有核细胞总数(ANC>500/μl),植入的中位时间为17.5d(7~44d),植入率77%;41例受体发生GVHD,发生率为63%。30例长期存活(无病生存时间>365d),无病存活率为61%。结论非亲缘性脐血移植具有良好的临床应用前景。     

Immunosuppression-related fibroproliferative polyps of the tongue.

Polypoid tongue lesions arising after bone marrow transplantation have been described. Their etiopathogenesis has been unclear, as has their relationship to similar lesions arising in other settings of chronic immunodeficiency. We identified 12 polypoid lesions (from 8 immunosuppressed patients aged 6 months to 13 years) among all tongue lesions biopsied over the course of 13 years at our institution. Clinical history, histologic and ultrastructural features, special stains (Gram, Grocott methenamine silver, acid-fast bacilli, CD34, actin, desmin, human herpesvirus-8), in situ hybridization for Epstein-Barr virus, and cytogenetic features were studied. Immunocompromise was from bone marrow transplantation for severe combined immunodeficiency (n = 1) and acute lymphoblastic leukemia (n = 3), hypogammaglobulinemia (n = 2), 22q11 deletion syndrome (n = 1), and asthma therapy (n = 1). Histologic examination revealed fibrous stromal cores with squamous epithelial covering and various degrees of ulceration and accompanying inflammation and granulation tissue. In 2 patients lesions were multiple in number. Fibroblasts were variably positive for smooth muscle actin and desmin and negative for CD34. Special stains, immunohistochemistry, in situ hybridization, and ultrastructural examination identified no organisms except occasional surface bacteria. The tongue lesion from 1 patient with Down's syndrome showed t(2;9)(p11;q34)+21 (translocation not seen in peripheral blood). Another patient had constitutional del 22q11. All transplant patients had Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) (translocations involving 9q34 and 22q11). Patients with congenital immunosuppression had polyps arise at significantly younger ages than did patients with acquired immunosuppression. Immunosuppression-related lingual polyps are a fibroproliferative process occurring in patients with bone marrow transplantation and other immune-deficient conditions. Our findings indicate that these polyps are driven by both immunosuppression and chromosomal rearrangement.     

可注射性纳米组织工程骨应用于牵拉成骨的实验研究

目的将可注射性纳米组织工程骨注入骨延长区,观察其能否加速延长区的骨生成。方法用新西兰大耳白兔制作兔牵拉成骨模型,获得成功存活动物71只,分为4组,A:对照组,17只;B:注射共培养成骨细胞、内皮细胞组,18只;C:注射单纯胶体纳米材料组,18只;D:注射共培养成骨细胞、内皮细胞复合胶体纳米材料组,18只。术后5d行胫骨延长,速度1mm/d,共延长20d,延长完成后,A组不做其他治疗;B组将共培养成骨细胞、内皮细胞悬液2ml注入骨延长区,细胞总数量约1×107个;C组将单纯纳米材料2ml注入骨延长区;D组将可注射纳米组织工程骨2ml注入骨延长区,通过X线检测、骨密度(BMD)测定观察延长结束后第3、6、9周骨愈合情况。结果BMD和X线检测结果显示注射纳米组织工程骨组新生骨质量较高,骨愈合情况要优于其他组。结论可注射性纳米组织工程骨应用于牵拉成骨,可促进延长区骨生成,且优于单纯注射细胞或可注射性纳米载体材料。     

Prepubertal growth and growth hormone secretion in children after treatment for hematological malignancies, including autologous bone marrow transplantation

Prepubertal growth standards were used to assess growth in 20 children who had undergone autologous bone marrow transplantation (ABMT) as part of their treatment for hematological malignancy. Most of the patients (16 of 20) were transplanted after a relapse of their disease. A negative change in height standard deviation score (H-SDS) was seen only in the group of patients (n=7) who had received both cranial irradiation therapy (CRT) and 7.5-Gy single-fraction total body irradiation (TBI). Height changes in this group were observed from the time of diagnosis. In contrast, the groups of patients conditioned with chemotherapy only (n=3) or both chemotherapy and TBI, without preceding CRT (n=10), did not demonstrate a significant loss in H-SDS. Weight related to height demonstrated large individual differences over time. Spontaneous growth hormone (GH) secretion, as measured by a four-point sleep curve, was followed longitudinally and an increasing proportion of patients with low peak levels was seen in all patient groups. In summary, prepubertal growth was suppressed only in patients who received cranial irradiation before ABMT. Despite low GH peak levels, normal prepubertal growth was found in patients with no CRT before ABMT.