儿童后交叉韧带损伤的诊断与治疗

我们在近 2 0年所收集的 44 5例膝部韧带损伤病例中发现 5例儿童后交叉韧带损伤 ,经手术治疗 ,效果良好 ,现报告如下。本组 5例中 ,男 3例 ,女 2例 ,年龄最小 9岁 ,最大 14岁。受伤原因 :车祸伤 3例、坠落伤 1例、跳远伤 1例。受伤时间最短 1ｄ ,最长 43ｄ。治疗方法 :5例均行手术治疗 ,4例新鲜伤 ,术中见后交叉韧带自胫骨后缘止点处断裂 3例 ,距止点 1ｃｍ处断裂1例 ,4例均无撕脱骨折。 3例远端残留较短 ,采用 10号丝线缝合 ,近端 8字交叉后 ,线从断端引出 ,再从远端残留处进针缝于胫骨后缘软骨上。 1例远端残留较长者 ,近端 8字交叉后 ,线…     

儿童臀部注射性坐骨神经损伤

目的 探讨儿童臀部注射性坐骨神经损伤的发病原因、特点、手术时机的选择。方法 回顾性分析1982～2002年收治的56例病例资料，均行手术治疗，术中探查、松解神经外膜及束问粘连，切除瘢痕组织。结果 术后随访6月～5年，疗效显著，优良率93％。结论 儿童臀部注射性坐骨神经损伤属医源性疾病，应尽量减少臀部注射，改变注射部位(三角肌，股外侧肌)，禁用苯甲醇溶剂，能避免该病的发生；诊断明确，应及时手术治疗，临床疗效显著。     

格林-巴利综合征肢体瘫痪的康复治疗

格林 巴利综合征 (ＧＢＳ)是急性感染性脱髓鞘多发性神经病[1] ,因运动及感觉系统障碍 ,常留有残疾。我们对 1998～ 2 0 0 2年我院收治的格林 巴利综合征 2 3例进行康复治疗 ,效果明显 ,现报道如下。资料与方法一、对象　 4 3例均为神经内科收治的病人 ,男 36例 ,女 7例 ;年龄 6～ 10岁 ,平均年龄 8岁。诊断符合《中华神经精神科杂志》诊断标准[2 ] 。康复组 2 3例 ,生命体征稳定后即进行康复 5例 ,余为出院后 15～ 35ｄ开始康复训练 ,其中 3例跟腱轻度挛缩 ,15例进入痉挛期 ,平均住院 92ｄ ;对照组 2 0例 ,平均住院 2 6 .6ｄ ,跟踪随访 7…     

儿童颞叶症状性癫痫的手术治疗

目的：探讨儿童颞叶症状性癫痫的原因和临床特征并总结手术治疗经验。方法：对我院自1994年1月至2002年8月手术治疗的17例儿童颞叶症状性癫痫，男11例，女6例，年龄3～14岁，平均9岁，均以癫痫为首发症状，病程13d到7年，平均为4．3年。手术方式为：单纯病灶切除6例，病灶加前颞叶切除11例，其中13例再行皮层脑电极检查，12例仍发现致病波，则加大病灶切除范围和／或病灶周围皮质区多处软膜下横纤维切断。结果：17例患儿无手术死亡及并发症。随访16例，时间为6个月～7年，术后症状完全消失者12例(占70．6％)，术后癫痫发作显著减少者(发作频率不到原来的25％)3例(17．6％)，术后癫痫发作减少者(发作频率不到原来的50％)2例(11．8％)。结论：在皮层脑电极监测下，多种手术方法结合治疗颞叶症状性癫痫患儿安全有效。     

儿童陈旧性孟氏骨折合并桡神经深支损伤手术疗效分析

目的 探讨手术治疗陈旧性孟氏骨折合并桡神经深支损伤的临床效果。方法 采用手术切开复位，矫正畸形治疗陈旧性孟氏骨折18例，手术前后进行X线表现和临床结果评定。结果 全部病例术后可使肘关节功能改善，桡骨小头与肱骨小头恢复了正常的匹配关系。结论 手术切开复位治疗陈旧性孟氏骨折合并桡神经深支损伤是一种有效的方法。     

儿童自主神经介导性晕厥的治疗

自主神经介导性晕厥是儿童常见疾病,严重影响患儿的身心健康,给予及时有效的治疗尤为重要。儿童自主神经介导性晕厥的治疗在国内外学者的共同努力下取得了巨大的进展,特别是个体化治疗策略的提出,显著提高了治疗的疗效。今后仍需探索干预及预防新策略,不断优化个体化治疗的预测技术,为不断提高儿童身心健康水平付出不懈的努力。     

