软组织重建治疗Wassel Ⅳ-D型复拇畸形

目的 探讨软组织重建治疗儿童Wassel Ⅳ-D复拇畸形的方法.方法 2007年10月至2011年3月对8例9手Wassel Ⅳ-D型复拇畸形通过软组织重建进行手术治疗,其中男5例6手,女3例3手.术中切除桡侧拇指,保留尺侧拇指,末节桡偏严重者,行桡侧关节囊松解,尺侧关节囊紧缩,指间关节和掌指关节用克氏针固定,掌骨头桡侧修整.A2滑车重建,屈拇长肌腱桡侧止点居中.随访时间4～33个月,平均18个月.结果 随访结果采用Tada等制定标准评价:优5例6指；良2例；差0例.家属对治疗效果均表示满意.结论 采用软组织重建治疗Wassel Ⅳ-D型复拇畸形,效果满意.     

Anatomical study of Wassel type IV-D thumb duplication in children

目的 探讨儿童Wassel IV-D复拇畸形的病理解剖.方法 本组11例12手,男7例8手,女4例4手.其中4例为继发性畸形.术中对组织结构进行解剖,观察屈伸肌腱结构及走向、骨关节的解剖结构.结果 4例术后发生继发性畸形的病例,肌腱分叉后滑车缺如,屈拇长肌腱止点附着于拇指末节基底桡侧.Wassel IV-D型屈拇长肌腱鞘管在A2区发育为膜状,附着于两拇指近节指骨的相对侧,屈肌腱在近节指骨中远1/3处分叉,由一束变为两束,桡侧束止于桡侧指末节指骨基底的尺侧,尺侧束止于尺侧指末节指骨基底的桡侧.桡侧指末节向尺侧轻度旋转,尺侧指向桡侧轻度旋转.结论 Wassel IV-D型屈拇长肌腱鞘管在分叉以远发育为膜状,附着于两拇指近节指骨的相对侧,屈肌腱在近节指骨中远1/3处分叉,由一束变为两束,桡侧束止于桡侧指末节指骨基底的尺侧,尺侧束止于尺侧指末节指骨基底的桡侧.     

小儿先天性桡偏手的手术治疗

目的 探讨先天性桡偏手的诊断和治疗.方法 3例男性患儿,右侧2例,双侧1例.手术年龄分别为20个月、6岁8个月、24个月.按Heikel分型,单侧的为Ⅳ型与Ⅲ型,双侧的为左侧Ⅲ型、右侧Ⅰ型.手术由3部分组成:尺骨远端中位化对应腕骨、尺骨干楔形截骨纠正弓状弯曲、尺侧伸腕肌腱移位稳固腕关节.结果 手腕桡偏纠正满意,腕关节稳定且有一定活动度,手指屈伸功能明显改善.随访6～43个月,以术前/术后/随访的X线片测量前臂-手之整体角评价术前畸形度、术后纠正量和复发量:例1为88°/-6°/-21°;例2为103°/0°/0°;例3为75°/-7°/-15°.结论 先天性桡偏手是一种少见而复杂的手畸形,尺腕中位化手术与尺骨截骨、肌腱转位同期完成可以重建稳定的腕关节,改善手腕与手指的外观和功能.     

儿童WasselⅣ-4型复拇畸形手术疗效分析

目的 WasselⅣ-4型复拇畸形,畸形复杂,治疗困难.本文介绍用改良的Bilhaut软组织合并矫形术治疗该型复拇畸形.方法 2005年8月至2011年1月治疗21例WasselⅣ-4型复拇畸形,男13例(61.9％),女8例(38.1％),平均年龄1.2岁.手术采用改良的Bilhaut软组织合并术,桡侧拇指切除,尺侧拇指重建.包括肌腱转移、韧带重建、关节囊修补,皮瓣成形,软组织合并.结果 19例术后平均随访25个月,对治疗结果用改良的Tada评分评估,优10拇(52.6％),良7拇(36.8％),中2拇(10.5％).结论 改良的Bilhaut软组织合并术治疗复杂型WasselⅣ-4型复拇畸形,重建拇指功能良好,外观优良.     

