手术治疗先天性肌性斜颈35例

目的 探讨先天性肌性斜颈的手术方式。方法 依据胸锁乳突肌挛缩程度分为Ⅲ级，结合年龄大小分别采用单纯胸锁乳突肌起点切断术，部分起始部切除术，周围松解术乃至胸锁乳突肌切除术，达到彻底松解，疗效分为优、良、差三级。结果 疗效优28例，良6例，差1例，优良率达97．1％(34／35)。结论 对先天性肌性斜颈根据挛缩程度和不同年龄段采用相应的手术方式可提高疗效。     

婴儿先天性肌性斜颈保守综合治疗1142例

目的分析和评估婴儿先天性肌性斜颈(congential muscular torticollis,CMT)综合治疗疗效和影响疗效的相关因素。方法对确诊为先天性肌性斜颈婴儿采取手法牵拉、按摩包块、超声短波理疗相结合的治疗方法,并根据患儿的恢复情况辅以局部注射糖皮质激素,按改良Cheng~([1])评估治疗的疗效,分析影响疗效的相关因素。结果 1 142例患儿中,男性684例,女性458例,最短随访时间1年,最长9年,平均为3.14年。有103例(占9.03%)最终行手术治疗,有效率90.97%。影响最终疗效的相关因素是有无肿块(P=0.049)、是否拉断(P0.001)、初诊年龄(P0.001)、旋转受限度数(尸0.001)和性别(P=0.038);物理治疗中发生拉断(Give-way)患儿与初诊年龄(P0.001)、是否难产(P=0.011)有关联;根据有肿块(P=0.044)、是否拉断(P=0.005)、初诊年龄(P0.001)和旋转受限程度(P0.001)分组后各组的手术率差异有统计学意义。结论手法牵拉、按摩包块、超声短波理疗三种相结合的方法治疗CMT,并根据患儿恢复情况辅以局部注射糖皮质激素的综合疗法,对于CMT患儿是一种安全、有效的方法。     

先天性肌性斜颈的综合治疗

目的 探讨小儿先天性肌性斜颈的治疗方法。方法 对我院1993-2003年收治的先天性肌性斜颈871例进行回顾性分析,其中288例采用单纯胸锁乳交肌切断术,583例采用以胸锁乳突肌部分切除术为主的综合治疗。结果 单纯胸锁乳突肌切断术满意率80.56％,综合治疗满意率93.14％,明显高于前者(P<0.005)。在综合治疗组中1-2岁年龄组满意率97.12％,明显高于其他年龄组(P<0.005)。结论 先天性肌性斜颈采用以胸锁乳突肌部分切除术为主的综合治疗,疗效很好,推荐手术年龄为1～2岁。     

改良式双极松解治疗学龄儿童先天性肌性斜颈

目的 探讨学龄儿童先天性肌性斜颈的治疗方法。方法 采用改良式双极松解(胸锁乳突肌双极松解和Z形延长)治疗学龄儿童先天性肌性斜颈17例，手术平均年龄9.3岁(6～14岁)，术后第3d开始颈部主动及被动锻炼，颈围领固定3个月。结果 随诊平均3年(1年～6年半)，全部病例颈部保持V形外观，其中13例面部不对称得到明显改善。头部无偏斜，颈部无挛缩带，活动无受限。按改良Ling标准评定，优13例，良4例。结论 改良式双极松解术是治疗学龄儿童先天性肌性斜颈的首选方法。     

