用Sauvegrain法测定青春期骨龄准确性的研究

背景：Sauvegrain方法是通过分析肘部X线片来评估骨龄，常用于青春期生长发育最为迅速的两年间的骨龄测定。本文旨在研究该方法的准确性以及在小儿骨科中的应用价值。 方法：Sauvegrmn法主要评估肘部的4个解剖标志点：外髁、肱骨滑车、尺骨鹰嘴突以及桡骨近端骨骺。它是一个27分制的评分系统。对上述结构所得的评分进行合计而得出一个总分，然后使用标准图表确定骨龄。让三位观察者分别利用该方法进行骨龄评估。三位观察者通过分析60个男孩和60个女孩样本左肘部的前后位和侧位X线片来测定骨龄，并将该结果与通过分析左手和腕部后前位X线片的Greulich和Pyle图谱而得出的骨龄结果进行比较。间隔4周后每个观察者再测定骨龄一次。 结果：通过分析肘部X线片的方法测定骨龄更为精确，因为采用该方法测定骨龄可以精确到半岁。根据观察者的评定，Sauvegrain法显示出很好的观察者之间的相关性（r=0．93）和可重复性（r=0．96）。Sauvegrain法与Greulich和Pyle图谱之间有很好的相关性（r=0．85）。然而，一些肘部生长中心显示出一种中间的发育形态，这种形态学不适合Sauvegrain法的评分。这就导致了数据分析时出现误差。我们建议对于这些样本设定中间评分，并且通过修改原始图表而使评分更为精确。 结论：改良的Sauvegrain法简单、可靠而且可重复性高，它补充了Greulich和Pyle图谱的不足。在临床实践中，骨骼成熟度可以通过骨龄、年生长率以及第二性征而得以很准确的评估。因此，当青春期需要进行骨骺或脊柱关节融合术时，这种方法对于确定手术时间具有重要意义。 可信水平：诊断性研究，Ⅱ级，进一步可信度参见作者介绍。     

Umbilicated Gastric Polyposis

A case of multiple centrally umbilicated gastric polyps is presented. Several endoscopic biopsies of the various polyps rapidly established the histological diagnosis of amelantoic melanoma. The significance and differential diagnosis of this endoscopic lesion is discussed.     

The influence of new maternal care facilities in rural Nigeria

Intrapartum care was begun in a public sector comprehensivehealth centre in Obukpa Town, a rural Nigerian community inMay 1987. Its influence on the utilization pattern of maternalhealth care services was studied in a sample of 488 women whounderwent an abortion or childbirth between May 1987 and July1989. There was an increase in utilization of prenatal carefacilities in the comprehensive health centre, from 52% in 1987to 66% in 1989, and a decline in the use of other health facilitiesfrom 41 % to 31 %. Use of the comprehensive health centre forintrapartum care increased from 15% in 1987 to 36% in 1989,while home delivery declined from 60% to 38% in the same period.Use of other health institutions for delivery remained unchanged.Logistic regression analysis showed that place of delivery andattendant at delivery varied significantly with year of delivery.Women were more than twice as likely to deliver in health institutions(OR =2.216, p = 0.01) and to be attended by trained staff (OR= 2.525, p = 0.003) in 1989 than in 1987. The cost of service was found to be about the same for the publicand private sectors for prenatal care, and marginally lowerfor intrapartum care at the comprehensive health centre. Serviceby traditional birth attendants was free or paid for in kind.The use of the comprehensive health centre was shown to declinewith increasing distance from a woman's residence, and distancewas considered the determining factor in the choice of a privateor public health care institution. The implications of thesefindings for maternal health policy are discussed and recommendationsfor change are made.