屈指浅肌移位治疗脊髓灰质炎后遗症大鱼际肌瘫痪12例

1992年以来我们共收治脊髓灰质炎后遗症引起大鱼际肌瘫痪 12例 ,均并同侧肩关节肌、肘关节肌或手部其他肌肉瘫痪 ,年龄 5～ 12ａ。男 9例 ,女 3例。术前检查 12例大鱼际肌肌力均在 0～ 1级 ,对掌功能丧失。一、手术方法　 12例采用中指屈指浅肌移位 2例 ,环指屈指浅肌移位 9例 ,小指屈指浅肌移位 1例。 12例同时进行肩关节功能位融合 ,屈肘功能重建 ,伸腕、伸指功能重建 ,桡腕关节功能位融合。二、手术要点　选择良好的动力肌腱。选择的肌肉必须有足够力量和滑动范围 ;建立有效的滑车装置 ,使肌腱走行与外展拇短肌方向一致 ,若尺侧屈腕肌正…     

近节平面截骨的On-Top-Plasty术治疗特殊WasselⅥ型拇指多指畸形

目的探讨近节平面截骨的On-Top-Plasty术在特殊WasselⅥ型先天性多拇畸形治疗中的应用和疗效。方法回顾性分析2012年1月至2020年12月于苏州瑞华骨科医院手外科治疗的8例9指特殊WasselⅥ型多拇指畸形患儿的临床资料。其中男5例, 女3例;平均年龄为3.9岁, 年龄范围在2.5～6.0岁。采用去除桡侧拇指发育不良的指骨(保留掌指关节)和尺侧拇指发育不良的掌骨(包括掌指关节), 将尺侧指发育正常的组织移植至桡侧拇指的正常组织上, 即重组桡侧拇指和尺侧拇指的正常组织, 重塑一个相对外观、功能较好的拇指。结果重组的8例9指全部成活, 患儿于4～6周拔除克氏针, 骨断端愈合良好。术后随访6～48个月, 拇指外形美观, 功能恢复良好。结论采用近节平面截骨的On-Top-Plasty技术, 将桡侧拇指和尺侧拇指的畸形部分拆分, 再将桡侧拇指和尺侧拇指存留的部分进行重组修复, 矫正拇指畸形。该手术方法简单易行, 疗效切实可靠, 是治疗此类拇指多指畸形的一种有效方法。     

儿童先天性拇指多指畸形手术时机选择的探讨

目的探讨儿童先天性拇指多指畸形的手术时机。方法对2008年8月至2011年12月经我们手术治疗的102例119指先天性多指畸形患儿进行回顾性分析，其中男性67例（65．7％），女性35例（34．3％）；年龄最小2个月，最大13岁，平均年龄（1．62±2．36）岁；左侧23例，右侧62例，双侧17例；5例伴有并指畸形。所有患儿术前均进行详细专科体查和影像学评估，根据患儿年龄、Wassel分型及畸形程度制订个体化手术方案，包括单纯多指切除术，各种皮瓣成形、肌腱移位（移植）、韧带重建、关节囊修复等矫形手术，部分大龄患儿酌情行截骨矫形术。结果81例术后随访3—27个月，平均随访11．6个月，根据改良Tada评分进行评估，优62指，良17指，中12指，差3指；2指术后2年出现继发性成角畸形，1指术后3年掌指关节桡侧残留骨骺，再次手术后外形及功能恢复正常。结论先天性拇指多指畸形的手术时机应根据拇指骨化中心出现时间而定，对于畸形严重、结构变异较大的复杂多指，应在严格把握手术时机的前提下，做好术前评估，制定个体化治疗方案，术中精细操作，术后长期定期随访。     

