应用Ilizarov技术治疗儿童僵硬型马蹄内翻足

儿童先天性马蹄内翻足的治疗方法很多 ,目前较常用的手术多数为一次性矫正畸形 ,对于僵硬型马蹄内翻足容易引起皮肤缺血坏死、继发感染和术后瘢痕挛缩等 ,远期疗效往往欠佳。 1990年3月～ 1999年 3月 ,我们应用Ｉｌｉｚａｒｏｖ技术治疗儿童僵硬型先天性马蹄内翻足9例 10足 ,疗效较满意 ,现报告如下。临床资料本组 9例 ,男 7例 ,女 2例。右侧5例 ,左侧 4例 ,双侧 1例 ,共 10足。9例均伴有不同程度小足畸形 ,其中 6例为手术后复发病例 ,患足矢状轴短缩 0 .5～ 1.5ｃｍ ,平均 1.2ｃｍ。手术年龄 3～12岁 ,平均 6岁。术后随访 1.5～ 8年 ,平均 …     

改良Mckay术治疗小儿僵硬型先天性马蹄内翻足

目的 探讨改良Mckay术治疗小儿僵硬型先天性马蹄内翻足(CCF)的临床应用及近期疗效.方法 2003年～2005年采用改良Mckay术治疗小儿僵硬型先天性马蹄内翻足36例(共54足),术中采用跟腱外侧弧形切口或直切口,加大后侧松解范围,充分延长跟腱和屈拇长肌腱,将胫前肌腱部分切断,以克氏针固定于距下关节,术后石膏固定6～8周.结果 均痊愈,平均随访2.3年(1～3年),根据术后足的外观形态、足印、踝部功能、有无疼痛及X线检查评价疗效,疗效优25例38足;良8例12足;可3例4足,优良率为92.59%.结论 改良Mckay术是矫正小儿僵硬型先天性马蹄内翻足的有效手术方法,其优点是损伤小、手术时间短,矫形效果良好.     

Turco松解胫前肌外移治疗小儿先天性马蹄内翻足

用Ｔｕｒｃｏ松解胫前肌外移术治疗小儿先天性马蹄内翻足１３０例１９０足，平均随访６年。矫治最大度数：足跖屈畸形４０°、前足内收４５°、跟内翻３０°，双踝联线与足底纵轴线夹角由４０～７０°恢复至８０～９０°，踝能背屈１５～２５°，跖屈１５～３０°。以Ｇａｒｃｅａｕ评价标难评定疗效，总优良率９４％，复发率６％。步态和鞋底磨损与正常儿童无明显差别。一次性彻底松解同时外移胫前肌，恢复了足的生物力学结构，能使患足恢复良好外形和功能。手术年龄以２个月至１岁为合适，复发与分次治疗、术中松解不够、患儿年龄偏大有关。     

先天性马蹄内翻足合并同侧小腿远端环状束带的治疗

目的 探讨先天性马蹄内翻足合并小腿环状束带的治疗方法。方法对7例患儿共12足进行手术治疗，马蹄内翻足的矫冶均采用改良Turco手术，根据环状束带的严重程度确定手术方法。结果Ⅰ期手术治疗4例共7足，5足临床效果满意；伤口皮肤裂开2足，并且出现足畸形反弹。分期手术3例共5足．1例双足畸形先行马蹄内翻足矫冶，结果出现束带部位伤口裂开，足的矫正效果回弹；另3足先行环状束带松解，2足临床效果满意，1足尚未行Ⅱ期马蹄内翻足矫治。结论对于Ⅰ型和Ⅱ型环状束带可Ⅰ期手术冶疗，手术后应进行高压氧治疗；Ⅲ型环状束带应该分期手术，先进行环状束带松解，再进行马蹄内翻足矫治。     

