临床判读结合超声测量直肠横径对儿童膀胱直肠功能障碍的诊断价值

目的 探讨临床判读联合经腹超声测量直肠横径（the rectum diameter,RD）对儿童膀胱直肠功能障碍（BBD）的诊断价值和临床应用。方法 选取2020年7月至2022年4月在我院泌尿外科门诊因排尿排便异常病史而疑诊为BBD的患儿167例作为观察组，均经相关检查排除身体解剖结构及神经系统异常。随机选取其中46位儿童家长填写BBD调查问卷（排泄功能异常温哥华症状评分表）。选取同期健康体检儿童172例为对照组，均无排尿排便异常症状，检查显示身体结构无异常。超声对两组儿童经腹壁进行膀胱后方RD测量。结果 观察组平均直肠横径（34.14±7.11）mm(95%CI:33.05～35.22)，对照组平均直肠横径（23.74±8.84）mm(95%CI:22.41～25.07)。观察组平均RD水平显著高于对照组，差异有统计学意义（P <0.05）。观察组中，有调查问卷的儿童与无调查问卷的儿童平均直肠横径差异无统计学意义（P> 0.05）。在治疗方案的选择上，临床判读+BBD调查问卷+超声直肠横径测量的诊断方法与仅有临床判读+超声直肠横径测量的诊断方法对最终治疗方案的选择差异无...     

区域性临床研究整合平台的建设探讨

目的 探讨国内建立区域性临床研究整合平台的可行方案，为研究者发起的临床研究（investigator initiated trial，IIT）提供数据支持。方法 总结国内外各类临床研究平台建设现状，以此为改进依据介绍上海交通大学医学院人工智能临床研究平台建设情况。结果 人工智能临床研究平台涵盖医学院附属医院的业务库文字及影像专病数据，支持回顾性与前瞻性临床研究，但在数据使用的伦理考量与共享机制等管理方面仍需要实践探索。结论 合规的区域性临床研究整合平台可支持科研人员发现临床问题、探索或验证临床假设，为开展多中心、大规模的IIT打下良好的数据基础。     

Clinical application of a Kirschner wire assisted double - hook water - injection hernia needle in complicated pediatric oblique inguinal hernia北大核心CSCD

Objective To explore the clinical value of single -hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double - hook water - injection hernia needle in treating complicated pediatric oblique inguinal hernia. Methods The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children's Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed. According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group. Children treated by a single - port laparoscopic double hook water -injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group. Children treated by a single - port laparoscopic Kirschner wire assisted double hook water - injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group. The independent sample t - test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery [(2. 87 ± 1. 88) years vs. (4. 91 ±2. 39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm3 vs. 9 650.97(3 849.24, 17 539.51) mm3]. The differences in the age at surgery and hernia sac volume were statistically significant (t - 5. 407, Z - 4. 218;all P <0. 001). There was no significant difference in body mass index between the 2 groups (P > 0. 05). Taking hernias with sac volume > 10 000 mm as huge hernias, there were 70. 18% (40/57 cases) and 47. 25% (146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively. The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group [(20(15, 20) min vs. 15 (15, 20) min] (Z - 2. 842, P < 0. 05). However, the operation time for huge oblique hernias with sac volume > 10 000 mm was not statistically significant between the 2 groups (P >0. 05). No recurrence in both groups was found during 6-1 6 months of follow - up. Conclusions For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas deferens and spermatic cord vessels smoothly. As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar. With good feasibility and safety, it is applicable for clinical popularization. © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.     

距下关节制动术治疗成人柔性平足症28例

目的:探讨距下关节制动术治疗成人Meryson分型Ⅱ期平足症的短期临床疗效。方法:回顾性分析2018年6月至2020年6月收治的采用距下关节制动术治疗的成年人平足症患者28例，共34足，均为Meryson分型Ⅱa期。其中男17例共22足，女11例共12足；年龄为21～60岁，平均年龄为(36.15±8.80)岁。术前测量所有患者的足部负重位X线片的Meary角、Pitch角、距骨第三跖骨角、跟骨外翻角、距舟覆盖角(Talonavicular Coverage Angle, TCA),并评估所有患者的美国骨科足踝协会(American Orthopedic Foot and Ankle Society, AOFAS)踝与后足评分及视觉模拟量表(VAS)评分并予以记录，用来评估影像学指标、足部功能及疼痛。随访末期记录相同观察指标并予以记录，比较各项指标是否与术前有统计学差异。结果:术后所有患者均获随访，随访时间为8～16个月，平均随访时间为(11.60±1.42)个月。术后随访第6个月足部负重位X线片评价正位Meary角为2.82°±1.65°,Pitch角为22.24°±2.60°,侧位...