先天性钩状拇指的手术治疗

目的 探讨先天性钩状拇指不同类型的手术治疗方法.方法 回顾分析山东大学齐鲁儿童医院小儿外科手术治疗的17例先天性钩状拇指的临床资料.17例均为双侧,共34手,年龄3～9岁(平均7岁9月);参照Weckesser分型.本组同一患儿双手分型相同,其中Ⅰ型9例(52.9%),Ⅱ型5例(29.4%),Ⅲ型3例(17.6%);Ⅰ型采用示指固有伸肌转移或桡侧腕长伸肌和掌长肌腱移植重建拇指伸肌功能;Ⅱ、Ⅲ型通过松解指蹼挛缩、掌指关节关节囊、背侧骨问筋膜及拇收肌横头第三掌骨止点.并采用示指同有伸肌或桡侧腕长伸肌、掌长肌腱转移重建伸肌功能等方法治疗.结果 随访7个月至15年,17例中11例(64.7%)优,3例(17.6%)良,2例(11.8%)中,1例(5.9%)差.结论 针对先天性钩状拇指的不同类型采用相应不同的手术方法治疗,治疗效果显著.     

腹部X线量表在新生儿坏死性小肠结肠炎中的应用价值

目的：评价腹部X线量表在新生儿坏死性小肠结肠炎中的诊断价值及在手术选择中的意义。方法：将2005年1月至2011年3月收住入院的61例新生儿坏死性小肠结肠炎患者根据Bell分期标准分为NECⅠ组（25例）,NECⅡ组（11例）,NECⅢ组（25例）。统计患儿的出生胎龄、性别、体重、临床表现、治疗方法及预后,并对患儿的腹部X线进行量表评分。结果：NECⅠ组、Ⅱ组、Ⅲ组的X线量表评分分别为3.2±1.4、5.3±1.7、8.9±1.7（χ2 =39.006,P<0.05）,NECⅢ组的分数最高,NECⅠ组的分数最低。NECⅢ组手术患儿和非手术患儿的X线评分分别为8.7±1.8和9.4±1.2,差异无统计学意义。肠穿孔组的X线评分（9.6±1.1）高于肠坏死组（6.8±1.8）（P<0.05）。手术组患儿X线量表分数为7分以上者占80%。NECⅠ组治疗好转率为96%,NECⅡ组好转率为64%。NECⅢ组患儿中,手术组痊愈出院患儿占71%,非手术组只有9%的患儿好转。结论：腹部X线量表可以评估新生儿坏死性小肠结肠炎的病情严重程度,X线评分在7分及以上是手术干预的指征。NECⅢ期患儿行外科手术治疗短期疗效好。     

C-反应蛋白、降钙素原在新生儿坏死性小肠结肠炎患儿的水平变化及临床意义

目的 探讨C-反应蛋白（CRP）、降钙素原（PCT）在新生儿坏死性小肠结肠炎（NEC）患儿的水平变化及意义。方法 142例NEC新生儿根据修正Bell分期分为Ⅰ期组（40例）、Ⅱ期组（72例）和Ⅲ期组（30例）。手术治疗的18例均为Ⅲ期,保守治疗的124例中Ⅲ期12例、余为Ⅰ、Ⅱ期。各组于治疗前、治疗后次日及恢复期检测CRP和PCT。结果 治疗前、治疗后次日及恢复期的Ⅲ期组CRP高于Ⅰ、Ⅱ期组,Ⅱ、Ⅲ期组治疗后次日的CRP高于治疗前,Ⅲ期组治疗后次日的PCT高于治疗前（P < 0.05）;Ⅱ、Ⅲ期组恢复期的CRP、PCT低于Bell同期的治疗前、治疗后次日（P < 0.05）。Ⅲ期组的呼吸衰竭发生率和机械通气使用率高于Ⅰ、Ⅱ期组（P < 0.05）,Ⅲ期组的脓毒症发生率高于Ⅱ期组（P < 0.05）;仅Ⅲ期患儿发生消化道穿孔（10例）和肠狭窄（8例）。治疗后次日的CRP对Ⅲ期NEC的发生有预测价值（P < 0.05）;治疗前及治疗后次日的CRP对于NEC手术具有预测价值（P < 0.05）。结论 CRP、PCT水平变化监测有助于Ⅱ、Ⅲ期NEC的早期诊断,CRP可能作为预测Ⅲ期NEC发生及手术的辅助指标。     