早期肌力平衡手术治疗先天性马蹄内翻足的远期疗效

报告并评价早期肌力平衡手术治疗先天性马蹄内翻足的远期疗效。１９５７～１９９４年采用早期矫正畸形建立肌力平衡手术治疗３个月～１２岁儿童先天性马蹄内翻足１０８８例１５２１足。采用自行制定的疗效评定标准，对术后６～３６年（平均１１年６个月）、随访时年龄１３～４０岁的１２８例１８８足（其中年龄在１８岁以上５２例７４足）的远期疗效进行评价。总优良率８９．４％，骨骼完全成熟患儿的优良率８９．２％。手术疗效与足踝部主要肌肉功能、术前足畸形程度和手术时年龄均有明显关系（Ｐ＜０．０５）。手术操作不当也可影响手术疗效。早期矫正畸形并建立动态肌力平衡手术是治疗儿童先天性马蹄内翻足的有效方法，能取得外观及功能满意的远期疗效。     

先天性马蹄内翻足早期康复治疗的近期疗效

目的探讨对先天性马蹄内翻足行早期康复治疗的方法和疗效。方法运用手法矫正、外固定、矫正支具等方法，对18例32足先天性马蹄内翻足进行早期康复治疗。结果9例17足在新生儿期开始治疗者有效率达100％，9例15足婴幼儿期开始治疗者有效率为60％。结论对不同程度的先天性马蹄内翻足畸形早期康复可以获得满意的疗效。     

Carroll手术治疗儿童先天性马蹄内翻足

目的 探讨Carroll手术治疗儿童先天性马蹄内翻足(congenital clubfoot,CCF)的疗效和影响疗效的可能性因素.方法 采用Carroll手术原理和方法对268例Dimeglio分型Ⅲ、Ⅳ型的先天性马蹄内翻足实施治疗,其中男200例(230足),女68例(78足),单侧228例,双侧40例,共308足;手术年龄为6个月～10岁,平均手术年龄为2.4岁,术后石膏固定6～8周.结果 268例(308足)全部随访,随访时间12个月～4年,平均2.8年.疗效评定根据足术后的外形、步态、足印、踝关节功能、有无疼痛及影像学检查进行综合评价.优258例294足,良8例10足,一般2例4足.无舟骨坏死发生.结论 Carroll手术是治疗儿童先天性马蹄内翻足畸形的理想方法之一,术前石膏矫正有助于手术矫正畸形,手术疗效与足畸形程度及手术年龄有关.     

早期手法矫正系列石膏固定治疗先天性马蹄内翻足

目的 评价早期应用手法矫正系列石膏固定(Ponseti方法)治疗先天性马蹄内翻足的效果。方法 从1997年5月-2001年12月保守治疗出生后3个月内的先天性马蹄内翻足22例共30个足。患儿的平均年龄为生后第23d，方法 采用Ponseti的手法矫正和连续长腿石膏固定，每周更换石膏一次。在石膏固定结束后，患儿穿戴矫形支具至少1年。结果 本组平均治疗时间10．5周，平均随访2年4个月。27个足(90％)的畸形获得满意矫正，3个足因支具穿戴欠配合，随访时仍有残余畸形，需广泛软组织松解术矫正。结论 Ponseti的“旋后外展”手法矫正方法和连续长腿石膏固定，可使不同畸形程度的先天性马蹄内翻足在早期获得充分的矫正，石膏固定结束后应佩戴矫形支具至少1年，以防畸形复发。     

重视矫形支具在马蹄内翻足Ponseti治疗中的作用

正过去二十年,采用Ponseti方法治疗先天性马蹄内翻足逐渐获得广泛接受,且中长期的临床随访显示其效果良好~([1-4])。Ponseti方法治疗马蹄内翻足主要分为两个阶段,第一阶段为畸形矫正期,主要包括序列手法+石膏固定矫正高弓、内翻、内收畸形,马蹄畸形多需要采取经皮跟腱切断(Percutaneous Achilles Tenotomy,PAT)来获得完全矫正,这个阶段一     