儿童自身免疫性溶血性贫血治疗进展

自身免疫性溶血性贫血是由各种原因导致机体免疫功能紊乱,产生可与红细胞自身抗原反应的自身抗体和(或)补体,导致红细胞破坏增多并超过骨髓造血的代偿能力。儿童多急性起病,临床表现与发病机制相关。糖皮质激素作为该病的一线治疗,多数患儿对其反应良好。部分患儿因存在激素依赖,激素耐药,或因抗体类型不同导致病程反复,常需采取二线治疗...     

小儿急性胰腺炎病情严重度评分的临床应用

目的 探讨小儿急性胰腺炎评分系统在病情严重度判定中的临床应用价值.方法 回顾分析2002年1月～2006年8月间本院收治的49例小儿急性胰腺炎(AP)病例,分析比较Ranson、APACHEⅡ及小儿急性胰腺炎评分(John评分)系统对小儿急性胰腺炎病情严重度评判的灵敏度、特异度、似然比及接收者工作特征(ROC)曲线下面积(AUC)等指标,检验各评分系统对小儿AP病情严重度评判的价值.结果 49例中,发生胰腺坏死/假性囊肿/脓肿,脏器功能障碍等严重并发症的小儿SAP重症急性胰腺炎(SAP)7例,轻症急性胰腺炎(MAP)42例.SAP组与MAP组间,3种评分系统的分值分别为(1.12±0.29)与(0.93±0.22),(3.39±0.73)与(2.85±0.68),(3.07±0.45)与(1.12±0.27),仅John评分分值的组间差异有统计学意义(t=15.1974,P=0.0000).3种评分系统对小儿SAP评判的灵敏度分别为28.57%、42.86%、85.71%,John评分高于前二者,特异度分别为88.10%、85.71%、83.33%.3种评分系统评判小儿SAP的AUC值分别为0.54、0.59及0.90,John评分的AUC值明显高于前二者,差异有显著性意义(P=0.0083、0.0112).结论 与Ranson及A-PACHEⅡ评分比较,John评分对小儿AP病情严重度和预后的评判价值较大.     

儿童盘状半月板损伤的关节镜诊治

目的 探讨关节镜对儿童膝关节盘状半月板损伤的诊断及成形手术的疗效。方法 对１８例儿童膝关节外侧盘状半月板损伤进行关节镜检查,并同时行盘状半月板成形手术。结果 １３例症状完全消失,４例膝关节活动时偶有弹响,无关节交锁及疼痛。１例膝关节疼痛、弹响及关节交锁较前减轻,半年后行半月板切除术。结论 症状性儿童膝关节盘状半月板应尽早行成形手术治疗,关节镜诊治具有创伤小、并发症少、恢复快等优点,是治疗膝关节盘状     

损伤控制外科技术在小儿严重胸部创伤急救中的应用

目的 探讨损伤控制外科技术(damage control surgery,DCS)在小儿严重胸部创伤急救中的应用疗效.方法 回顾性分析我科应用损伤控制外科技术救治的10例严重胸部创伤的小儿患者与常规外科手术治疗的5例胸部外伤小儿患者临床资料,分为DCS组和对照组.比较两组患者术前创伤严重程度评分(ISS)及复苏期患者体温、血pH值、PT值和血氧饱和度值变化情况.结果 术前DCS组和对照组ISS评分分别为24.28±6.43和23.54±5.96,两组差异无统计学意义(P＞0.05);复苏期体温变化两组分别为(37.04±0.62)℃和(36.46±0.94)℃,差异无统计学意义(P＞0.05),DCS组体温变化更趋于平稳;DCS组和对照组复苏期血pH值分别为7.38±0.10和7.26±0.07、PT值分别为21.34±5.20和29.82±6.25和血氧饱和度值分别为(96.43±4.38)％和(90.18±3.25)％,两组相比差异有统计学意义(P＜0.05);两组患儿术后康复情况比较,DCS组明显优于对照组.结论 对于严重胸部创伤的小儿患者采用损伤控制外科手术处理效果明显优于传统常规手术,在挽救生命的同时对促进术后患儿康复亦起着重要作用.     

