楔形冻干同种髂骨块在Salter、Pemberton手术中的应用

目的评价楔形冻干同种髂骨块在两种骨盆截骨手术中的应用效果。方法回顾性测量1998年7月～2000年9月期间Salter和Pemberton骨盆截骨手术前和手术后不同时期的髋臼指数变化,平均观察植骨块在不同时期的成骨融合情况。结果30例患儿34髋术后平均随访3年,采用Salter手术、楔形冻干同种髂骨块移植、克氏针内固定治疗18髋,随访末期髋臼指数平均矫正19°,植骨块完全融合时间平均1.2年;采用Pemberton手术、楔形冻干同种髂骨块移植治疗16髋,随访末期髋臼指数平均矫正24°,植骨块完全融合时间平均1.3年。结论在年幼儿童先天性髋关节脱位的Salter、Pem鄄berton手术中应用冻干同种髂骨块,既能弥补单纯自体髂骨植骨块厚度和强度的不足,又能够有效防止手术纠正后的髋臼指数的丢失。     

髋臼坐骨切迹周围骨盆截骨对儿童DDH的疗效探讨

目的介绍一种新的骨盆截骨即髋臼坐骨切迹周围骨盆截骨操作技术,并初步评价治疗儿童发育性髋关节脱位(Development Dysplsia of the Hip,DDH)的临床疗效。方法骨盆截骨线起自髂前上、下棘中点,与髋臼后上缘平行,并向髋臼后下方延长,止于距离坐骨切迹骨皮质3～5mm处,撑开截骨间隙时产生坐骨切迹皮质不完全性骨折,获得髋臼向前外方向的旋转,再用自体或异体楔形骨块嵌入截骨间隙,从而实现改变髋臼方向和增加对股骨头覆盖的目标。结果我院自2002年以来创用该术式治疗儿童发育性髋关节脱位64例(76髋)。对随访时间大于2年的12例14髋,按照McKay髋关节评定标准和Severin放射学分类评价标准评价其疗效,优12髋,良2髋。结论髋臼坐骨切迹周围骨盆截骨兼有Salter和Pemberton骨盆截骨的优点,但手术操作更为安全简便,适应征也比较宽泛。     

髂骨复合截骨旋转术治疗大龄儿童发育性髋关节脱位

目的探讨髂骨复合截骨旋转术应用于大龄儿童发育性髋关节脱位中的治疗效果。方法切开关节囊,找到真臼,去除真臼内填充物和粘连带,复位股骨头;以髂前下棘上缘和坐骨大切迹为标志,作前1/2髂骨全板截骨,将髂骨外侧皮质沿髋臼弧上方1cm向内向后作半板截骨,然后向下向外下压旋转髋臼,嵌入植骨块,增加股骨头包容。结果本组共16例22髋,经2～4年的随访,按照周永德先天性髋脱位疗效评定标准,优15髋,良6髋,可1髋,术后优良率为90%。结论髂骨复合截骨旋转术是治疗发育性髋关节脱位行之有效的一种好方法。     

同种异体骨块在salter截骨术中应用

salter骨盆截骨术在治疗小儿先天性髋关节脱位、髋臼发育不良等疾病中已被广泛采用,但小年龄的患儿由于髂骨薄、软骨成分多,所以可取骨块不多,小而薄,术中固定困难,术后可能影响髂骨发育,为此我院自2001年9月起,应用同种异体骨块替代自身髂骨块治疗先天性髋关节脱位、髋臼发育不良59例(共63髋),取得良好效果,报告如下。     

在Pemberton手术中冻干同种皮质骨环的应用

Ｐｅｍｂｅｒｔｏｎ手术是通过骨盆不全截骨、远端翻转来矫正先天性髋脱位患儿髋臼的异常指向和降低髋臼指数 ,因此维持术中远端翻转变位的植骨块质和量十分重要 ,年龄 2～ 3岁的患儿和再次手术的患儿取自体髂骨植骨质和量均存在着不足。对此我们应用冻干同种皮质骨环 +自体髂骨植入取得满意的效果 ,现报告如下。临床资料1.一般资料　本组 16例 ,男 4例 ,女 12例。左侧 10例 ,右侧 4例 ,双侧 2例 ,共 18髋。年龄 2～ 5岁 ,平均 3岁 2个月。再次手术 2例。2 .手术方法　按Ｐｅｍｂｅｒｔｏｎ手术原则作关节囊周围弧形向“Ｙ”形软骨截骨、远…     