Ilizarov技术治疗下肢畸形并发症的探讨

目的：探讨Ｉｌｉｚａｒｏｖ技术治疗下肢畸形出现的并发症及对策。方法：应用Ｉｌｉｚａｒｏｖ技术治疗下肢短缩１２例（１４个肢体），先天性胫骨假关节２例，骨髓炎骨缺损１例，矫治先天性马蹄内翻足９例。结果：２４例均达到预期畸形矫正目的。在股骨和胫骨畸形矫正中发生轴向偏移３５．２９％，针道感染２９．４１％，肌肉关节挛缩３５．２９％，延迟愈合５．８８％。并观察到带架下地活动时下肢外展，足呈外翻位致截骨处出现外翻应力是轴向偏移重要因素。延长超过４ｃｍ将出现肌肉关节挛缩，强力功能训练不能克服８～１０ｃｍ延长所致的挛缩。足畸形矫正中跖骨切割３３．３３％，跗间关节强直、针道感染分别高达５５．５６％和７７．７８％。结论：克氏针足够张力和改变引起下肢出现外翻应力的姿态以及对严重短肢畸形分次延长可减少轴向偏移和肌肉关节挛缩。Ｉｌｉｚａｒｏｖ技术不是治疗先天性马蹄内翻足首选方法。     

儿童陈旧性外伤性髋关节脱位

目的 探讨儿童陈旧性外伤性髋关节脱位的延误原因及治疗,提高对儿童外伤性髋脱位 的认识。方法 回顾性地分析并随访了我院1990年-2001年收治的6例该病患儿。其中男性5例,女性 1例,<7岁1例,7～14岁5例。车祸伤2例,高处坠落伤3例,运动创伤1例。我院收治时病程3～4周4例, 4周以上2例。6例均行初开复位,髋人字石膏或支具固定治疗。结果 5例获得3年以上的随访,1例 仅随访1.5年。优3例,良2例,可1例(合并股骨头坏死)。结论 外伤性髋关节脱位多发生在青壮年, 儿童极其罕见。易被忽视或治疗不当导致延误。陈旧性外伤性髋关节脱位治疗以手术为主,术前可行牵引 治疗,术中注意松解适当,减少创伤粘连,争取更好的效果。强调儿童外伤性髋关节脱位早期诊断,手法闭合复位治疗简单、效果好,后遗症发生率低。     

跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足的疗效

目的评价跟腱延长前移术治疗儿童脑性瘫痪痉挛型马蹄足的疗效。方法收集1998年5月-2011年6月应用跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足儿童53例85足。男28例45足,女25例40足;年龄2.5～14.0岁,平均6.8岁。痉挛程度按Ashworth 5级法评定:3级12足,4级38足,5级35足。患儿均能行走,智力发育及下肢肌力基本正常,伴不同程度肌张力增高,腱反射亢进,踝阵挛和Babinski征阳性,无明显内翻、外翻及平足畸形,X线片未提示明显骨性畸形。合并双髋内收畸形5例,双膝屈曲畸形2例,均在术前或同期行手术矫正。结果患儿均获随访,随访时间0.5～11.2 a,平均2.3 a。1例于术后2周出现切口裂开、跟腱断裂,再次行跟腱吻合术,术后恢复良好;患儿术后均未发现小腿三头肌肌力较术前下降。53例85足均获满意疗效,优55足,良30足,优良率达100%。结论跟腱延长前移术利用生物力学原理,在跟腱延长的基础上将跟腱止点前移至跟距关节后缘,缩短了跟腱至踝关节的力臂,平衡了踝关节背伸与跖屈肌肌力,远期效果良好,是儿童脑性瘫痪痉挛型马蹄足较好的治疗方法。     

Pediatric intracranial aneurysms: simple and complex cases.