肾积水患儿术后肾形态及功能恢复的比较研究

目的：分析先天性肾积水患儿手术前后患肾形态及功能的变化,探讨手术年龄及肾积水程度对肾脏恢复的影响,为手术时机的选择提供依据。方法对2007年至2013年82例肾积水手术患儿进行随访,收集患肾手术前后超声及肾核素显像资料,按手术年龄及术前积水程度分组：A组（1岁以内）33例;B组（1～5岁）22例;C组（5岁以上）27例。其中SFU3度28例,SFU4度54例。随访时间6～70个月,平均（20±1．5）个月。统计分析患肾功能及形态变化与手术年龄及积水程度之间的关系。结果各年龄组术后肾脏形态较术前改善,P＜0.05,肾实质面积/肾盂面积与随访时间呈正相关,r＝0.381,P＜0.05。各年龄组术后患肾分肾功能改善,C 组术后肾小球滤过率无明显变化（P＝0.053）。不同程度肾积水术后肾脏形态和功能均有好转,组间肾脏形态和肾小球滤过率改善无统计学意义,P＞0.05。SFU4度积水术后分肾功能较3度恢复明显,P＝0.02。结论 SFU3度和4度肾积水患儿手术后肾脏功能和形态均有恢复,并随着时间延长,患肾功能及形态逐渐恢复。5岁以内患儿术后患侧肾小球滤过率明显恢复。SFU 4度肾积水术后患侧分肾功能较SFU3度恢复明显。     

基质金属蛋白酶-1与基质金属蛋白酶抑制剂-1在纤维性肌性斜颈患儿中的表达

目的探讨基质金属蛋白酶-1(MMP-1)和基质金属蛋白酶抑制剂-1(TIMP-1)在先天性纤维型肌性斜颈胸锁乳突肌的表达。方法采用Masson三色胶原染色法观察先天性肌性斜颈患儿胶原的增生情况,并进行肌肉型和纤维型分组,获得纤维型标本22例,应用免疫组织化学染色法观察MMP-1、TIMP-1在纤维型组中的表达情况,并与6例对照组比较。结果免疫组织化学染色显示,MMP-1在先天性纤维型肌性斜颈胸锁乳突肌患儿明显减少,与对照组比较有显著性差异(P<0.01);先天性纤维型肌性斜颈胸锁乳突肌患儿TIMP-1表达与对照组比较无显著性差异(P>0.05)。结论先天性肌性斜颈胸锁乳突肌的纤维化与MMP-1减少有关。     

2124例婴儿斜颈首诊的临床流行病学分析

目的探讨1岁以内斜颈患儿的临床流行病学特征。方法设计门诊首诊斜颈患儿就诊表格,对年龄小于1岁的斜颈患儿,收集并分析其首诊年龄、颈部歪斜方向、是否早产、胎位、产式（剖腹产、难产、顺产）、胎次、及是否伴有下肢外展阳性等。结果2003年11月至2011年9月,本院共2124例年龄小于1岁的斜颈患儿就诊,根据颈部肿块史、临床体检和超声检查,分为先天性肌性斜颈（Congential Muscular Torticollis,CMT）组和姿势性斜颈（Posture Torticollis,PT）组,对两组患儿的患侧分布、胎位不正、难产、早产、第2胎、伴下肢外展阳性等观察指标进行比较,结果显示差异均有统计学意义（P〈0．05或0．01）。结论CMT以右侧稍多,盯以左侧稍多;年龄小的患儿应注意CMT的排查。CMT患儿多有胎位不正、难产史;患儿为早产或第2胎者发生CMT相对少。因此,胎位和分娩异常可能与CMT发病相关。有包块的CMT更易伴有下肢外展阳性,应注意排查DDH。     

Congenital muscular torticollis: Early and intensive treatment is critical. A prospective study

