神经肌肉性脊柱侧凸和特发性脊柱侧凸患儿脊柱融合术中出血和凝血的比较

目的　在脊柱融合术中常见大量失血。作者以往已证明神经肌肉性脊柱侧凸较特发性脊柱侧凸术中失血更多 ,且输血亦较多。本研究的目的是了解儿童和青少年脊柱侧凸患儿行脊柱融合术时的病因、失血与凝血改变的关系。对象和方法　对大学教学医院的 2 5例接受脊柱融合术的患儿进行前瞻性观察研究 ,11例为神经肌肉性脊柱侧凸 ,14例系特发性脊柱侧凸。分别于术前、术中 2h和 4h、术后2h和 2 4h取血查凝血酶原时间 (PT)、部分凝血活酶时间(PTT)、凝血时间、血小板计数、D 二聚体、VII因子及VIII因子活性、血栓与血栓素III复合物和维生素K缺失诱发蛋白(PIVKA)。采用重复变量分析测量法对不同时间的凝血变化进行分析。组间比较采用独立t检验。结果　神经肌肉性脊柱侧凸患儿较特发性脊柱侧凸患儿出血明显增多 ,血液丢失的中位数分别为全血容量的 78% (2 5 %～ 12 7% )和 2 0 %(2 %～ 82 % ) ,P <0 0 0 1。两组PT随时间延长而增加 ,且神经肌肉性脊柱侧凸组手术前、后均明显高于特发性脊柱侧凸组 (P <0 0 5 )。两组VII因子活性则随时间延长而下降 (P <0 0 0 1) ,且术中神经肌肉组较特发性脊柱侧凸组更低 (P <0 0 5 )。PTT ,TT或VIII因子活性未见改变。术中 4h时两组均出现D 二聚体。所有患儿均未检测到PIVKA。结     

加速康复外科模式在先天性脊柱侧凸患者围手术期治疗中的应用研究

目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)模式在先天性脊柱侧凸患者围术期中的应用效果.方法 选择首都医科大学附属北京儿童医院2020年8月至10月接受手术治疗的27例先天性脊柱侧凸患者作为研究对象,男7例,女20例,平均年龄7.3岁,患者均接受脊柱后路截骨矫形植骨...     

一期后路半椎体切除短节段内固定治疗先天性脊柱侧凸

目的 探讨一期后路半椎体切除、短节段内固定手术治疗小儿先天性脊柱侧凸的临床疗效.方法 2004年9月至2009年6月,作者采用一期后路半椎体切除,短节段经椎弓根钉棒系统或椎板钩棒系统内固定手术治疗因半椎体所致的先大性脊柱侧凸患儿31例,男19例,女12例,年龄1～8岁,平均年龄3.6岁,术后支具固定4～6个月.术前站立位X线片显示单个半椎体28例,2个以上3例;半椎体位于胸段4例,胸腰段21例,腰段6例;Cobb's角侧凸平均42°(36°～64°),后凸39°(31°～58°).结果 经平均2.8年(6个月至4年)随访,无一例出现神经系统并发症,术中出现2例椎弓根螺钉切割椎体现象,采取更换固定上或下一椎体处理.术后冠状面矫正18°～37°,平均矫正25°,平均矫正率69.4%;矢状面矫正16°～38°,平均矫正24.5°,平均矫正率62.8%.未出现矫正度丢失或"曲轴现象".结论 对小年龄脊柱半椎体畸形患儿进行早期后路切除并短节段内固定,不仅可以矫正和控制脊柱畸形的发展,而且还能最大限度地保留脊柱的生长潜能和运动节段,疗效可靠.     

3D打印模型在儿童先天性脊柱侧凸治疗中的应用研究

目的探讨3D打印模型在儿童先天性脊柱侧凸治疗中的应用疗效。方法回顾性分析2015年12月至2016年12月于首都医科大学附属北京儿童医院接受手术治疗的83例先天性脊柱侧凸患儿临床及影像学资料,根据是否使用3D打印模型分为试验组(n=44)和对照组(n=39),比较两组手术时间、术中透视次数、置钉准确性、矫形效果及并发症情况。结果本研究共纳入83例先天性脊柱侧凸患儿,其中男童47例,女童36例,平均手术年龄5.98 (1.5~13)岁。行半椎体切除术40例,Ponte截骨术31例,经椎弓根截骨术8例,全脊椎切除术4例。随访时间24~35个月。试验组患儿手术时间短于对照组[(180.92±16.74) min (201.51±27.60) min],差异有统计学意义(t=2.798,P<0.05),试验组术中出血量[(340.23±89.52) mL vs.(392.64±100.41) mL]及术中透视次数(4.36±0.89 6.05±1.28)明显少于对照组,差异有统计学意义(P<0.05);试验组置钉准确率高于对照组(93.55%vs 79.91%)(X^2=218.00,P<0.05),平均置钉时间明显短于对照组[(4.24±1.05) min vs.(8.35±2.29) min],差异有统计学意义(t=10.71,P<0.05)。两组患儿矫形率无明显差异(t=-1.135,P=0.272)。试验组与对照组患儿术后胸膜损伤、硬膜损伤发生率无明显差异(P>0.05)。结论 3D打印模型能清晰、直观显示先天性脊柱侧凸患儿的脊柱结构及形态,为制定手术计划及手术置钉提供帮助,从而提高置钉准确率,减少术中透视次数,缩短手术时间,减少术中出血量。     

弯型对青少年特发性脊柱侧凸矫形手术中神经电生理监测的影响研究

目的比较分析不同弯型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)患儿矫形手术中神经电生理监测(intraoperative neurophysiological monitoring, IONM)结果, 探讨弯型对AIS患儿IONM监测的影响。方法回顾性分析2015年6月至2019年12月于南京大学医学院附属鼓楼医院脊柱外科行手术治疗的400例女性AIS患儿临床资料, 按照弯型, 分成单胸弯组、胸腰弯组/腰弯组、双胸弯组及胸腰双弯组, 每组各100例。比较组内及组间左右侧体感诱发电位(somatosensory evoked potential, SSEP)和经颅电刺激运动诱发电位(transcranial electric motor evoked potential, TCeMEP)的潜伏期及波幅差异, 计算不同弯型病例组间不对称性SSEP的发生率。结果单胸弯组及双胸弯组组内左右侧SSEP及TCeMEP的潜伏期和波幅比较, 差异均无统计学意义(P>0.05)。胸腰弯/腰弯组左侧TCeMEP潜伏期较右侧显著延长(P=0.032...     