Between 1984 and 1990, 20 aneurysms in 16 patients (9 males and 7 females), 18 years or younger (mean age, 8 years; range, 7 months to 18 years), were treated at our institution. Seven patients had a solitary saccular aneurysm located at an arterial bifurcation which manifested as a subarachnoid hemorrhage. Six of these patients were treated with clip obliteration. Postoperative results were excellent or good in 5 and fair in 1. Nine patients had complex or multiple aneurysms of variable origins (3 giant, 2 infectious, 2 traumatic and 2 associated with an arteriovenous malformation) and presentation. Surgical treatment of these children required the use of hypothermic arrest, trapping, bypass and anastomotic procedures. Outcome was excellent or good in 7 and fair in 2. An analysis of these patients with regard to pathogenesis and management is presented.     

Cerebral venous thrombosis after embolization of pediatric AVM with jugular bulb stenosis or occlusion: Management and prevention

PurposeThrombosis of cerebral arteriovenous malformation after embolization is rare, but can involve the normal venous network with extensive venous thrombosis. We report angioarchitecture findings, our management and prevention strategy for this complication in pediatric AVMs.MethodsIn this 5.5-year retrospective series, we reviewed records of 13 patients under 15 years who were anticoagulated after embolization. In our initial experience 4 children who didn't receive any prophylactic anticoagulation presented with extensive venous thrombosis after embolization (group 1). Following this, nine children with similar angioarchitecture and embolization modalities were treated with prophylactic anticoagulation immediately after embolization (group 2). We analyzed the type of AVM, angioarchitecture, dose of prophylactic anticoagulant, efficacy/complications of treatment and late outcome.ResultsAll patients in group 1 had severe jugular bulb stenosis/occlusion associated with cerebral venous dilatation. In group 2 with similar angioarchitecture, only three patients (33%) developed extensive thrombosis. In both groups, thrombosis occurred within two days of treatment in six children and two weeks in one child. The diagnosis was suspected on intracranial hypertension in five patients and occulomotor disorder in one. One was asymptomatic. All children were treated with therapeutic doses of LMWH (anti-Xa: 0.5–1). No hemorrhagic complications occurred. Good venous remodeling was observed in all but one patient.ConclusionAnticoagulation in extensive venous thrombosis after AVM embolization in children appears to be safe and effective. In cases with angioarchitectural features of dilatation of the cerebral venous network and occlusion/severe stenosis of the jugular bulbs, full dose anticoagulation may be required to prevent thrombosis.     

Effectiveness of an outside-the-boot ankle brace in reducing parachuting related ankle injuries

OBJECTIVES: To examine the efficacy of an outside-the-boot parachute ankle brace (PAB) in reducing risk of ankle injury to army paratrooper trainees and to identify inadvertent risks associated with PAB use. DESIGN: The authors compared hospitalization rates for ankle, musculoskeletal, and other traumatic injury among 223,172 soldiers trained 1985-2002 in time periods defined by presence/absence of PAB use protocols. Multiple logistic regression analysis estimated adjusted odds ratios (OR) and 95% confidence intervals for injury outcomes, comparing pre and post brace periods to the brace protocol period. SETTING: A research database consisting of training rosters from the US Army Airborne training facility (Fort Benning, GA) occupational, demographic, and hospitalization information. MAIN OUTCOME MEASURES: Injuries were considered training related if they occurred during a five week period starting with first scheduled static line parachute jump and a parachuting cause of injury code appeared in the hospital record. RESULTS: Of 939 parachuting related hospitalizations during the defined risk period, 597 (63.6%) included an ankle injury diagnosis, 198 (21.1%) listed a musculoskeletal (non-ankle) injury, and 69 (7.3%) cited injuries to multiple body parts. Risk of ankle injury hospitalization was higher during both pre-brace (adjusted OR 2.38, 95% CI 1.92 to 2.95) and post-brace (adjusted OR 1.72, 95% CI 1.27 to 2.32) periods compared with the brace protocol period. Odds of musculoskeletal (non-ankle) injury or injury to multiple body parts did not change between the brace and post-brace periods. CONCLUSION: Use of a PAB during airborne training appears to reduce risk of ankle injury without increasing risk of other types of traumatic injury.     