持续被动活动下自体骨膜移植防治髋关节僵硬

目的在持续被动活动条件下,自体骨膜移植修复髋臼关节面软骨缺损防治先天性髋脱位术后关节僵硬。方法5例7个髋关节,年龄10～14岁。其中先天性髋脱位术后关节僵硬2个,采取髋关节粘连松解;先天性髋脱位5个,行切开复位、改良Chiari骨盆截骨。以上7个髋臼的关节面软骨缺损采用髋臼加深及自体胫骨骨膜移植修复其缺损。术后持续被动活动每天6h,连用6周。结果经1～4年随诊,原来僵硬的2个髋关节屈髋活动分别为90°、30°,先天性髋脱位的5个髋分别为70°、80°、80°、90°、90°,X线片显示髋关节间隙5个清晰,2个狭窄。结论持续被动活动下自体骨膜移植修复髋臼关节面软骨缺损可有效地防治先天性髋脱位术后关节僵硬。     

发育性髋关节脱位Dega骨盆截骨术并发症原因分析

目的探讨Dega骨盆截骨术治疗发育性髋关节脱位并发症的发生原因。方法回顾性分析2001年12月至2006年12月采用Dega骨盆截骨术治疗的发育性髋关节脱位病例59例（72髋），对其并发症情况进行分析。结果59例（72髋）中，发生并发症7例（7髋），其中3髋出现股骨头缺血性坏死，均为男性，并有闭合复位病史，手术年龄均小于2岁；3髋发生半脱位，1髋为髂骨截骨部位嵌入骨块移位，1髋为髂骨截骨远端下翻不充分，1髋为再脱位术后关节囊不能紧缩缝合；1髋活动受限，与髂骨截骨远端下翻过多及股骨短缩不充分有关。结论Dega骨盆截骨术发生并发症的原因主要与术前对髋关节脱位的病理变化了解不充分，术中没有掌握好髂骨截骨要领及头臼压力过大有关。     

经前外侧人路髋臼周围三联截骨术在儿童髋关节疾病中的应用

目的探讨前外侧入路、单一切口内进行髋臼周围三联截骨,在青少年髋臼发育不良、髋关节半脱位、股骨头无菌性坏死、发育性髋脱位治疗后残余覆盖不良等髋关节疾病治疗中的应用。方法选择19例（22髋）患儿,平均手术年龄9岁2个月（6～12岁）。术中将Bikini切口向下部分延伸,在单一切口内,进行髋臼周围三联截骨（髂骨、耻骨上支及坐骨支截骨）。术中通过C型臂透视定位,辅助确定截骨位置及截骨方向,使髋臼围绕股骨头骺向前、外侧旋转并向内移,在没有增加股骨头压力的前提下,达到良好的头臼覆盖;使用多枚克氏针或螺钉经髂骨截骨面支撑固定,术后用髋人字石膏固定6周。结果通过比较,手术前后及随访期间X线片上的髋臼指数（或Sharp角）、中心边缘角（CEA）、髋臼与股骨头覆盖率均有明显改善。少数患儿出现坐骨支截骨不愈合,但不影响负重行走。结论采用前外侧入路、髋臼周围三联截骨,相对于其它髋臼周围三联截骨方式（如Tsnnis、Steel、LeCoeur等）,具有经单一切口操作、髋臼旋转充分、截骨后内固定方便等特点,适合于Y型软骨尚未闭合,并需大角度改善头臼包容情况的患儿。     

