儿童面部黑色素痣诊治379例

目的回顾性分析2010年1月至2014年12月在本院经手术治疗的379例面部黑色素痣患儿临床资料,总结儿童面部黑色素痣的手术治疗经验。方法379例中,男175例,女204例;年龄44 d至16岁。采用3种术式:单次(235例)或分次(71例)切除缝合,切除加全厚植皮(38例),切除加皮瓣修复,邻近皮瓣转移(34例),1例左面部巨痣行痣大部分切除加股前外游离皮瓣转移修复。采用皮肤科医师和患儿家属双盲主观评价疗效,评价内容为切口瘢痕、面部畸形、色差。结果除1例股前外游离皮瓣转移患儿游离皮瓣吻合口栓塞改为全厚植皮外,所有患儿均完整切除面部黑色素痣,切口Ⅰ级愈合。所有单次或分次切除缝合、临近皮瓣转移者未出现明显瘢痕增生或挛缩,皮肤色泽和弹性与正常皮肤接近,除部分邻近皮瓣转移患儿家长对附加切口不满意外,均获得满意评价。全厚植皮术者植皮区创缘发生轻度瘢痕增生,植皮区色素沉着。所有患儿未继发面部畸形。结论儿童面部黑色素痣的手术设计需兼顾其所处面部美容单位、面积大小,遵循面部美容单位自然的分界线及面部皱纹线走向,选择适宜的切除缝合、皮瓣转移、全厚植皮等术式进行修复,术后可获得较好的美容效果。     

The correlation between the clinical, laboratory and histopathological features of childhood membranoproliferative glomerulonephritis and response to treatment.

In this study, the clinical, laboratory and histopathological features of 50 children with membranoproliferative glomerulonephritis are reviewed. Age distribution varied from 5 to 15 years. The clinical presentation in the patients was nephrotic syndrome (24%), acute nephritic syndrome (20%) and nephritic/nephrotic syndrome (56%). Hypertension, macroscopic hematuria and hypocomplementemia were present in 40 percent, 58 percent and 34 percent of the patients, respectively. Light microscopic findings were as follows: glomerular lobulation (36%), mesangial sclerosis (20%), tubulointerstitial findings (36%), and crescents (26%). C3 (93%) was the most common immunofluorescence and IgM (86%), the most frequently encountered immunoglobulin. Response to treatment could not be anticipated by the initial clinical and laboratory features. Patients who did not have tubulointerstitial changes tended to have a greater response to therapy.     

Yield and clinical efficacy of funduscopic examinations performed in the pediatric emergency room

Consultations by ophthalmologists to rule out papilledema are frequently requested by emergency room (ER) physicians. The clinical setting and optimal timing for examination are not well established, and the impact on patient management is unclear. We evaluated the yield of emergency funduscopic examinations, aiming at establishing the optimal timing and efficacy of the consultation. The medical records of all children aged 0–18 years referred for funduscopic examinations from the ER between June 2010 and May 2011 were reviewed. Of 19,772 ER visits, 1,920 (9.7 %) were seen by an ophthalmologist and 479 (2.4 %) to rule out papilledema. Headache (44.5 %) and head trauma (18.4 %) were the most common indications. Sixty percent of the 479 patients had been symptomatic for <24 h, all having normal eye exams. Only 6/479, with diverse etiologies, depicted papilledema. Among these six children, visual complaints associating with headache were statistically significant to suggest the presence of papilledema (p?=?0.014). Seventy-one of the 479 children underwent neuroimaging studies despite normal funduscopic examinations. A single tumor case (medulloblastoma), symptomatic for weeks, had normal funduscopy. Conclusion: The vast majority of ER consultations to rule out papilledema show normal findings, particularly among children with signs and symptoms lasting for <24 h. The yield of funduscopy may be higher if visual disturbances are reported. If neuroimaging studies are considered, emergency room ophthalmological consultation is probably not warranted, except for young infants with neurological signs and symptoms in whom retinal hemorrhages suggestive of physical abuse must be ruled out.     

Monotherapy with meropenem versus combination therapy with piperacillin plus amikacin as empiric therapy for neutropenic fever in children with lymphoma and solid tumors.