BACKGROUND: Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of this outcome, such as treatment duration and exercise frequency. The aim of the present study was to define factors related to treatment duration, to compare different frequencies and intensities of home treatment programs and their effect on the speed of recovery. METHODS: The present study was a prospective study of 45 infants (26 male, 19 female) with congenital muscular torticollis referred to the pediatric surgical outpatient during a I year period. Following a standardized initial assessment, parents were taught our intensive home treatment protocol, consisting of passive stretching exercises repeated every 3 h. RESULTS: The mean age at initial assessment was 38.6 days (range 15-120 days). Mean treatment duration was found to be 3.2 +/- 1.3 months. All patients were treated by use of our intensive protocol of passive stretching exercises (100% success). No surgery was necessary. CONCLUSIONS: In patients with early treated congenital muscular torticollis, there is no place for surgical treatment. This group of patients can be successfully treated using an intensive protocol of passive stretching exercises. In addition, this treatment protocol has a very short treatment duration compared with other standardized protocols. A successful outcome depends primarily on good cooperation with the parents, especially in developing countries.     

影响胆总管囊肿手术疗效的因素分析

目的探讨手术方式、年龄及囊肿扩张形状与胆总管囊肿手术疗效的关系。方法先天性胆总管囊肿患儿83例（男23例,女60例,平均年龄3．8岁）,采用囊肿切除、肝管空肠Roux-Y吻合术治疗,其中腹腔镜下手术59例,开腹手术24例。对83例患儿手术前后血生化指标进行分析,包括总胆红素（TBIL）、直接胆红素（DBIL）、AST、ALT、GGT和ALP。根据手术年龄将患儿分为三组：〈1岁组,1～3岁组和〉3岁组。根据囊肿扩张形状分为囊形扩张组和梭形扩张组。分析手术方式、手术年龄及囊肿扩张形状与手术前后血生化变化的关系,探讨手术方式、手术年龄及囊肿扩张形状与手术疗效的关系。结果所有患儿术后血TBIL、DBIL和ALP水平较术前显著降低;腹腔镜手术与开放手术比较,术后各生化指标降低程度无显著差别。手术年龄越小,术前血胆红素水平越高,肝功能指标越高。3岁以内手术者术后TBIL和DBIL降低程度显著高于手术年龄〉3岁者。、囊形扩张组和梭形扩张组比较,术后肝功能降低程度无显著差别;囊形扩张组术后TBIL、DBIL和ALP较术前显著降低。结论腹腔镜胆总管囊肿根治术手术疗效与开放手术无差别。早期发病的胆总管囊肿患儿（3岁以内）肝损伤较严重,应及早手术,术后效果明显。囊肿扩张形状不影响胆总管囊肿根治术的手术疗效,但囊形扩张者手术效果更明显。     

Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases.

OBJECTIVES: Congenital muscular torticollis is a common and controversial condition in infancy. We studied prospectively a group of infants with clearly defined sternomastoid tumor treated with a well-defined protocol. STUDY DESIGN: A total of 510 cases of sternomastoid tumor in infants over a 10-year period were studied prospectively with a mean follow-up of 3.5 years and a range from 1. 5 years to 13 years. The clinical presentations, associated abnormalities, treatments, and outcomes of the overall group and subgroups were evaluated to determine the most important prognostic factors. RESULTS: The mean age of presentation was day 24, with most (92.7%) presenting before the age of 3 months. There was a high correlation with breech presentation and assisted delivery. Clinical subgroups according to the deficit in passive rotation of the neck correlated with the incidence of hip dysplasia (up to 11.6%), mode of delivery, time of presentation, degree of craniofacial asymmetry, head tilt, and the size and extent of the pseudotumor (P <.05). With an early and prolonged manual stretching program, 90.7% had excellent and good overall results. The 6.7% of patients in the poor outcome group requiring surgical treatment all belonged to the more severe rotation limitation groups. CONCLUSIONS: Subgrouping patients with sternomastoid tumor according to the passive limitation of rotation of the neck has prognostic significance, with good overall results of conservative treatment with manual stretching.     

