小儿胰腺损伤

报道７例小儿胰腺损伤的临床表现，诊断方法及治疗原则。方法１９８１年来治疗７例胰腺损伤，４例单纯损伤中３例保守治疗，１例手术外引流；２例分别伴有脾破裂及胃穿孔行脾切除及胃穿孔修补；１例胰腺颈体部横断伴十二指肠为裂行胰腺远、近端与空肠端端、端侧Ｒｏｕｘ－ｅｎ－Ｙ吻合，胃空肠吻合。     

儿童肘部损伤后肘外翻畸形

为了积极有效地治疗儿童肘部损伤后发生的肘外翻畸形，对肘外翻发生的原因、预防和治疗进行讨论。本组共２６例，肘部损伤时年龄２～１４岁（平均７．５岁）。儿童肘部损伤为肱骨外髁骨析１４例，肱骨外髁骨折合并桡骨小头脱位１例，肱骨髁上骨折８例，肱骨内髁骨折１例，桡骨小头脱位２例。肘关节提携角２０～４５（平均２８）。合并创伤性尺神经炎１９例，创伤性关节炎７例。１９例合并创伤性尺神经炎作神经松解前移术，平均随访６．６年，优良率８８．２％。５例肘外翻作肪骨髁上截骨术，平均随访９．４年，肘关节外观及功能满意。结论：延误诊治、复位固定不良是儿童肘部损伤后发生肘外翻的原因。早期诊断、及时准确复位和确切固定是减少肘外翻发生的重要措施，对有移位的骨折的反复手法复位可加重骨骺损伤。８岁以上严重肘外翻畸形可作肱骨髁上截骨术矫正，合并创伤性尺神经炎应早期作尺神经松解前移术。     

儿童颈椎外伤的诊断及治疗

目的 探讨儿童颈椎外伤的临床特点、诊断、治疗方法及难点和要点.方法 回顾性分析我院1995年1月至2005年12月期间治疗的儿童颈椎外伤病例的临床资料,同时检索分析国内外关于儿童颈椎外伤的文献.结果 11例患儿纳入本研究,其中男8例,女3例;平均年龄(12.1±4.0)岁;受伤机制包括坠落伤(3例),运动伤(3例),车祸伤(2例),直接暴力伤(2例),因娱乐致伤(1例).受伤部位分布为C1-34例,C4-77例.4例合并神经系统症状,其中1例为无骨折脱位型脊髓损伤.4例接受手术治疗,7例行保守治疗.结论 儿童颈椎外伤相对少见,其在临床表现、影像学检查及治疗方法上均存在与年龄相关的特点.熟悉这些特点对儿童颈椎外伤患儿的诊断及治疗至关重要.     

去甲氧柔红霉素治疗小儿肿瘤9例分析

我科采用个去甲氧柔红霉素（ＩＤ）治疗小儿白血病等恶性肿瘤和朗罕氏组织细胞增生症（ＬＣＨ）９例,取得良好的疗效,现报道如下。材料和方法１．对象（１）小儿急性淋巴细胞性白血病（ＡＬＬ）,６例：男５例、女１例。年龄从８个月～１０岁。按全国标准评定［１］高危（ＨＲ－ＡＬＬ）４例,超高危（超ＨＲ－ＡＬＬ）２例。（２）急性髓细胞性白血病（ＡＭＬ）,１例,Ｍ６型,３岁半。误诊骨髓异常增生综合征１年,已多次使用Ａｒａ－Ｃ等化疗药物,确诊Ｍ６型后,经采用ＨＯＡＰ、ＶＰ１６＋Ａｒａ－Ｃ等方案诱导治疗失败。骨髓：原始…     

小儿脑囊虫病46例临床分析

儿童寄生虫病是我国广大农村的多发病,颅内的寄生虫病也多有发生,如能及时正确地诊断治疗,其预后良好。本文对我院１９９１年～１９９８年收治的４６例小儿脑囊虫病进行分析,现报告如下。１临床资料１．１一般资料患儿４６例,男２７例,女１９例。年龄３岁～６岁４例...     