The purpose of this study was to compare meropenem monotherapy with combination therapy for empirical treatment of neutropenic fever in children with lymphoma and solid tumors. Ninety episodes of neutropenic fever in children (0.7-16.0; mean age 7.7 years) with solid tumors in a single center were randomized to receive either meropenem (50 mg/kg/dose-maximum 1 g, every 8 hours) or piperacillin (200 mg/kg/dose, every 6 hours) plus amikacin (15 mg/kg daily). Failure was defined as treatment modification. Non-Hodgkin's lymphoma (NHL) accounted for 62.2 percent of all episodes, and solid tumors (37.8%) for the rest. Blood cultures were positive in 23 percent of all episodes. Sixty-seven percent of all isolated microorganisms stained Gram-positive. Overall success was 70.0 percent (63/90). The success with meropenem was comparable to that seen with piperacillin plus amikacin: 76.6 versus 64.6 percent (p = 0.25). The failure rate was 33 percent with Gram-positive culture and 78 percent with Gram-negative or mixed cultures. The solid tumor group had significantly less bacteremia (4/34 versus 17/56; p < 0.05) and treatment failure (3/34 versus 24/56; p < 0.001) than the NHL group. No serious drug-related adverse event was noticed. Meropenem monotherapy was as effective as piperacillin plus amikacin combination in the empirical treatment of neutropenic fever in children with lymphoma and solid tumors.     

Radiographic features of Kirner's deformity

We conducted a study of Kirner's deformity to investigate its radiologic features and consider its possible causes. Sixty‐seven patients with Kirner's deformity, 41 in our series and 26 retrieved in a survey of the literature were investigated. We divided Kirner's deformity into three types according to the site of curvature: the epiphyseal line, diaphysis, and distal tip. Among our series, 12 hands were affected in males and 26 in females. The gender of the patients for the other three hands was unknown. Twelve cases occurred on the right side, five on the left side, and 24 on both sides. Radiographic data for 34 hands were available. The palmar surface of the distal phalanx was at a mean angle of 27.4 degrees to the long axis of the middle phalanx. Epiphyseal line curvature was seen in four hands (mean patient age, 11 years), diaphysis curvature in 10 (mean age, 12.4 years), and distal tip curvature in 20 (mean age, 26.5 years). Dorsal subluxation of the distal phalanx was noticed in six hands (18%). Radiographic data for 26 hands reported previously were analyzable. The differences between epiphyseal line or diaphysis curvature and distal tip curvature in terms of age were significant in both the present study and the literature.     

股骨远端截骨和髌腱止点远端移位联合手术治疗儿童脑瘫屈膝步态的近期效果评价

目的 评价股骨远端截骨和髌腱止点远端移位联合手术治疗儿童痉挛性脑瘫屈膝步态的近期效果.方法 2009年4月至2012年7月对存在屈膝步态、膝关节固定屈曲畸形10°～30°的痉挛性脑瘫儿童行股骨远端截骨和髌腱止点远端移位联合手术.16例(26侧下肢)纳入研究,其中男11例,女5例,年龄7.5～11.6岁,平均8.9岁.术后高分子绷带固定6周,拆除石膏后功能锻炼,夜间长腿管型支具固定维持矫形.记录手术前后的膝关节固定屈曲畸形角度、腘角、膝关节活动范围、屈膝步态改善情况、膝关节疼痛视觉模拟评分(VAS)评分、股四头肌肌力、腘绳肌肌力、小腿三头肌肌力、侧位膝关节X线片Insall-salvati指数和Wren改良的屈膝步态的医师视觉评分,并进行统计学分析.结果 GMFCS分级为Ⅱ级9例,Ⅲ级7例,无GMFCS分级Ⅰ、Ⅳ、Ⅴ级病例.均行股骨远端截骨和髌腱止点远端移位联合手术.6侧下肢同时行髂腰肌松解术.10侧下肢同时行跟腱延长术.病例随访48～65个月,平均54个月.治疗后所有病例屈膝步态均明显改善或消失.患儿膝关节疼痛VAS评分较术前降低(P＜0.05).膝关节屈曲畸形角度及腘角明显减小(P＜0.01),膝关节屈伸活动范围明显增大(P＜0.01).股四头肌肌力显著增加(P＜0.05).腘绳肌肌力、小腿三头肌肌力无显著变化.侧位膝关节X线片Insall-salvati指数明显减小,髌骨高位得到纠正.2例(2侧下肢,7.7％)出现一过性坐骨神经损伤症状,经更换高分子绷带,增大膝关节屈曲至20°左右,并予营养神经等对症处理后症状消失.2例(3侧下肢,11.5％)出现切口感染,经换药处理后愈合.3例(3侧下肢,11.5％)出现股骨截骨远端轻度移位,未做特殊处理,截骨端塑型良好.无一例出现过度矫正、膝反屈、压疮等其他并发症.结论 股骨远端截骨和髌腱止点远端移位联合手术治疗儿童脑瘫屈膝步态能有效改善步态,纠正膝关节屈曲畸形和髌骨高位,增加股四头肌肌力,减轻膝关节疼痛,近期效果良好.     