不同年龄化脓性脑膜炎临床特点及致病菌分析

了解不同年龄阶段儿童化脓性脑膜炎临床表现和致病菌的差异,为临床诊治提供依据。方法 　回顾分析天津市儿童医院2004年1月至2008年12月诊 断的173例儿童化脓性脑膜炎的临床资料,并按发病年龄分为4组,第1组为生后5～28 d的新生儿48例（27.8%）,第2组为＞28 d～12月龄婴儿73例（42.2%）,第 3组为＞1～5岁幼儿22例（12.7%）,第4组为>5岁儿童30例（17.3%）,比较4组临床特点及主要致病菌差异。结果　第1组66.7%患儿表现低热或中等程度发热,症 状体征不典型。第2组抽搐、前囟膨隆、更改经验治疗、合并症发生率高于其他3组（P <0.01）。第3组临床特点介于婴儿期和儿童期之间。第4组脑膜刺激征、头 疼发生率高于其他各组,均为93.3%（P <0.01）,且第4组伴发身体解剖结构的缺陷所致脑脊液漏或外科手术后患者多达27.3%。63例脑脊液致病菌培养阳性,总 阳性率36.4%,各组第1位致病菌分别为大肠埃希菌、凝固酶阴性葡萄球菌、脑膜炎奈瑟菌和肺炎链球菌。结论　儿童化脓性脑膜炎不同年龄阶段的临床表现各有 特点,致病菌谱也存在一定差异。临床诊治应根据发病年龄区别对待,提高针对性。     

Success of nonoperative treatment for congenital muscular torticollis is dependent on early therapy

Congenital muscular torticollis (CMT) begins in infancy, and exercise treatment is often recommended. There is controversy about the type, length, and effectiveness of conservative treatment. We have used a standard technique of passive stretching exercises (PSE) in 126 children with CMT seen over 30 years. We reviewed the results and compared the rate of surgical treatment with the age at which PSE began. In 88 infants who began PSE prior to 3 months of age, outcome was excellent or good in 92%, with none needing surgery. In comparison, 45% of older children required sternomastoid myotomy (P <.005). The likelihood of surgery was directly related to the age at initiation of PSE. We conclude that PSE are effective for early CMT, and should be continued until a full passive range of neck motion is achieved and maintained. Success is dependent on frequent follow-up and parental encouragement.This paper was originally presented to the Canadian Association of Pediatric Surgeons, Quebec City, September 1991.     

儿童消化性溃疡穿孔临床特征及其危险因素分析

目的　探讨小儿消化性溃疡并发穿孔的临床特征及其危险因素,为临床干预提供参考依据。方法　回顾性分析2014年12月至2019年12月郑州大学附属儿童医院688例胃镜检查诊断为消化性溃疡患儿的临床资料。患儿分为消化性溃疡合并穿孔组47例和非穿孔组641例。分析人口统计学、发病率、临床特征、病因、症状、内镜或外科处理方法及临床转归,通过多因素Logistic分析消化性溃疡并发穿孔的危险因素。结果　本组共14916例行胃镜检查,筛查消化性溃疡688例（4.61%）,其中合并穿孔47例（6.83%）。男性412例、女性276例,中位年龄8.5岁（1月龄～14岁）。溃疡患儿居住农村为主485例（70.49%）;无家族史353例（51.31%）,穿孔不伴腹膜刺激征424例（61.63%）;溃疡位置主要为胃窦228例（33.14%）,十二指肠球部264例（38.37%）;溃疡多以直径＜10 mm为主（461例,67.01%）,单发较多（465例,67.59%）;溃疡因幽门螺旋杆菌（Hp）感染（306例,44.48%）和非甾体类抗炎药（109例,15.84%）为主。穿孔组年龄明显低于非穿孔组［（5.3±1.2）岁 vs.（9.8±3.5）岁,P＜0.001］;溃疡合并穿孔多发生于农村患儿（38例,80.85%）;穿孔组更易出现发热、 白细胞及C反应蛋白升高,两组比较差异有统计学意义（P＜0.05）;穿孔好发位置为胃窦、十二指肠球部,与溃疡好发位置基本重叠;穿孔组溃疡直径≥10 mm（35例,74.47%）,穿孔组多发溃疡比例（33例,70.21%）显著高于非穿孔组（P < 0.001）;引起儿童消化性溃疡穿孔主要原因为Hp感染（28例,59.57%）和NSAID（8例,17.02%）。开腹手术预后好,但腹腔镜住院周期明显缩短。多因素Logistic回归分析提示年龄、溃疡位置及大小、病因是穿孔发生的独立危险因素。结论　消化性溃疡并发穿孔存在复杂的危险因素,尽早合理治疗利于缩短病程、提高预后。     