三合一骨融合术在儿童先天性胫骨假关节联合手术中的应用

目的 探讨采取联合手术同时行三合一骨融合术治疗儿童腓骨完整型先天性胫骨假关节的短期疗效.方法 回顾性分析2014年3月至2015年8月采取联合手术(切除胫骨假关节及病变组织、经足踝髓内棒固定、伊氏架外固定装置加压固定)的同时,行三合一骨融合术(腓骨近端截骨、胫骨假关节远近二个骨端与局部完整的腓骨三者融合、取自体髂骨包裹式植骨)治疗17例腓骨完整型先天性胫骨假关节患儿的临床资料.17例均为单侧,术时平均年龄为3岁(1.1～7.7岁).其中,男12例,女5例;左侧7例,右侧10例.3岁以下者10例(占59％),2例既往有1次胫骨假关节手术史;均伴腓骨完整.伴有胫骨近端发育不良4例,1型神经纤维瘤病10例;11例患儿存在胫骨短缩,胫骨平均短缩1.6 cm (0.3～3.4 cm).术中行腓骨近端截骨、切除胫骨假关节及病变组织、经足踝髓内棒固定、伊氏架外固定装置加压固定、胫骨假关节二个骨端与腓骨融合、取自体髂骨包裹式植骨,2例同时行胫腓骨截骨延长.初步评价胫骨假关节患儿的早期愈合率,再骨折发生率,踝外翻、胫骨不等长和胫骨外翻等后遗畸形的发生情况.结果 本组平均手术时间4.1 h(3.3～4.2 h).所有患儿均获得完整随访,平均随访时间19.5个月(9～26个月).17例患儿均实现初期愈合,平均愈合时间4.9个月(4.1～7.8个月),初期愈合率为100％.13例(76％)患儿存在胫骨不等长,平均胫骨不等长1.2 cm(0.5～2 cm);6例(35％)患儿发生胫骨近端外翻,平均外翻7.8°(5～16°),均行胫骨近端内侧“8”字形钢板螺钉半侧骺板阻滞术予以矫正;2例患儿发生踝外翻,分别为12°、17°.术后胫骨假关节愈合区域的横断面积平均增大至胫骨远近端骨干处横断面积的1.74倍(1.14～2.60倍).17例患儿均未发生再骨折.5例患儿恢复踝关节活动,平均背伸22°(20～30°),平均跖屈41°(40～50°);另外12例踝关节仍固定于中立位.结论 在联合手术同时行三合一骨融合术治疗伴腓骨完整的先天性胫骨假关节初期愈合率高,胫骨假关节愈合处横断面积增加,短期疗效良好.     

Conservative management of large avulsions of the lip and local landmarks

Large lip avulsion injuries that involve significant tissue loss to the lip vermilion and other local landmarks can often pose a surgical dilemma for the reconstructive surgeon. Immediate reconstruction of these injuries are frequently performed using local flaps and adjacent tissue transfer to close the defect, but these repairs frequently suffer from the unfortunate consequence of increased associated scarring and further permanent distortion of the local anatomy. We present 2 patients sustaining dog bite injuries associated with extensive traumatic tissue loss to the lip vermilion and other local landmarks. These patients were treated conservatively with excellent functional and cosmetic results. A single minor surgical revision of 1 patient's cupid's bow was performed 1 year after injury. In cases of significant traumatic avulsion involving the lip vermilion and the perioral composite soft tissue, even with injuries including delicate anatomic landmarks, healing by secondary intention can be instituted as the initial treatment of choice in younger patients, often providing optimal results.     