可延长髓内钉治疗成骨不全股骨严重畸形的临床应用

目的 探讨应用可延长髓内钉(Fassiver-Duval,FD)采用多段截骨矫形手术治疗成骨不全股骨严重畸形方法及疗效.方法 2009年6月至2011年6月共收治成骨不全患儿31例,所有患儿均进行股骨干截骨矫形FD钉手术固定.31例患儿中,26例为双侧股骨干弯曲畸形,5例为单侧股骨干畸形,畸形成角度数(畸形两侧骨干轴线的交角)为20°～90°,平均43°.男17例,女14例,术后按照Barthel指数运动功能分级量表评估治疗前后运动功能及儿童功能独立评定表(WeeFIM评定表)评估治疗前后生活自理能力情况.结果 所有患儿均获得随访,平均随访时间43个月(36～60个月).手术时间平均2 h(1.5～3 h),术中出血约200 ml(100～400 ml),股骨截骨处平均3.7处(3～5处).股骨截骨平均8.5周(7～12周)愈合.患儿撤除石膏后即在床上练习患肢活动,复查X线片显示截骨愈合后开始负重行走.全部患儿的父母对手术结果及畸形矫正效果满意,患儿Barthel指数评分由术前平均59.55分(30～80分)提高到术后平均93.18分(80～100分),WeeFIM评分由术前平均55.55分(34～80分)提高到术后平均77.45分(61～90分).未出现感染、骨髓炎等并发症,无神经血管损伤病例.结论 多段截骨应用FD钉手术治疗成骨不全股骨畸形,对肢体损伤较小,不进入关节,出血少.可以减少再骨折,最大程度的矫正畸形,改善下肢功能,提高生活质量.     

High intracranial pressure with the spreading of the cranial sutures as a leading symptom of herpes simplex meningitis

A four-year old girl developed signs of increased intracranial pressure (head-ache, vomiting, ataxia, tremor, papilledema, cranial suture spread). Abacterial meningoencephalitis due to herpes virus was diagnosed, while the initially suspected brain tumor was ruled out. Without specific therapy the patient recovered completely; even the cranial suture spread disappeared. This case report demonstrates an unusual and more benign course of central nervous herpes virus infection.     

Incidence and treatment of diplopia after three-wall orbital decompression in Graves' ophthalmopathy

PURPOSE: To describe our experience treating diplopia after orbital decompression in patients with thyroid orbitopathy. PATIENTS AND METHODS: From May 1997 to July 2001, we performed orbital decompression on 102 patients (34 men and 68 women) with severe proptosis. In 10 (9.8%) of these patients who had no diplopia preoperatively, diplopia in primary gaze occurred after decompression. In 19 (18.6%) of the patients with diplopia in primary gaze before surgery, there was no modification of diplopia after decompression. In 24 (23.5%) of the patients with diplopia in primary gaze before surgery, a more severe imbalance occurred after decompression. Forty-four (83%) of these 53 patients underwent adjustable extraocular muscle surgery with the use of viscoelastic substances to gain single vision in primary position. In 9 (17%) of the patients, diplopia was resolved with the use of prismatic lenses. RESULTS: In 31 (70.4%) of 44 patients, we obtained a stable resolution of diplopia in primary position (minimum follow-up, 6 months). In 10 (22.7%) of these patients, a second surgery on the oblique muscles was necessary 6 months after the first surgery to resolve torsional diplopia. In 3 (6.8%) of the patients, diplopia has been resolved with prismatic lenses. CONCLUSION: Orbital decompression reduces proptosis, but may cause diplopia or worsen it.     