一种新的儿童先天性胫骨假关节的X线分型

目的 探讨一种新的儿童先天性胫骨假关节的X线分型,为临床治疗和判断预后提供依据.方法 回顾性分析本单位2004年至2014年期间收治的171例先天性胫骨假关节患儿的X线片,男125例(73％),女46例(27％),手术时平均年龄42.5个月.胫骨X线表现包括以下四种情况:Ⅰ型,胫骨前弓,在畸形的顶点处骨皮质增厚、但骨髓腔正常;Ⅱ型,胫骨前弓,在畸形的顶点处髓腔狭窄、骨皮质增厚和骨小梁的缺失;Ⅲ型,胫骨囊性病变,可以发生在胫骨的任何部位;Ⅳ型,胫骨假关节.腓骨X线表现包括以下四种情况:a:腓骨发育正常;b:腓骨发育不良(腓骨直径小于健侧腓骨直径);c:腓骨囊性变,多数发生在腓骨下1/3;d:腓骨假关节.根据患儿就诊时胫骨和腓骨的X线表现,提出一种新的X线分型方法.无论患儿是否曾经历手术治疗、是否有内外固定.结果 171例儿童先天性胫骨假关节按新的X线分型方法,不同类型的病例数如下:Ⅰa型9例,Ⅰb型3例,Ⅰc型3例,Ⅰd型4例.Ⅱa型9例,Ⅱb型15例,Ⅱc型3例,Ⅱd型6例.Ⅲa型6例,Ⅲb型12例,Ⅲc型8例,Ⅲd型17例.Ⅳa型13例,Ⅳb型10例,Ⅳc型4例,Ⅳd型49例.结论 结合儿童先天性胫骨假关节的胫骨和腓骨的X线表现、提出的这种新的X线分型方法,能够囊括目前本单位所有的病例.有可能为先天性胫骨假关节的治疗、术后并发症的防治、预后判断提供重要的指导作用,但仍有待进一步研究.     

切开复位接骨板内固定术治疗尺桡骨远端双骨折

目的 探讨小儿尺桡骨远端骨折的治疗方法.方法 12例小儿尺桡骨远端双骨折手法复位石膏外固定失败后行切开复位内固定术,桡骨远端应用掌侧切口,于桡侧腕屈肌与掌长肌之间进入,显露骨折断端,应用T形接骨板固定桡骨;尺骨应用尺背侧切口,切开皮肤即可显露尺骨,应用粗细适合克氏针固定,对其疗效进行分析.结果全部患者均进行随访,随访时间6个月,12例骨折均愈合,无复发骨折,Gartlang ＆ Werley评分系统优11例,良1例,优良率100%.评分优的11例患儿腕关节无疼痛,关节活动无障碍;评分为良的1例患儿腕关节偶有轻微疼痛,关节功能无障碍.结论尺桡骨远端双骨折行切开复位内固定术,可使骨折达到解剖复位,手术入路安全,对腕关节周围稳定系统损伤小.应用解剖型接骨板固定稳定可靠,患儿可以早期活动,减少腕关节功能障碍的发生.     

先天性食管闭锁73例诊治分析

目的 探讨先天性食管闭锁患儿手术治疗及术前、术后处理策略,以提高生存率,降低术后并发症.方法 1995年10月至2009年6月共收治先天性食管闭锁患儿73例,男51例,女22例,男：女约2.3：1,低体重儿（＜2 500g）14例.首次住院治疗患儿平均入院日龄为（3.27±3.16）d.8例放弃手术及2例未手术患儿死亡,63例均行Ⅰ期食管重建术.结果 63例手术患儿按Gross分型：Ⅰ型6例,Ⅲa型11例,Ⅲh型46例.合并其他先天性畸形41例,主要包括先天性心脏病30例,肛门闭锁5例,肛门狭窄1例,肺发育不良2例,环状胰腺1例.2例术后放弃治疗,其余61例手术病例术后治愈率为100%.术后发生肺炎47例（74.60%）,吻合口狭窄36例（57.14%）,吻合口漏11例（17.46%）.结论 早诊断、加强围手术期管理以及成熟的吻合技术是提高先天性食管闭锁患儿手术成功率的关键.对长段型食管闭锁行胃、胃管、结肠代食管术是有效的方法.营养支持是提高手术成功率的保障.     

Surgical Procedure for the Cleft Hand: Especially in Relation to Restoration of Instinsic Muscle Function of the Shifted Index Finger*