发育性髋关节脱位的手术治疗

目的 探讨手术治疗发育性髋关节脱位的临床疗效。方法 自1995年6月～2002年12月,手术治疗发育性髋关节脱位112例(135髋)。股骨颈前倾角的矫正：术前应用CT扫描,准确测量股骨颈前倾角度数,术中根据测量数值,准确完成前倾角矫正;髋臼截骨：两截骨端之间的距离,也就是植骨块的高度,应用公式：L=2πRA／360计算,髋臼指数矫正较准确;对于8岁以上、髋臼发育较差的患儿,髋臼截骨后用螺钉或克氏针固定植骨块,以加强髋关节的稳定性。髋臼截骨有45例(54髋)植骨仅采用同种异体骨。术后早期被动运动结合主动功能锻炼。结果 经平均5年的随访,按照吉士俊等所制定的疗效评定标准评定,优81髋,良47髋,可7髋,优良率达94．8％。应用自体髂骨植骨组优良率为95％,应用同种异体骨植骨组优良率为94％,无再脱位发生。发生股骨头缺血性坏死13髋,占9．6％,并发关节僵硬11髋,占8．1％。结论 正确计算股骨颈前倾角和髋臼指数并按结果进行手术治疗,使畸形矫正准确,矫正后角度不易丢失,复位稳定,可缩短手术时间,减小创伤,减少并发症发生,疗效可靠。     

Le Coeur骨盆截骨术在DDH治疗中的应用

目的介绍一种可用于治疗发育性髋关节发育不良（developmental dysplasia of the hip，DDH）的Le Coeur骨盆三联截骨术。方法本组9人10髋，平均手术年龄8岁7个月（6岁5个月～12岁11个月）。手术由股骨近端的短缩、内翻或／和旋转截骨与骨盆三联截骨两个部分组成。骨盆截骨经二个切口完成：内收肌入路截断耻骨上下支，髋前外侧入路截开髂骨；将耻骨上下支向后、内推移并使断端重叠，将截开的髂骨远端向下翻压、向前旋转；自体股骨干骨块或异体骨块嵌入髂骨截面作支撑，2～3枚克氏钢针固定；术后髋人字形模具固定6～8周。结果7人有保守复位史，3人有手术复位史。手术后及短期随访的X线片上的髋臼指数（acetabular index，AI）或Sharp角，Wiberg中心边缘角（center edge angle，CE），髋臼股骨头指数（acetabular-head-index，AHI）均有明显改善，闭孔的形态大小可基本恢复对称。结论Le Coeur骨盆三联截骨术操作简单，风险小，能使股骨头获得良好的覆盖，适合于大龄儿童的髋臼发育不良或半脱位。     

生物标记物粪便胆汁酸的测定在过敏性紫癜患儿诊治中的意义

目的 探讨生物标记物粪便胆汁酸浓度在过敏性紫癜(HSP)患者中的变化及其在诊治中的临床意义。方法 选取2014~2016年确诊为HSP的19例患儿为HSP组,另选取27例健康儿童为健康对照组。采集HSP组患儿急性期、恢复期及健康对照组儿童粪便标本,应用液相质谱技术检测各组儿童粪便胆汁酸水平。结果 HSP组患儿恢复期胆酸水平均高于健康对照组和HSP组急性期 (P < 0.016)。HSP组患儿恢复期鹅脱氧胆酸水平高于健康对照组 (P < 0.016)。HSP组患儿急性期和恢复期脱氧胆酸、石胆酸水平均低于健康对照组 (分别P < 0.05、P < 0.016)。各组间熊去氧胆酸水平比较差异均无统计学意义 (P > 0.05)。结论 HSP患儿急性期粪便次级胆汁酸脱氧胆酸和石胆酸低于健康对照组,这可能与HSP的发病或转归有关。     

霉酚酸酯和环磷酰胺治疗儿童大量蛋白尿型过敏性紫癜性肾炎的前瞻性随机对照研究

目的 探讨霉酚酸酯(MMF)和环磷酰胺(CTX)分别治疗具有大量蛋白尿[24?h尿蛋白定量≥50?mg/kg或晨尿蛋白/肌酐(mg/mg)≥2.0]的过敏性紫癜性肾炎(HSPN)患儿的疗效和安全性.方法 前瞻性纳入2016年8月至2019年11月在首都儿科研究所附属儿童医院肾脏内科住院并诊断为有大量蛋白尿的HSPN患儿...     