椎弓根-肋骨撑开术在儿童先天性脊柱侧弯中的应用

目的报道椎弓根-肋骨撑开术治疗儿童先天性脊柱侧弯的初步经验.方法选择35例先天性脊柱侧弯患儿,男19例,女16例;平均年龄5.5岁(1.7～7.5岁);术前脊柱侧弯Cobb角平均为55°(30°～94°);采取后路手术,切断骨桥、融合肋,根据患儿年龄选择器械进行脊柱侧弯凹侧撑开,近端肋骨用钩固定,远端椎体用椎弓根钉固定.术后每半年至1年撑开1次.结果患儿均获随访,平均随访时间28个月(18～49个月),撑开2～5次;术后脊柱侧弯Cobb角平均为38°(15°～61°),可持续撑开;患儿畸形改善,并发症少.结论椎弓根-肋骨撑开术治疗儿童先天性胸(腰)段脊柱侧弯操作简单,安全,有效,可达到非融合手术的目的,伴发胸廓畸形也能得到改善.     

Oral occlusion pressure in scoliosis and neuromuscular syndromes

Oral occlusion pressure, a neuro-muscular index of the activity of the respiratory centers, was measured in 2 groups of children: one of 43 "healthy" children, in order to establish a predictive equation according to age (Y = 1.23 + 8.30 X A-1) and another of children presenting with respiratory failure, either due to an impairment of the thoracic cavity (10 dorsal scoliosis) or to an impairment of the respiratory muscles (29 children with muscular dystrophy or spinal muscular atrophy). The occlusion pressure increases with the degree of the ventilation deficiency in children with scoliosis. It remains paradoxically normal in children with neuro-muscular disease, irrespective of the ventilation deficiency. In the latter, the respiratory centers activity being considered as normal, this situation would indicate their muscular incapacity to correctly express this activity. It would show a severe muscular deficiency with a high risk of occurrence of respiratory distress accidents.     

不稳定性儿童骨盆骨折的内固定治疗

目的 对9例不稳定性儿童骨盆骨折的诊断治疗进行分析，总结儿童骨盆骨折的特点及内固定治疗的方法和经验。方法 回顾分析9例复杂儿童骨盆骨折病例，男5例，女4例，年龄6～16岁，平均12岁。Key Ⅲ型8例，Ⅳ型1例，均采用切开复位内固定手术。结果 经6～50个月，平均24．5个月的随访。根据X线片、临床检查及患儿的主观感受评定。按照Majeed的疗效评价标准，优8例，良1例。结论 对于不稳定性骨盆骨折的患儿，非手术治疗无法复位并保持稳定者应考虑及时采取手术治疗，根据年龄选择手术及内固定的方式，手术效果满意。     

Evaluation of pelvic contractility in ureteropelvic junction obstruction: an experimental study.

BACKGROUND/PURPOSE: Ureteropelvic junction (UPJ) obstruction causes adaptive and/or compensatory alterations in renal pelvic contractility. As these alterations directly affect the outcome after renal damage, definition of these alterations is of the utmost importance from a clinical point of view. Thus, an experimental study was designed to determine the alterations of renal pelvic contractility in response to partial and complete UPJ obstruction. METHODS: Fifteen adult female New Zealand white rabbits were randomly assigned into three groups (each containing 5 rabbits) according to the degree of unilateral UPJ obstruction. Group I: sham operation was performed and served as the control group; group II: partial UPJ obstruction was made; group III: complete UPJ obstruction was made. The animals in groups I and II were sacrificed after three weeks and the rabbits in group III were sacrificed after two weeks. Muscle strips from the renal pelvis were prepared. Spontaneous mechanical activity and contractile responses to phenylephrine (PE), serotonin (5-HT), and KCl were recorded isometrically and compared in all groups. RESULTS: Both the frequency and amplitude of spontaneous mechanical contractions were significantly (p < 0.05) increased in partial (group II) and complete UPJ obstruction (group III) groups. PE and 5-HT-induced tonic contractions, which were more prominent in the complete and partial obstruction groups when compared with the control group (p < 0.05). PE and 5-HT also increased the frequency of spontaneous contractions in both partial and complete obstruction groups. KCl induced long lasting tonic contractions in the control muscles. The duration of contraction to reach the maximum amplitude was shortened in the obstruction groups and the amplitudes of the contractions were significantly augmented when compared to control preparations. CONCLUSION: UPJ obstruction alters the contractile properties of renal pelvis smooth muscle. Increased frequency of spontaneous mechanical activity suggests that pacemaker cells of the renal pelvis change their activities in response to UPJ obstruction. Increase in tonic contraction amplitudes in response to PE and 5-HT suggests an increased sensitivity of smooth muscle cells to these agents. Potentiation of the contractile response to KCl suggests that adaptive changes take place at the level of excitation-contraction coupling in the smooth muscle of the renal pelvis following UPJ obstruction.