ABSTRACT We have thirty-eight patients of cleft hand, and they were divided into three groups from the surgical point. Four patients (seven hands) has only one digit on the radial side of the cleft. In these patients there was little indication for the surgical improvement. The thumb and index finger are completely webbed in six patients (seven hands), and reconstruction to permint thumb function is essential above all in these. In most patients of cleft hand (thirty-one out of thirty-eight) thumb function is preserved, but abduction of the thumb was more or less limited. Surgical procedure for these patients are discussed. There are three important point in surgical reconstruction of the celft hand; First is a skin incision to restore thumb abduction; Second is a realignment of the second metacarpal (index ray); and Third is a restoration of intrinsic function. Regarding the first and second point we reported previously (Miura and Komada, 1979). Now, we would like to emphasis that intrinsic function act as a key to get satisfactory result in surgical procedure for the cleft hand. We could use the extrinsic extensor or flexor muscles of the missing middle finger as a proper force for restoration of intrinsic function. We were pleased to use the extrinsic extensor that is found in same incision for the translocation of the index ray. The extrinsic flexor in extrinsic extensor was used. The extrinsic extensor of the middle finger was abscent in one patient.     

Clinical analysis of the trigger thumb of childhood

Trigger thumb of childhood, termed congenital trigger thumb, is a pathology of the flexor pollicis longus tendon with an unknown etiology. In this study, treatment outcomes of 47 trigger thumbs of 36 children were evaluated. There were 18 males and 18 females with a mean age of 34 months (9 months-13 years). Average age of recognition of pathology by the family was 20.5 months (0-8 years). In seven of 11 bilateral cases pathology was recognized simultaneously while in the other four, diagnosis was made at different times. We used conservative treatment for all patients under three years of age, which was unsuccessful. Thus, surgical relase was performed in all cases. In the mean follow-up of seven years (range 5-15), contracture and palpable nodules disappeared. In conclusion, we believe trigger thumb in childhood should be treated surgically and that the term "congenital trigger thumb" should be changed to "developmental trigger thumb".     

应用改良LCH-Ⅰ方案治疗郎格罕细胞组织细胞增生症疗效观察

探讨国际组织细胞协会制定的LCH-Ⅰ方案的治疗效果，提高重症郎格罕细胞组织细胞增生症 (LCH)患儿的疗效。方法17例LCH均经临床、实验室检查及活组织病理检查确诊。按hvin-Osband评分方 法将疾病严重程度分为4级。Ⅰ～Ⅳ级均采用改良LCH-Ⅰ方案，即先予大剂量甲基泼尼松龙冲击治疗，继以8 个疗程的鬼臼噻酚甙(VM26)完成整个治疗。按协会疗效标准进行评价。结果Lavin-Osband分级Ⅰ级8例、 Ⅱ级1例、Ⅲ级2例、Ⅳ级6例。短期疗效Ⅲ、Ⅳ级8例全部好转，有效率为100％；Ⅰ、Ⅱ级6例好转，有效率为 66.7％。追踪结果Ⅲ、Ⅳ级2例治愈、5例好转、1例恶化；Ⅰ、Ⅱ级6例好转，3例稳定，总有效率为76.5％ (13/17)。结论新的诊断标准明确，与国际标准接轨。LCH-Ⅰ方案疗效显著，尤对治疗时年龄＜1岁、病程＜ 3个月、病情重及S-100蛋白阳性者更显其优越性。     

儿童脊髓性肌萎缩合并肺部感染36例诊治分析

目的　总结儿童脊髓性肌萎缩合并肺部感染的临床特征,提高临床医生对该病的认识,改善预后。方法　回顾性分析温州医科大学附属第二医院育英儿童医院2008年1月1日至2017年12月31日收治的36例脊髓性肌萎缩症（SMA）合并肺部感染患儿的临床资料。结果　36例中Ⅰ型19例,Ⅱ型9例,Ⅲ型 8例。临床表现和体征以发热、咳嗽、气促或呼吸费力、三凹征、肺部细湿啰音等多见。有11例患儿出现呼吸衰竭,其中Ⅰ型SMA患儿7例（63.6%）,Ⅱ型SMA患儿2例（18.2%）,Ⅲ型SMA患儿2例（18.2%）。5例SMA患儿影像学检查提示脊柱侧弯,3例为Ⅱ型SMA患儿,2例为Ⅲ型患儿。有18例患儿病原学检测阳性,Ⅰ型SMA患儿10例（55.5%）,Ⅱ型SMA患儿4例（22.2%）,Ⅲ型SMA患儿4例（22.2%）,以院内条件致病菌混合感染多见,其中洋葱伯克霍尔德氏菌最常见。3例患儿在院内死亡,22例患儿好转出院,其余11例患儿放弃治疗。住院治疗的次数,重症肺炎、呼吸衰竭的发生率在前、后5年的比较差异均有统计学意义（P＜0.05）。结论　SMA极易并发肺部感染,要警惕条件致病菌感染,对呼吸衰竭者及时使用机械通气。积极有效的呼吸道护理,对减少肺部感染发生,改善SMA患儿的预后有积极的影响。     