Ponseti方法治疗先天性马蹄内翻足疗效

目的评价Ponseti方法早期治疗先天性马蹄内翻足的疗效。方法应用Ponseti方法(连续石膏矫形加皮下跟腱切断加足外展矫形支具)治疗先天性马蹄内翻足25例31足。男20例25足,女5例6足;年龄5d~12个月。结果病例随访2~24个月,平均16.3个月,按Dimeglio和Pirani分类和评价方法,25例31足中24例30足(96.8%)畸形获得满意矫正,1例1足残余部分畸形需手术治疗。结论Ponseti方法早期治疗先天性马蹄内翻足均可取得良好疗效。     

Malignant childhood proptosis: study of 104 cases

Children < or =18 years with malignant proptosis enrolled in ophthalmic tumor clinic at a tertiary cancer center from July 2003 to December 2006 were retrospectively analyzed. The incidence of proptosis among the pediatric cancer patients was 4.9%. Secondary tumors accounted for majority of cases (n=62, 59.6%) with retinoblastoma (51%) being the commonest cause of proptosis. Fourteen (13.5%) patients presented with bilateral proptosis; all but one had metastatic tumor as underlying cause. Metastatic malignancies had significantly lower hemoglobin and platelet count and higher white blood count. Therefore, careful analysis of symptomatology, hemogram, and those with bilateral proptosis warrant a hematologic work-up before imaging studies and invasive orbital biopsy.     

Evaluation of sixteen children with pseudotumor cerebri

Pseudotumor cerebri (PTC) is a clinical condition characterized by signs and symptoms of increased intracranial pressure, such as headache and papilledema. A total of 16 patients diagnosed with PTC [12 (75%) female; 4 (25%) male] were included in the study. The age of onset of symptoms was 123.4 +/- 34.3 months (range: 60-168 months). Obesity was found in four (25%) of them. Two patients had venous sinus thrombosis, two had corticosteroid withdrawal, and one had posttraumatic PTC. The most common symptom was headache, recorded in 93.8% of the patients. All patients were treated medically. Two patients in our group also required a lumboperitoneal shunt. In conclusion, PTC in children is rare. Both papilledema and sixth nerve palsy resolved rapidly with treatment. However, children can sustain loss of visual field and visual acuity despite treatment.     

Bilateral Ulnar Agenesis: Case Report and Review of the Literature

Bilateral ulnar agenesis is a rare abnormality. A total of 36 cases are analyzed: 35 of these are documented in the literature and 1 stillborn male is presented in this study. Most patients had one of the three conditions: Al-Awadi/Raas-Rothschild syndrome, syndrome of ulnar aplasia with split hand/split foot deformity, or the Brachmann—de Lange syndrome. Fifty percent of all cases with bilateral ulnar agenesis were associated with lower limb defects and these cases, for the most part, also belonged to the aforementioned syndromes. Nonskeletal, internal organ malformations were identified in 34% of all patients. Nine patients presented with isolated bilateral ulnar agenesis. The Al-Awadi/Raas-Rothschild syndrome and the split hand/split foot deformity are heritable disorders. There was no evidence for genetic etiology in most of the other cases. Bilateral ulnar agenesis in our fetus was part of the Brachmann—de Lange syndrome with associated cardiac defect, diaphragmatic hernia, and umbilical artery agenesis.     

A clinical trial of procarbazine plus vincristine plus bis-chloroethyl-nitrosourea plus imidazole carboxamide dimethyl triazeno in metastatic malignant melanoma.

Only a limited percentage of patients with metastatic malignant melanoma respond to single-agent chemotherapy. Vincristine, procarbazine, imidazole carboxamide dimethyl triazeno (DTIC) and bis-chloroethyl-nitrosourea (BCNU) have been used as single agents by various investigators. A response rate of +/- 20% was seen with vincristine (1-3) and BCNU (3, 4), and a response rate of 20-30% has been observed with DTIC (3, 5-8) and procarbazine (3, 9, 10). Newer agents such as triazeno imidazole carboxamide mustard (TIC mustard) (11), chloroethyl cyclohexyl nitrosourea (CCNU) (12), and chloroethyl methylcyclohexyl nitrosourea (methyl-CCNU) (13) have not so far proved superior. During the last years various drug combinations have been tried in an effort to improve the results of treatment in patients with metastatic malignant melanoma. In 1959 Moon reported objective response in 9 out of 20 patients who received a minimum of two courses of a combination of BCNU and vincristine (14). In a randomized trial performed by Acute Leukemia Group B (15), only 24% responded to this combination as compared to 32% and 29% for two different DTIC schedules. There were 120 patients who entered onto this protocol. A combination of DTIC plus cyclophosphamide plus vincristine was reported to give a 25% response (16). Workers at the Mayo Clinic reported objective response in 4 out of 18 patients treated with a combination of DTIC plus vincristine as compared to 1 out of 19 using CCNU (12). Costanza and co-workers (Eastern Co-Operative Oncology Group study) reported that 12 out of 61 patients responded to treatment with DTIC plus BCNU as compared to 9 out of 51 on DTIC alone (17); while Cohen (18) and co-workers reported that 10 out of 16 patients treated with the triple combination of vincristine plus BCNU plus DTIC showed significant response and concluded that this combined approach in the treatment of disseminated malignant melanoma warranted further study. Preliminary analysis of an Eastern Co-Operative Oncology Group protocol showed no statistical advantage of DTIC plus methyl-CCNU over each drug on its own (19). The present study was undertaken to investigate the possible advantage of combining DTIC plus vincristine plus BCNU plus procarbazine in courses of treatment. All of these agents are of some value on their own and all four have possible different mechanisms of action.     