儿童X线检查无异常的脊髓损伤（附31例临床报告）

治疗Ｘ线检查无异常的小儿脊髓损伤３１例，占同期儿童脊髓损伤患儿（８８例）的３５％。对该病的解剖学基础，发病机制以及诊断，治疗中的若干问题进行了讨论。     

小儿支气管镜检技术对肺部局部病变患儿的诊断和治疗作用

小儿支气管镜检查过去临床主要用来取异物,近年来已广泛用于儿科临床的诊断和治疗。我院自１９９２年２月～１９９９年２月对１７１例胸Ｘ线片有浸润灶伴肺不张和（或）肺气肿的患儿进行硬质支气管镜检,现将结果报告如下。对象：１９９２～１９９９年共收治经胸Ｘ线片证实为肺部浸润灶病变伴肺不张和（或）肺气肿患儿１７１例,男１０３例,女６８例。年龄最小１２天,最大１２岁,其中～１岁２０例,～３岁１１４例,～６岁１９例,～９岁１０例,～１２岁８例。平均２－５±２－６岁。均有不同程度的咳嗽和喘息症状,其中有呛咳史者６７…     

小儿脊髓栓系综合征

目的 探讨小儿脊髓栓系综合征（ＴＣＳ）的病理及手术治疗效果。方法 本组ＴＣＳ患儿２１例,检查确诊后,手术切除脂肪瘤或切除瘢痕、松解粘连、切断终丝,使ＴＣＳ得以松解。结果 ＴＣＳ在大体病理上有脂肪瘤型及瘢痕型两大类,部分病例有神经根缺失。１９例得到随诊,单纯双下肢软瘫的１例治愈,１７例尿失禁患儿中,３例治愈,６例明显好转,８例无变化。结论 ＴＣＳ患儿应尽早治疗,疗效确切。对脊髓脊膜膨出患儿应在ＴＣＳ     

小儿肝外伤的外科治疗体会

小儿肝脏位于右侧膈下和季肋部深部 ,受胸廓和膈肌保护 ,加之小儿肋骨柔韧性较好 ,因而不易损伤肝脏。本院近２０年收治小儿肝外伤仅３１例 ,占腹部脏器损伤的１７% ,位居脾、肾损伤之后 ,现总结如下。临床资料男１９例 ,女１２例 ;年龄３岁～１４岁。本组均为闭合性损伤 ,其中全肝多发性挫裂伤２例 ,右肝叶２３例 ,左肝叶６例 ,有１３例合并其他脏器损伤。按照Ｍｏｏｒｅ分类法 :Ｉ级２例 (包膜撕脱 ,无活动出血 ;肝实质裂伤深度＜１ｃｍ ,无活动出血 ) ,ＩＩ级９例 (肝实质裂伤深１ｃｍ～３ｃｍ ;肝周穿透伤 ;包膜下血肿直径＜１０ｃｍ) ,…     

手术治疗小儿布－加综合征4例

手术治疗小儿布－加综合征４例薛涣洲，姜青峰，田建国，张宏伟１９８７年６月至１９９２年１２月我们为４例小儿布－加综合征（Ｂｕｄｄ－Ｃｈｉａｒｉ）施行了手术治疗，取得较满意效果。本组男３例，女１例。年龄分别为５、７、９和１３岁。本组患儿均有不同程度的下肢...     

Concurrent paediatric seat belt injuries of the abdomen and spine

Between 1981 and 1989, 541 children were admitted with abdominal injuries sustained as passengers in motor vehicle accidents. Twenty-nine of them had seat belt injuries of the abdomen. From 1981 to 1984, 1 child was admitted each year with such injuries and 21% of the abdominal injuries were due to seat belts. The number of cases had increased to 8 in 1989 and 78% of abdominal injuries were due to seat belts. These changes coincided with increased compliance with seat belt legislation in the State of Victoria. Restraint of children under 8 years of age in the front seat was legislated in 1976 and in the rear seat in 1981. In 1985, drivers were also held responsible for the restraint of children 8–17 years of age. Most of the children with seat belt injuries of the abdomen used lap belts or poorly fitting lap/sash belts. Twenty of the children had other non-abdominal injuries including 11 head, 7 thoracic, and 12 limb injuries. Eight children had spinal injuries including 7 Chance flexion-distraction fractures of the spine and 1 spinal cord injury without radiological abnormality. Chance fractures were only detected in one-half of the children on admission and in only 1 of the 9 children who had a laparotomy. Seventy-five per cent of children with spinal injuries had a laparotomy; 67% of those with abdominal injuries had spinal injuries, while only 7% of those not undergoing laparotomy had spinal injuries. These findings indicate that all children with seat belt injuries of the abdomen need careful clinical and radiographic assessment of the thoracolumbar spine. Prevention of seat belt injuries of the abdomen and spine requires legislation that ensures that all children use effective restraints that are appropriate for their age, size, and position within the vehicle. Correspondence to: W. G. Cole     