大龄儿童跟骨关节内骨折治疗方法的探讨

目的 根据骨折的不同类型,分别采用保守治疗、撬拨复位和切开复位等方法治疗大龄儿童跟骨关节内骨折,并分析其疗效,总结适宜的治疗策略.方法 回顾分析2001年5月至2009年2月收治的39例42足儿童跟骨关节内骨折的临床资料,其中保守治疗9足(均为Sanders Ⅰ型);撬拨复位治疗14足(SandersⅡ型10足,SandersⅢ型4足);切开复位治疗19足(SandersⅡ型8足,SandersⅢ型7足,SandersⅣ型4足).结果 随访15～73个月,平均36.2个月,随访时骨折均获愈合.手术组的B(o)hler角和Gissane角治疗前后比较分别是(17.6±6.3)°比(32.4±2.3)°和(137.9±11.6)°比(124.8±4.7)°,差异有统计学意义(P＜0.01).按Maryland评分,保守治疗优良率为100%,撬拨复位优良率为85.7%,切开复位优良率为84.2%,总体优良率为88.1%.结论 儿童跟骨关节内骨折治疗方式的选择应根据患儿的个体状况、骨折类型等综合考虑.Sanders Ⅰ型骨折可采取保守治疗;外侧壁膨出不明显的SandersⅡ型骨折及软组织条件较差者,可选用撬拨复位;外侧壁膨出明显的SandersⅡ型骨折和复杂的Sanders Ⅲ、Ⅳ型骨折,无手术禁忌者,宜选择切开复位.

Abstract：

Objective To review our experience of managing treat intraarticular calcaneal fractures in older children with non-operative approach, closed reduction and open reduction depending on fracture type. Methods A retrospective study was done on 42 intraarticular calcaneal fractures in 39 children treated in our department from May 2001 to February 2009. Among them, 9 patients were treated conservatively (all type Sanders Ⅰ fractures), 14 treated with closed reduction (10 patients with type Sanders Ⅱ fractures and 4 with type Sanders Ⅲ),and 19 treated with open reduction(8 patients with type Sanders Ⅱ fractures, 7 with type Sanders Ⅲ and 4 with type Sanders Ⅳ). Results The average follow-up was 36. 2 months(range, 15-73 months). All patients had a complete healing of their fractures. There was a significant difference in the operative group as to the restoration of B(o)hler angle and Gissane angle before and after operation(P ＜ 0. 01). According to Maryland Foot Score, the excellent or good rate was 100% in conservative treatment, 85. 7% inn closed reduction and 84. 2% in open reduction respectively. The overall excellent or good rate was 88. 1 %. Conclusions Therapeutic plan should be developed on patients' clinical conditions and fracture type. Conservative treatment can be used for type Sanders Ⅰ fractures. Closed reduction is alternative for part of type Sanders Ⅱ fractures without the widen posterior facet, and the patients whose soft tissues condition are poor. Open reduction is recommended for type Sanders Ⅱ with the widen posterior facet, type Sanders Ⅲ and type Sanders Ⅳ fractures.     

新生儿食管闭锁的外科治疗

目的 总结新生儿食管闭锁的诊断和治疗经验.方法 回顾性分析我院2002年6月至2010年6月收治的新生儿食管闭锁61例,男34例,女27例.手术年龄18 h～7 d,平均(2.5±0.6)d,体重1 500～4 000 g,其中低体重儿(＜2 500g)16例.61例中按Gross病理解剖分类:Ⅰ型2例,Ⅲa型32例,Ⅲb型27例,Ⅲa型中有1例远端食管有局限狭窄,开口约0.2 cm;合并畸形:先天性心脏病15例,肠道畸形4例,泌尿系畸形3例.结果 61例中2例Ⅰ型食管闭锁先行近端食管引流、胃造瘘,2周后行结肠代食管手术,59例Ⅲ型均Ⅰ期食管气管瘘切断缝扎、食管端端吻合术,Ⅲa型中远端食管有1例局限性狭窄,行纵切横缝解除狭窄.术后并发单侧或双侧严重肺炎42例,硬肿症3例,近期吻合口狭窄24例,吻合口瘘3例.除1例术后2d合并肠穿孔死亡,3例放弃治疗(均为早期病例:1例为术后1周出现核黄疸,2例术后合并严重肺部感染不能脱离呼吸机),余57例均痊愈出院.术后随访3个月～8年,轻度胃食管反流3例,余均进食良好,生长发育正常.结论 尽早诊断、及时手术,积极预防和治疗并发症,新生儿食管闭锁可取得良好的效果.

