Parental Activity as Influence on Childrenˋs BMI Percentiles and Physical Activity

Parents play a crucial role in the development of their children’s lifestyle and health behaviour. This study aims to examine associations between parental physical activity (PA) and children’s BMI percentiles (BMIPCT), moderate to vigorous PA (MVPA) as well as participation in organised sports. Height and body weight was measured in 1615 in German children (7.1 ± 0.6 years, 50.3% male) and converted to BMIPCT. Parental BMI was calculated based on self-reported height and body weight. Children’s MVPA and sports participation as well as parental PA were assessed via parental questionnaire. Analysis of covariance (ANCOVA), controlling for age and family income was used to examine the association between parental and children’s PA levels as well as BMIPCT. 39.7% of the parents classified themselves as physically active and 8.3% of children were classified as overweight or obese. Lower BMIPCT were observed with both parents being physically active (44.5 ± 26.3 vs. 50.2 ± 26.9 and 52.0 ± 28.4, respectively). There was no association between parental and children’s PA levels but children with at least one active parent displayed a higher participation in organised sports (102.0 ± 96.6 and 117.7 ± 123.6 vs. 73.7 ± 100.0, respectively). Children of active parents were less likely to be overweight and obese. The lack of association between subjectively assessed parental PA and child MVPA suggests that parental support for PA in children is more important than parents being a role model. More active parents, however, may be more likely to facilitate participation in organised sports. These results underline the importance of the inclusion of parents in health promotion and obesity prevention programmes in children.

Key points

• A higher prevalence of overweight or obese children was found with inactive parents.
• Children’s BMI percentiles were lower if both parents were physically active compared to children whose parents were both inactive or only had one physically active parent.
• Parental activity had no influence on daily time spent at MVPA and time spent in non-organised sports.
• There was a significant association between parental physical activity and the number of minutes per week boys and girls participated in organised sports.
• On average, children who had at least one physically active parent spent significantly more time participating in organised sports than children with inactive parents.

Key words: Health and exercise, effects on body weight, health promotion     

Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases

Background:

Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD).

Materials and Methods:

50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P < 0.05 was considered to be statistically significant.

Results:

Among 50 patients, 22 received one level fusion and 28 two level''s, with corresponding operation time and estimated blood loss being approximately 90 min, 150 ml and 120 min, 200 ml, respectively. No severe complications happened perioperatively. The mean VAS (back, leg) scores dropped from (7.6, 7.5) preoperatively to (2.1, 0.6) at 12 months’ followup, ODI from 49.1 preoperatively to 5.6 and JOA score raised from 10.6 preoperatively to 28.5, all P < 0.001, suggesting of good clinical outcome. From the three-dimensional reconstructed CT, 62 out of 70 segments displayed solid fusion with fusion rate of 88.6% at 12 months postoperatively.

Conclusions:

TLIF using uPS fixation plus cTLFS fixation is a safe, feasible and effective technique in the treatment of one or two level lumbar degenerative diseases short termly.     

不对称经椎弓根截骨矫治成人先天性脊柱侧后凸畸形

【摘要】 目的：分析应用不对称经椎弓根截骨技术矫治成人先天性脊柱侧后凸畸形的临床疗效。方法：2009年9月~2013年10月采用不对称经椎弓根截骨矫治成人先天性脊柱侧后凸畸形患者16例,男9例,女7例。年龄18～42岁,平均23.6岁。均有腰背痛,无神经受压症状。16例患者脊柱侧凸Cobb角43°~97°,后凸Cobb角15°~70°。侧凸畸形和后凸畸形顶椎均位于同一节段,其中顶椎位于胸椎10例、腰椎6例。于术前、术后及末次随访时在X线片上测量脊柱冠状面主弯Cobb角、矢状面后凸角、冠状面平衡及矢状面平衡,比较术前、术后及末次随访时影像学参数评估手术矫形效果。于术前、末次随访时填写SRS-22问卷量表,评估患者术后的生活质量变化。结果：手术融合节段5~12个,平均7.23个节段。手术时间3~7h,平均4.26h。术中出血量700～2500ml,平均1265ml。1例L1部位截骨患者术后出现双下肢痛觉过敏,急诊手术探查发现截骨部位硬脊膜皱褶,脊髓受压,对截骨部位椎板切开减压,术后症状明显好转,术后3个月随访神经症状消失。2例患者术后出现一侧胸腔积血,紧急行胸腔闭式引流术,1周后拔除引流管。15例患者获得6～48个月（平均13.4个月）随访。获得随访的15例患者冠状位主弯Cobb角术前为58.67°±20.36°（43°～97°）,术后为20.32°±8.76°（8°～37°）,末次随访时为21.76°±8.34°（10°～41°）,术后与术前比较差异有统计学意义（P<0.01）,矫正率为50.76%~82.36%,平均为65.36%,末次随访时与术后比较丢失率为2.45%。术前矢状位后凸角度为45.62°±16.26°（15°～70°）,术后为16.35°±16.87°（-20°～40°）,末次随访时为18.27°±13.92°（-15°～40°）,术后与术前比较差异有统计学意义（P<0.01）,矫正率为50.97%~79.32%,平均为64.16%,末次随访时与术后比较丢失率为4.2%。15例患者中,6例术前存在冠状面失平衡,术后均恢复平衡;4例术前存在矢状面失平衡,术后3例恢复平衡,1例仍为失平衡。SRS-22问卷量表总得分由术前66.47±12.35分（49～79分）提高至末次随访时的84.13±6.42分（76～92分）（P<0.01）。15例患者均获得骨性融合,无假关节形成或内固定断裂。结论：应用不对称经椎弓根截骨技术矫治先天性脊柱侧后凸畸形,可获得较好的矫形效果,显著改善患者躯体外观及躯体平衡,同时明显改善患者的生活质量。     