Obesogenic home food availability,diet, and BMI in Pakistani and White toddlers

Individuals of South Asian ethnicity have an increased risk for obesity and related diseases. Foods available in the home during the first 1000 days (conception to 24 months old) are an important determinant of diet, yet no study has examined the association of early‐life home food availability (HFA) with later diet and obesity risk in South Asian households. We examined whether obesogenic HFA at 18 months of age is associated with dietary intake and body mass index (BMI) at 36 months of age in low‐income Pakistani and White households in the United Kingdom. In this prospective birth cohort study (Born in Bradford 1000), follow‐up assessments occurred at 18 (n = 1032) and 36 (n = 986) months of age. Variety and quantity of snack foods and sugar‐sweetened beverages (SSBs) in the home and consumed were measured using the HFA Inventory Checklist and food frequency questionnaires, respectively. BMI was calculated using measured length/height and weight. Multinomial logistic regression models examined associations between HFA and tertiles of dietary intake, and multivariable linear regression models assessed associations between HFA and BMI. Pakistani households had a greater variety and quantity of snack foods and SSBs available compared with White households. Variety and quantity of snack foods and SSBs in the home at 18 months were positively associated with children''s intake of these items at 36 months, but associations between HFA and BMI were null. Reducing obesogenic HFA during the first 1000 days may promote the development of more healthful diets, though this may not be associated with lower obesity risk during toddlerhood.     

EFFECT OF CYPROTERONE ACETATE (CA) ON GROWTH AND ENDOCRINE FUNCTION IN PRECOCIOUS PUBERTY

Abstract. Stahnke, N., Ilicki, A. and Willig, R. P. (Department of Paediatrics, University Hospital, Hamburg, West Germany). Effect of cyproterone acetate (CA) on growth and endocrine function in precocious puberty. Acta Paediatr Scand, Suppl. 277: 32, 1979.–16 girls with precocious puberty have been studied. Following low dosage cyproterone acetate (CA) therapy (mean daily dosage 65 mg/m² BSA) a beneficial effect on growth and skeletal maturation was observed. During high dosage therapy (150 mg/m² per day) endocrinological studies were performed in 10 of these patients. There was no significant difference in HGH levels (insulin-and arginine-test), T₃ and TSH values (TRH-test) between patients and controls, T₄ concentration was significantly increased. Basal prolactin levels and prolactin response to TRH was definitely elevated. Oral glucose load and arginine infusion resulted in a significantly enhanced insulin release. There was a significant reduction in basal LH levels and an increase in FSH response to LH-RH. Basal and diurnal plasma cortisol values were markedly reduced and the cortisol release due to corticotrophin injection, (lsinevasopressin (LVP) injection and insulin-hypoglycemia as well. A definite increase in basal ACTH levels was observed, during LVP-and insulin-hypoglycemia test ACTH concentrations were within or significantly above normal range. In our patients a primary adrenocortical insufficiency due to CA treatment was evident.     

Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances.

OBJECTIVES: To compare the causes of non-fatal work and non-work injuries and the places or environments where they occur. It has been suggested that many injuries may have similar etiologies on and off the job and thus involve some common prevention strategies. However lack of comparable data on work relatedness has prevented testing this proposition. METHODS: The National Health Interview Survey (NHIS) now collects information on the cause, location, and work relatedness of all medically attended injuries. National US estimates of non-fatal work and non-work injuries were compared by cause and place/location for working age adults (18-64 years). RESULTS: Overall 28.6% of injuries to working age adults were work related (37.5% among employed people). The causes and locations of many work and non-work injuries were similar. Falls, overexertion, and struck/caught by were leading causes for work and non-work injuries. Motor vehicle injuries were less likely to be work related (3.4% at work v 19.5% non-work) and overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults were less than 1% of work injuries and 1.8% of non-work injuries. Both work and non-work injuries occurred in every location examined-including the home where 3.5% of injuries were work related. CONCLUSIONS: Work and non-work injuries share many similarities suggesting opportunities to broaden injury prevention programs commonly restricted to one setting or the other. Comprehensive efforts to prevent both non-work and work injuries may result in considerable cost savings not only to society but also directly to employers, who incur much of the associated costs.     

Prenatal dietary diversity may influence underweight in infants in a Ugandan birth‐cohort

Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed ({"type":"clinical-trial","attrs":{"text":"NCT04233944","term_id":"NCT04233944"}}NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD‐W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0–4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.