Abstract：

Objective To summarize the diagnosis and treatment for congenital esophageal atresia (CEA) in neonates. Methods From June 2002 to June 2010, 61 neonates with congenital esophageal atresia underwent surgery at this center. Of these patients, 34 were boys and 27 were girls. Their age ranged from 18 hours to 7 days (mean, 2. 5 ±0. 6 days). Their weight ranged from 1500 grams to 4000 grams. Sixteen patients were very low-birth-weight infants (＜1500 g). According to the anomalies of CEA, 2 were diagnosed with type Ⅰ CEA, and the other 59 were type Ⅲ CEA (32 type Ⅲa and 27 type Ⅲb). The most common associated anomalies were cardiac anomalies (16, 26%), followed by intestinal anomalies (5, 8%) and renal anomalies (3, 5%). Results The 2 cases with type Ⅰ CEA underwent proximal drainage of esophagus and gastrostomy to stabilize their conditions. Two weeks later, they underwent the second stage surgery to replace esophagus with colon. The 59 patients with type Ⅲ CEA underwent fistulectomy and end-to-end esophagus anastomosis via thoracic approach. A stenosis in the medial-distal esophagus was found on 1 type Ⅲa CEA patients, and was repair with longitudinal incision and transverse suture. Postoperative complications included pneumonia on 42 patients (68. 8%), scleredema on 3 patients (4. 9%), mild anastomosis orifice stenosis on 24 patients (39. 3%), and anastomosis orifice fistula on 3 patients (4. 9%). One patient died of intestinal perforation 2 days after surgery. Three patients were given up including 1 developed kernicterus 1week after surgery, and the other 2 had serious pulmonary infection and couldn't be withdrawn from mechanical ventilation. The other 57 cases were discharged from hospital. The patients were followed up for 3 months to 8 years. Three patients had mild gastroesophageal reflux. The others ate and drank normally during follow-up. Conclusions Early diagnosis and carefully management of postoperative complications are important to improve clinical outcomes and prognosis of congenital esophageal atresia in neonates.     

儿童Wassel Ⅱ型复拇畸形术后继发性畸形的原因分析

目的 探讨儿童Wassel Ⅱ复拇畸形术后继发性畸形的原因.方法 患儿分为两组,A组:35例37指年龄在10个月至6岁Wassel Ⅱ复拇畸形的儿童,行桡侧多指切除,关节囊重建,分叉处伸指肌腱切除术或移植至末节指骨基底,术后克氏针固定5周,拔针后戴支具3个月.B组:8例年龄在4～14岁Wassel Ⅱ先天性复拇畸形术后出现拇指侧偏畸形,除1例因第一次术后只有2个月,未行再次手术治疗外,其余7例经再次手术治疗.行偏侧瘢痕"Z"字成形、关节囊松解,对侧关节囊紧缩,克氏针固定,6周后拔针并戴支具3个月.结论 A组28例患儿随访6个月至30个月,平均18个月.优22例;良5例;差1例.B组7例随访6～28个月,平均16个月.优4例;良2例;差1例.结论 Wassel Ⅱ型复拇畸形术后继发性畸形的主要原因是被切除拇指的残存伸指肌腱未做处理,关节囊、侧副韧带未修复和近节指骨远端未修整.拔除克氏针后支具的使用对防止继发畸形具有重要的作用.