Spinal cord injuries in older children: is there a role for high-dose methylprednisolone?

We present a retrospective case series of 15 children (aged 8-16 years) with blunt traumatic spinal cord injury who were treated with methylprednisolone as per the National Acute Spinal Cord Injury Study protocol. Of all patients, 12 (80%) were male. Causes were sports injuries (n = 9), motor vehicle crashes (n = 2), and falls (n = 4). Most injuries were nonskeletal (n = 14), and all patients had incomplete injury of the spinal cord. The most common location of tenderness was cervical (n = 7). Of the 15 patients, methylprednisolone was initiated within 3 hours in 13 patients and between 3 and 8 hours in 2 patients. All patients received the medication for 23 hours as per the National Acute Spinal Cord Injury Study protocol. Of the 15 patients, 13 recovered completely by 24 hours and were discharged with a diagnosis of spinal cord concussion. One patient had compression fracture of T5 and T3-T5 spinal contusion but no long-term neurological deficit. One patient was discharged with diagnosis of C1-C3 spinal cord contusion (by magnetic resonance imaging) and had partial recovery at 2 years after injury. All patients with a diagnosis of cord concussion had normal plain films of the spine and computed tomographic and magnetic resonance imaging findings. None of the patients had any associated major traumatic injuries to other organ systems. The high-dose steroid therapy did not result in any serious bacterial infections.     

The spectrum of seat belt syndrome among Canadian children: Results of a two-year population surveillance study

BACKGROUND

Seat belts have been proven to save lives. However, if they are not properly fitted, ‘seat belt syndrome’ can occur. The aim of the present study was to describe injuries encountered in Canadian children with seat belt-associated injuries.

METHODS

Canadian paediatricians and paediatric subspecialists were surveyed monthly through the Canadian Paediatric Surveillance Program. Children younger than 18 years of age who were restrained in motor vehicles at the time of a collision, with abdominal or thoracolumbar spine injuries, were included. The children may have been restrained in child safety seats, booster seats, or two- or three-point seat belts.

RESULTS

Twenty-eight children, between two and 16 years of age, with injuries compatible with seat belt syndrome were reported in Canada between September 2003 and August 2005. Although 12 children were younger than eight years of age, only one was restrained in a booster seat and only four of the older children were properly restrained with a three-point seat belt. Twenty-four children had abdominal injuries. Of these, 18 had stomach and/or intestinal injuries and 11 had solid organ injuries. Twelve patients had a spinal fracture, including only five Chance-type fractures. Seven patients presented with paraplegia, and none of them recovered.

CONCLUSION

In Canada, over a two-year period, 28 children were reported to have sustained injuries consistent with seat belt syndrome; seven of these children remained paraplegic. These results emphasize the necessity to review restraints in motor vehicles to adequately protect children.     

Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

Background

In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories.

Materials and methods

This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1.

Results

The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20–679 days). Study outcomes were categorized as: n?=?26 children with accidental head trauma, n?=?38 with abusive head trauma (n?=?18 presumptive AHT, n?=?20 suspicious for AHT), and n?=?10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a statistically significant relationship with a study outcome of abusive head trauma or help discriminate between accidental and abusive head trauma. Of the 30 children with supratentorial brain injury, 16 (53%) had a bilateral hypoxic–ischemic pattern. There was a statistically significant relationship between bilateral hypoxic–ischemic brain injury pattern and abusive head trauma (P?<?0.05). In addition, the majority (81%) of children with bilateral hypoxic–ischemic brain injuries had cervical injuries.