儿童坠落伤110例分析

总结１９８７年元月以来收治的１１０例儿童坠落伤。结果表明：８９．１％的损伤是２～８ｍ高处坠落造成，５岁以上儿童从３ｍ以下高处坠落较多，而５岁以下者从３ｍ以上坠地较多。损伤严重度评分（ＩＳＳ）显示，落差越高，损伤越重。３ｍ以上坠落时，应警惕头、胸、腹内脏器损伤；落差小于３ｍ应警惕四肢骨折；脊柱及脊髓损伤少见。     

几种新生儿危重评分的比较

新生儿危重评分是一种评估疾病危重程度,预测死亡风险的评分系统,用以指导新生儿重症监护室的临床工作,对我国日益发展的新生儿医学有其必要性和重要性.该文着重介绍并比较了几种国际上常用的危重评分系统.与新生儿急性生理学评分、新生儿急性生理学评分围生期补充及国内新生儿危重评分相比,新生儿临床危险指数、新生儿急性生理学评分-Ⅱ、新生儿急性生理学评分围生期补充-Ⅱ及新生儿临床危险指数-Ⅱ的变量更精简,分度更科学,评分时间缩短,预测死亡风险的准确性较高,具有更高的实用及推广价值.     

Evaluation of an asthma severity score

Objective : To evaluate inter-observer agreement and validity of an asthma severity score derived from wheeze, heart rate and accessory muscle use components.
Methodology : Children with acute asthma were examined independently and simultaneously by two observers, followed by pulse oximetry and spirometry in those over 5 years with repeatable measurements.
Results : Inter-observer agreement was very good (weighted kappa 0.82, 95% confidence interval 0.63 to 1.00). the component with the best agreement being the accessory muscle score (0.76, 0.57 to 0.95).
The score correlated significantly with oxygen saturation, heart rate, and forced expiratory volume in 1 s (FEV1). In a multivariate model, FEV1 was best related to accessory muscle use.
Conclusions : The asthma severity score has very good inter-observer agreement with a moderate relationship to oxygenation and FEV1.     

The impact of pediatric trauma in the Amish community

OBJECTIVE: To describe the epidemiology of trauma in Amish children and to determine differences in treatment and outcome related to injury mechanism. STUDY DESIGN: In this retrospective review, data were collected on all Amish children with trauma requiring hospital admission. Demographic, interventional, and outcome data were collected. Categorical outcomes were compared by using chi-square, logistic regression, or Fisher exact test; continuous outcomes were compared with analysis of variance. RESULTS: A total of 135 trauma admissions were studied. There was a significant difference of proportion of injury by month (P < .01). The most common mechanisms of injury were falls (39%), buggy versus motor vehicle accidents (MVA; 16%), and animal injuries (14%). A total of 41% of patients required operative procedures, and 50% of subjects required intensive care. Animal injuries and buggy versus MVA were significantly associated with a requirement for surgery, increased length of stay, and increased severity (all P < .01). The overall mortality rate was 3%. There were significant associations between mechanism of injury and outcome scores (P < .05) and hospital charges (P < .05). CONCLUSIONS: The spectrum of traumatic injuries is unique among Amish children. These injuries contribute significantly to morbidity and mortality and impose a large monetary burden on the Amish community. Education may decrease the incidence of these events.     

Estimating injury severity using the Barell matrix

OBJECTIVE: To determine whether the Barell matrix (Inj Prev 2002;8:91-6) could effectively categorize injuries by severity. METHODS: Injury diagnoses of cases in the 2002 US Nationwide Inpatient Sample were classified according to the Barell matrix. For each cell of the matrix, the authors used ICDMAP-90 to determine the predominant Abbreviated Injury Score (AIS) and body region, and calculated the weighted proportion surviving (bPScell) among patients with any diagnosis in that cell. These findings were used to estimate maximum AIS (bAISmax), ISS (bISS), and the minimum or product of bPScell (bPSmin, bPSprod) for injured patients in the 1996-2000 US National Hospital Discharge Surveys. Case survival was determined for different scores, and outcome models using age, sex, comorbidity, mechanism, and bISS or bPSmin were compared to models using ISS calculated from ICDMAP-90 (mISS) or using ICISS. RESULTS: Case survival decreased with increasing bAISmax or bISS; survival was closely approximated by bPSmin, and also increased monotonically with bPSprod. Outcome models using bISS or bPSmin were similar to those using mISS or ICISS. An Abbreviated Barell Categorization, with only four groups, was also effective. CONCLUSION: Barell matrix categorization of administrative data allows severity scoring similar to that obtainable with ICDMAP-90 or ICISS.