肠道病毒71型手足口病121例临床分析

摘要：目的　 分析肠道病毒71型（EV71）感染所致手足口病的临床特征。方法　回顾性分析2010 - 05 - 01—2010 - 08 - 31日温州医学院附属育英儿童医院121例EV71感染所致手足口病的住院患儿病例资料。比较重型组和危重型组的临床表现及辅助检查资料。 结果（1）危重型组较重型组患儿高热明显（P = 0.002）、皮疹不典型（P = 0.000）;（2）120例（99.17%）EV71阳性患儿累及神经系统,主要表现有萎靡（84.30%）、频繁呕吐（65.30%）、肢体抖动（60.33%）和睡眠障碍（53.72%）、查体发现膝反射异常（52.07%）;（3）危重型组呕吐、神志不清、肌张力异常、心率异常、血压异常、毛细血管充盈时间（CRT） > 3 s、呼吸急促或呼吸困难、胸片提示有肺部渗出性病变的发生率显著高于重型组（P < 0.01）;（4）51例（42.15%）患儿外周血白细胞总数（WBC） > 12 ×109/L或者 < 4×109/L;52例（42.98%）患儿血糖 > 6 mmol/L,22例（18.18%）肌钙蛋白-I（cTnI）升高,危重型组的这3项指标与重型组比较差异均有统计学意义（P = 0.000）。 结论 EV71感染所致手足口病多累及神经系统,高热、皮疹不典型、频繁呕吐、神志改变、肌张力异常、心率异常、血压异常、毛细血管充盈时间（CRT） > 3 s、呼吸急促或呼吸困难及肺部渗出性病变是手足口病重型患儿进展为危重型的高危因素。     

Congenital muscular torticollis: current concepts and review of treatment

PURPOSE OF REVIEW: The purpose of this review is to better understand the spectrum of disease in torticollis, which is the third most common pediatric orthopaedic diagnosis in childhood. Besides the benign muscular tightness of the sternocleidomastoid muscle leading to the classic head position, the differential diagnosis of the wry neck include sequelae to inflammatory, ocular, neurologic or orthopedic diseases. Patients present with a stiff and tilted neck, and therefore require a thorough and systematic work-up, including a complete physical and neurologic examination and cervical spine radiographs. RECENT FINDINGS: Recent findings show that magnetic resonance imaging of the brain and neck is no longer considered cost-effective, or necessary, in congenital muscular torticollis. Observation and physical therapy, with or without bracing, is usually an effective treatment in most cases, especially if instituted within the first year of life. Botox has recently been shown to be an effective intermediate method of treatment for more resistant cases of congenital muscular torticollis. In those presenting after the age of 1 year, there is an increased rate of sternocleidomastoid muscle lengthening. The lengthening may improve the range of motion, but not necessarily the plagiocephaly, facial asymmetry, or cranial molding. SUMMARY: It is important to differentiate muscular from nonmuscular torticollis. Congenital muscular torticollis is benign; missing a case of nonmuscular torticollis could be potentially life threatening.