Abstract：

Objective To investigate the causes of the secondary deformity after the correction of the Wassel type Ⅱ thumb duplication. Methods The patients were divided into two groups: Group A was consisted of 37 thumbs of the 35 patients(20 females,15 males;mean age 3.6 years;range 10 months to 6 years) underwent surgery.Treatment included resection of the most hypoplastic thumb,followed by reinsertion of the articular capsule and the collateral ligament,and the articular surface of the head of the proximal phalanx was shaved,the extensor tendons were centralized on the distal phalanx or cut,and the alignment maintained with Kirschner-wire fixation for five weeks.Immobilization with orthosis was conducted for three months after withdrawing Kirschner-wire.Eight patients who had been treated at other hospitals originally for type-Ⅱ deformity and had residual deformity were included in group B,their age ranged from 1 to 6 years.Seven of them underwent scar release by a z-plasty,reefing of ulnar joint capsule,shaving articular cartilage to establish more congruent joint surfaces,and the alignment being maintained with Kirschner-wire fixation for six weeks.Immobilization with orthosis was adopted for three months after withdrawing Kirschner-wire.Results Based on the Tada scoring system,the results of group A were good in 22,fair in 5,and poor in 1 after mean one and half year follow-up(range 6 months to 30 months).In group B,the mean follow-up was 1 year and 4 months(range 6 months to 28 months),the results were good in 4,fair in 2,and poor in 1.Conclusions The main causes of the secondary deformity after the correction of the Wassel type Ⅱ congenital thumb polydactyly include the extensor tendons are not centralized on the distal phalanx,the articular capsule and the collateral ligament are not construction and the articular surface of the head of the proximal phalanx is not shaved.It is important to used orthosis after withdrawal of Kirschner-wire for the treatment of secondary deformity after the correction of the Wassel type Ⅱ thumb duplication.     

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。     

小儿Amyand's疝的临床特点分析

目的 探讨小儿Amyand's疝的临床特点及治疗经验.方法 回顾性分析2002年1月至2009年12月17例Ⅱ、Ⅲ型Amyand's疝的临床资料.结果 17例患儿中男孩15例,女孩2例;中位年龄1.1岁(25 d至6岁5个月).临床共同的特征是:腹股沟区疼痛性肿块17例,呕吐9例,发热(≥38.5°)9例;X线平片显示肠梗阻5例;B超表现为腹股沟区混合性包块17例;实验室检查17例患儿白细胞均升高(＞10 000).17例Ⅱ、Ⅲ型Amyand's疝患儿顺利完成了疝环松解+阑尾切除+疝内容物还纳+疝囊高位结扎术,术后恢复较快,均痊愈出院.术后病理诊断为单纯性阑尾炎7例,化脓性阑尾炎8例,坏疽性阑尾炎2例.随访10个月至8年,无一例复发.结论 Amyand's疝临床较少见,Ⅰ型AH在处理上与一般的嵌顿疝相似,阑尾直接还纳入腹腔;Ⅱ、Ⅲ型AH行疝环松解+阑尾切除+疝内容物还纳+疝囊高位结扎术.提高对本病的认识,正确处理不同类型的AH,是提高治愈率的关键.

Abstract：

Objective To study clinical features and treatment experience of Amyand's hernia in children. Methods Clinical information of 17 cases of types Ⅱ and Ⅲ hernia was studied retrospectively from January 2002 to December 2009. Results There were 15 boys(88. 24%) and 2 girls (11.76%)in the study, the median age was 1.1 years (25 days to 6 years and 5 months). The common presenting symptom was painful inguinal or inguinoscrotal swelling (100%), vomiting (52. 94%), fever (≥ 38. 5 °) (52. 94%). X-ray showed intestinal obstruction (29. 41 %). Ultrasound found mixed mass in the groin area (100%). All of 17 cases presented with elevated WBC (＞10,000). 17 cases of types Ⅱ and Ⅲ Amyanc's hernia were completed successfully by the cut-down herniorrhaphy + appendectomy. The specimens were proved appendicitis in 7 cases, suppurative appendicitis in 8 cases, and gangrenous appendicitis in 2 cases by pathological diagnoses. No recurrence was found within the follow-up time (10m ～ 8y). Conclusions Amyand's hernia is rare, the treatment of type Ⅰ Amyanc's hernia is similar to generally incarcerated hernia, putting the appendix into the abdominal cavity, directly; type Ⅱ and Ⅲ Amyand's hernia were treated by the cut-down herniorrhaphy and appendectomy.