残端疝囊剥离联合腹股沟管引流对巨大腹股沟斜疝术后阴囊并发症的影响

目的探讨残端疝囊剥离联合腹股沟管引流对巨大腹股沟斜疝术后相关阴囊并发症的影响及残端疝囊剥离的手术技巧。方法回顾性分析2010年1月至2013年10月,成都军区总医院收治的巨大腹股沟斜疝患者20例临床资料,疝囊直径≥10cm,进入同侧阴囊。术中均完整剥离残端疝囊并在腹股沟管内放置血浆引流管引流。结果手术均取得成功,剥离残端疝囊时间为3～7min,平均4．6min。剥离残端疝囊出血量：出血量≤2ml12例,出血量～5ml 8例,术后住院时间1～3d,平均1．6d。术后阴囊无明显肿胀,无积液积血。患者无阴囊下坠等不适。结论精细解剖和分离疝外组织,完整剥离疝囊,彻底止血并联合腹股沟管内引流,可减少腹股沟疝术后阴囊并发症的发生。     

疝囊腹膜前间隙还原法治疗股疝疗效分析

目的探讨疝囊腹膜前间隙还原法治疗股疝的临床效果。方法回顾性分析2010年3月至2013年3月,西安电力中心医院采用疝囊腹膜前间隙还原法治疗股疝27例患者的临床资料。结果27例患者手术时间35～66min,平均46min。患者在术后24～48h均能够下床活动,切口仅有轻微疼痛,无发生切口感染、局部血肿等并发症,术后随访6～24个月,均无复发。结论疝囊腹膜前间隙还原法治疗股疝符合现代疝修补的理念,采用腹股沟入路的方式,易于掌握,效果良好,并发症少,值得推广。     

罗哌卡因局部浸润麻醉对腹股沟疝日间手术后早期切口疼痛的影响

目的：探讨罗哌卡因局部浸润麻醉对腹股沟疝日间手术后早期切口疼痛的影响,寻找影响早期切口疼痛的因素。方法回顾性分析2009年5月至2013年4月,首都医科大学宣武医院接受腹股沟疝日间手术,且在术毕接受罗哌卡因浸润麻醉患者的临床资料。于术后4、8、12、24、48 h记录患者的疼痛评分。多元Logistic 回归分析寻找术后早期切口疼痛的独立危险因素。结果共721例患者进入研究,患者术后4、8、12、24、48 h VAS评分分别为（2．52±1．47）分、（2．80±1．54）分、（1．72±0．89）分、（1．33±1．01）分、（0．46±0．25）分。WHO疼痛分级＞Ⅰ级患者比例分别为11．8％（85／721）、15．9％（115／721）、8．5％（61／721）、5．1％（36／721）、1．2％（9／721）。116例（16．1％）患者需要额外口服NSAIDs类止疼药,9例（1．2％）需要弱阿片类药物。回归分析表明患者年龄及BMI是术后早期疼痛的独立危险因素。结论罗哌卡因能使疝日间手术患者术后切口疼痛感处于一个较低的水平,患者年龄及BMI指数与术后早期疼痛显著相关。     

高龄腹股沟疝无张力修补日间手术的术式选择

目的 比较不同腹股沟疝无张力修补方式在高龄（≥70岁）患者中的疗效。方法 回顾性分析2009年5月至2013年4月,首都医科大学宣武医院接受腹股沟疝无张力修补日间手术的253例老年患者的临床资料料。依据术式不同分为疝环填充式修补组（157例）及腹膜前间隙修补组（96例）。比较二组患者术后总体并发症率、腹股沟区慢性疼痛及疝复发率。结果 腹膜前间隙修补组手术时间较疝环填充式修补组略长,但均未超过50min。二组患者术中麻醉药用量差异均有统计学意义（t=2．081,P=0．032）,术后镇痛比例比较差异有统计学意义（X^2=15．722,P=0．000）。疝环填充式修补组与腹膜前间隙修补组患者术后并发症率比较差异无统计学意义（X^2=0．024,P=0．878）,术后复发率差异无统计学意义（P=0．636）,术后切口区域慢性疼痛发生率差异无统计学意义（P=1．000）。结论老年患者经日间手术行腹股沟疝疝环填充式疝修补或腹膜前间隙修补均是安全可行的。     

拇指尺背侧岛状皮瓣修复拇指深度创面的临床应用

目的 了解拇指尺背侧岛状皮瓣修复拇指深度创面的效果 . 方法 2007年5 月-201 3年12月,笔者单位应用拇指尺背侧岛状皮瓣共修复22例患者拇指Ⅳ度损伤创面,创面面积为2.0cm×1.5cm～4.0cm×2.5cm,皮瓣切取面积为2.1cm×1.6cm～4.1cm×2.6cm,供瓣区均于同侧上臂内侧切取全厚皮片移植修复 . 结果 术后皮瓣全部成活,血运良好,拇指创面愈合良好,供瓣区移植皮片成活 . 术后随访6个月～1年,患者皮瓣质地、色泽、外形良好,患指功能恢复良好.结论 拇指尺背侧岛状皮瓣具有手术操作简单、术后成活率高、外形不臃肿等优点,是修复拇指深度创面的较佳选择.