Conclusion

Although detection of cervical spine injuries by MRI does not discriminate between accidental and abusive head trauma, it can help to distinguish a traumatic from non-traumatic intracranial subdural hemorrhage. Cervical MRI should be considered in children with acute intracranial bleeds and otherwise non-contributory history, physical examination and ophthalmological findings. There is a statistically significant relationship between diffuse hypoxic–ischemic brain injury patterns and abusive head trauma. The high incidence of cervical injuries in children with hypoxic–ischemic injuries suggests a causal relationship. Overall, increased utilization of brain and spine MRI in children being evaluated for abusive head trauma can be helpful.     

Birth injury to the spinal cord

11 cases of children with birth injury to the spinal cord born between 1960 and 1970 are presented in review and compared to about 200 previously published cases. 8 children presented at delivery with one or both feet and 2 with breech. 9 of these infants were born by difficult extraction and needed resuscitation due to primary asphyxia. One child had an easy vertex delivery without evident risk. Diagnosis was established within the first days of life, based on flaccid motor and sensory paralysis below a defined level, mostly in the cervical or upper thoracic spine, with bladder and bowel paralysis, and confirmed by autopsy or by follow-up study. One child with disruption of the spinal cord above C4 survived only a few hours despite artificial ventilation. 4 children died within the first three years of life, 3 of them due to acute pneumonia. 5 of 6 surviving children were followed regularly and are now 10 to 18 years old. They are ambulant with crutches and are well integrated in their families. 4 children attend normal school, and one girl gets special training for mentally retarded children.     

小儿脊髓纵裂诊疗分析

目的探讨小儿脊髓纵裂的临床特点及治疗方法。方法回顾性分析2001年1月至2011年5月作者收治的9例脊髓纵裂患儿临床资料,年龄2个月至6岁,平均年龄17个月。出现症状时间平均7个月。临床表现有背侧中线皮肤病损7例,脊柱畸形4例,下肢功能障碍及畸形4例,排尿障碍6例,排便障碍5例,下肢疼痛1例。6例术前经CT或MRI检查确诊,3例为术中发现。Pang分型：Ⅰ型6例,Ⅱ型3例。所有病例均合并终丝栓系,合并其它脊髓畸形6例,包括脊髓脊膜膨出2例,脊髓脂肪瘤3例,皮样囊肿1例。所有病例均行手术治疗,切除脊髓分隔,同时解除合并的其它脊髓栓系畸形。结果9例患儿中,5例痊愈,所有神经症状消失,3例显著改善,1例好转,无症状加重及无效病例。结论小儿脊髓纵裂多合并其它脊髓畸形,临床表现不典型。早期诊断、早期治疗是提高疗效的关键。     

Imaging of spinal injury in abusive head trauma: a retrospective study

Background

Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT.

Objective

The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages <48 months: 1) those with AHT, 2) those with accidental trauma, and 3) those with nontraumatic conditions.

Materials and methods

This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P?Results Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were statistically significant. Among the AHT group, ligamentous injuries were statistically correlated with evidence of brain ischemia.

Conclusion

Injury to the cervical spinal posterior ligamentous complex is common in AHT and even more prevalent than in clinically symptomatic traumatic cases. The high correlation between the radiographic findings of occipitocervical ligamentous injuries and hypoxic-ischemic brain injury is consistent with an interpretation that transient upper occipitocervical spinal cord injury in AHT leads to disordered breathing and results in hypoxic-ischemic encephalopathy. We recommend imaging the entire spine in AHT to properly identify and classify these injuries.     

小儿椎管内肠源性囊肿的诊断与治疗

目的探讨小儿椎管内肠源性囊肿的临床表现、MRI影像及显微手术治疗。方法回顾性分析1996年至今8年间5例椎管内肠源性囊肿的临床资料，并结合文献加以分析。结果全部病例采用显微外科手术治疗，其中2例全切，2例次全切除，1例大部切除。无一例死亡，经病理报告证实均为肠源性囊肿，术后神经根痛症状基本消失。随访0．5～2年，无一例复发；格拉斯哥预后评分，良好恢复4例，中残1例；脊髓损伤的Frankel分级，E级4例，D级1例。结论小儿椎管内肠源性囊肿有典型的临床表现和MRI特征，作为一种先天性病变，其最佳治疗方法是早期确诊并采取显微外科手术方法切除。