儿童先天性胫骨假关节术后并发症与手术时年龄的相关性研究

目的 探讨儿童先天性胫骨假关节(congenital pseudarthrosis of tibia,CPT)不同手术年龄与术后并发症间的关系.方法 回顾性分析2007年12月至2011年10月收治的59例Crawford Ⅳ型CPT患儿的临床资料.根据CPT手术时年龄大小,将其分为小于3岁组(A组,34例)和大于3岁组(B组,25例),比较2组患儿胫骨假关节初期愈合率、再骨折发生率,踝外翻、胫骨外翻和下肢不等长这些后遗畸形的发生情况.结果 A组31例(91.2％)患儿实现初期愈合.其中,7例(22.6％)发生再骨折;14例(45.2％)发生踝外翻,平均踝外翻11.3度(5～25度);13例(41.9％)发生胫骨外翻,胫骨平均外翻8.5度(5～20度);14例(45.2％)存在下肢不等长,平均下肢不等长2.4 cm(0.5～4.0 cm).B组21例(84.0％)患儿实现初期愈合.其中,7例(33.3％)发生再骨折;8例(38.1％)发生踝外翻,平均踝外翻13.8度(5～30度);12例(57.1％)发生胫骨外翻,胫骨平均外翻9.5度(5～20度);16例(76.2％)存在下肢不等长,平均下肢不等长1.8 cm(1～3 cm).B组下肢不等长发生率比A组高,差异有统计学意义(P=0.044).结论 1岁以上CPT患儿一旦形成胫骨假关节,如患儿无严重骨质疏松、营养状况较差等不利条件;即可考虑手术治疗,以减少术后下肢不等长并发症的发生.     

Efficacy of treatment for child and adolescent traumatic stress

BACKGROUND: Despite the expenditure of large sums of public monies to ameliorate the consequences of childhood trauma, little is known about the efficacy of treatment for traumatized children and their families. OBJECTIVE: To review the efficacy of treatment for child and adolescent traumatic stress. DATA SOURCES: An extensive literature search identified 102 studies addressing child and adolescent trauma treatment. STUDY SELECTION: Only 8 studies met the minimal inclusion criteria of (1) using a comparison group and (2) including symptoms of traumatic stress as a treatment outcome. DATA EXTRACTION: These studies are critically evaluated for adherence to standards of good efficacy research using formal criteria of treatment research quality. DATA SYNTHESIS: Treatment for traumatic stress appears to lead to greater improvement than either no treatment or routine community care. CONCLUSIONS: Child and adolescent posttraumatic stress disorder treatment research lags behind both adult posttraumatic stress disorder treatment research and other child treatment research. There is considerable need to establish a programmatic approach to developing evidence-based child trauma treatment. Barriers to conducting child trauma treatment research include sensitivity to the rights of victims and child service models that perceive research as intruding on vulnerable children at critically sensitive points in their development.     

血必净对创伤后脓毒症患儿血清IL-6水平的时效和量效影响

目的 探讨血必净对创伤后脓毒症患儿血清IL-6水平的时效和量效影响,为儿科临床应用提供客观依据.方法 选择65例创伤后脓毒症患儿随机分为治疗组(53例)和对照组(12例),对照组仅给予抗感染等常规治疗,死亡4例;治疗组同时给予血必净治疗,死亡5例,并依据血必净剂量(2、3、4、5、6、7 ml·kg-1·d-1)分6组,每组8例.所有患儿在入院和治疗第一周内每天留取静脉血,应用ELISA法检测血清IL-6水平.结果 各组治疗1周内除第二和第三天外,其余各天之间血清IL-6水平的差异均有统计学意义(P<0.05).各组随着治疗时间增加,血清IL-6水平先出现显著增高,在3 d内脓毒症得到控制,IL-6达到峰值,然后降低;但随着血必净剂量增加,脓毒症得到控制的时间缩短,IL-6峰值降低.除剂量1组外,对照组和各剂量组之间血清IL-6水平的差异具有统计学意义(P<0.05);剂量1组与剂量2～6组,剂量2组和3组分别与剂量4～6组之间血清IL-6水平的差异有统计学意义(P<0.05);而剂量2组与剂量3组,以及剂量4、5和6三组之间血清IL-6水平的差异无统计学意义(P>0.05).结论 应用血必净可使创伤后脓毒症患儿得到控制的时间缩短,血清IL-6峰值降低,其最佳应用剂量为5 ml·kg-1·d-1.