附着点炎性反应相关性关节炎34例临床特征、预后和转归

目的分析附着点炎性反应相关性关节炎(ERA)的临床特征,探讨ERA的远期预后和转归。方法回顾分析1994年6月-2005年12月本科收治的34例ERA临床表现、实验室和辅助检查,通过门诊复诊、电话、信函进行,随访24~120个月,分析随访者目前的病情和生活状况。结果34例患儿中一级亲属中强直性脊柱炎(AS)4例、骶髂关节炎2例。33例患附着点炎,4例行骶髂关节CT检查提示AS特征性改变。急性期多有WBC、ESR、CRP和血清IgG、IgA、IgM及补体C3增高,人类白细胞抗原B27(HLA-B27)均阳性。予非甾体类抗炎药和甲氨蝶呤(MTX),个别予其他免疫抑制剂治疗。随访34例,仍有活动性关节炎20例诊断为AS 4例,发展为多关节型JIA 9例,出现关节畸形和(或)功能障碍25例,无1例死亡。结论掌握ERA临床特征有助于诊断,ERA预后不佳,大部分出院后仍存在活动性关节炎,73.5%出现关节畸形和(或)功能障碍。     

Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy

We reviewed retrospectively 31 cases of candidemia in children with central venous catheters. Infection rate was significantly higher in 1- to 4-year-old children with central venous catheters. Infection rate was significantly higher in 1- to 4-year-old children than in other age groups (8.4% vs. 2.2%; P less than 0.05). Serious sequelae occurred in 11 (35%) cases and included fatal outcome (5 instances), Candida endocarditis (2), renal abscesses, meningitis, arthritis and osteomyelitis (1 each). Complications were significantly more common in infants than in older children (P less than 0.05) and appeared 3 to 52 days after the first positive blood culture (mean, 16 days). In fatal cases catheters were left in place a significantly greater number of days than in nonfatal cases (P less than 0.05). A literature review identified 43 additional cases of catheter-related candidemia described in 11 series. The rate of Candida infection in the group as a whole was 2.7%. Patients treated with catheter removal plus amphotericin B had a significantly higher cure rate then patients treated with catheter retention plus amphotericin B (P = 0.009). Prompt catheter removal remains crucial in the treatment of catheter-related candidemia.     

Long-term sequelae after pediatric brain tumors: their effect on disability and quality of life

In an unselected series of pediatric brain tumors, 56 of 60 long-term survivors--craniopharyngiomas and pituitary tumors excluded--were investigated and interviewed mean X = 10 (5-16) years after diagnosis. After this time, sequelae were stable and included cognitive (38%), motor (25%), visual (20%), hormonal (20%), and psychological-emotional (14%) dysfunction. Memory dysfunction was found in 22% of patients with normal intelligence. Moderate or severe disability, from combinations of these impairments, was found in 34%. Sixty-six percent had no or mild disability compatible with active life and employment. However, these patients less often were married or had children compared with a control group of healthy subjects. Moderate and severe disability was found in 48% of supra- and in 21% of infratentorial tumors, after radiotherapy (RT) in 55% vs. without RT in 18%. RT before 6 years of age caused subnormal IQ in all cases. The self-reported quality of life was not related to degree of disability. Patients with psychological-emotional sequelae self-evaluated their quality of life lower than did patients with other types of long-term sequelae.     

宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血的效果

目的比较局部缝合术与宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血的临床效果及预后影响。方法选取秦皇岛市海港医院2012年10月至2017年10月收治的前置胎盘剖宫产术发生宫颈管出血的患者64例,依据宫颈缝合方式分为宫颈上提缝合组和局部缝合组,每组32例。比较两组患者的手术情况(包括手术时间、术中出血量、红细胞悬液输入量、血浆输入量、止血时间、术后1 d阴道流血量)、宫颈管出血原因及程度。术后随访8周,比较两组患者腹腔感染率、子宫切除率及产褥病率。结果宫颈上提缝合组患者手术时间[(74±15)min]、止血时间[(18±4)min]均明显短于局部缝合组[分别为(97±20)min、(33±7)min, P值均<0.05]。宫颈上提缝合组患者术中出血量[(769±88)ml]、红细胞悬液输入量[(429±28)ml]、血浆输入量[(112±21)ml]、术后1 d阴道流血量[(99±18)ml]均明显少于局部缝合组[分别为(925±104)、(538±44)、(190±44)、(169±23)ml,P值均<0.05]。宫颈上提缝合组与局部缝合组患者宫颈管出血原因及程度比较差异无统计学意义(P>0.05);术后8周宫颈上提缝合组腹腔感染率(3.12%)、子宫切除率(0.00%)均明显低于局部缝合组(分别为9.37%、12.50%,P值均<0.05),两组患者产褥病率比较差异无统计学意义(P>0.05),宫颈上提缝合组术后总不良反应发生率(9.37%)明显低于局部缝合组(31.25%,P<0.05)。结论宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血对于患者术中情况有明显改善,安全性高,预后好,值得在临床推广。     

Neuroblastoma in southern Brazil: an 11-year study

The authors report on the incidence and clinical characteristics of neuroblastoma in southern Brazil. The aims of the study were to evaluate the age at diagnosis, tumor stage, MYCN status, and tumor histopathology, and to relate these factors to survival. All patients with neuroblastoma, 15 years old or younger (n = 125), admitted to the three major pediatric oncology hospitals in the state of Parana over a period of 11 years (between January 1990 and December 2000), were included in the analysis. All patients were followed for at least 5 years. In addition, a FISH evaluation for MYCN status was conducted in a subset of 34 tumors. Overall survival for tumor stages 1, 2, 3, and 4 was 100%, 72%, 59%, and 17%, respectively. Sixty-two percent (77/125) of all patients were older than 2 years; these represented 71% (57/80) of the patients with stage 4 disease. Children who presented with an unfavorable histopathology had a significantly worse prognosis (20% survival) than children with a favorable histopathology (67% survival). MYCN amplification was detected most commonly in stages 3 and 4 tumors (13/16). These data showed a delayed diagnosis of neuroblastoma in children in southern Brazil, and consequently survival was considerably lower in these patients.     

Nuss术治疗小儿漏斗胸的CT指数评估

目的 探讨采用CT指数客观评估Nuss手术治疗小儿漏斗胸效果的价值.方法 2005年5月至2009年1月,采用胸腔镜辅助下改良Nuss术治疗115例中重度漏斗胸患儿,将已拔除钢板的30例患儿作为研究对象.采用胸部CT扫描分别测量术前、Nuss术后、拔除钢板后的CT指数,进行对比研究.选取年龄匹配的30例排除胸部畸形的患儿作为对照组.将实验组分为小年龄组(≤10岁)22例及大年龄组(>10岁)8例;对称型组18例及不对称型组12例;中度组(CT指数≤5)18例及重度组(CT指数>5)12例.各组之间进行对比及统计分析.结果 实验组Nuss术后以及拔除钢板后的CT指数与术前进行配对t检验显示差异均具有统计学意义(P<0.001),拔除钢板后CT指数与Nuss术后相比,差异无统计学意义(P=0.472),并且与对照组的2.48±0.24相比,差异无统计学意义(P=0.057).小年龄组与大年龄组Nuss术后及拔钢板后的CT指数与术前相比,差异均有统计学意义(P<0.05),而两组之间相比,差异均无统计学意义(P=0.093,P=0.116).对称型组和不对称型组Nuss术后及拔钢板后的CT指数与术前相比,差异均有统计学意义(P<0.05),而两组之间相比,差异均无统计学意K(P=0.281,P=0.610).中度组和重度组Nuss术后及拔钢板后CT指数与术前相比,差异均有统计学意义(P<0.05),两组之间Nuss术后相比,差异有统计学意义(P<0.05),但拔钢板后差异无统计学意义(P=0.093).结论 CT指数可以客观地评估Nuss术矫治小儿漏斗胸术后乃至拔除钢板后的手术效果.无论年龄、畸形类型及畸形程度,Nuss手术均能取得良好效果.