The role for hip surveillance in children with cerebral palsy

Spastic hip displacement is the second most common deformity seen in children with cerebral palsy (CP), and the long-term effects can be debilitating. Progressive hip displacement leading to dislocation can result in severe pain as well as impaired function and quality of life. Recent population-based studies have demonstrated that a child’s Gross Motor Functional Classification System (GMFCS) level is most predictive for identifying hips “at-risk” for progressive lateral displacement. As a result, in many developed countries, hip surveillance has now been adopted as an integral piece of the comprehensive care puzzle for the management of children with spastic hip displacement. This paper reviews the spectrum of treatments available for progressive hip displacement, examines the current literature on the success of hip surveillance, and illustrates an example of a current hip surveillance program stratified by the GMFCS level.     

Le blood-patch : un remède d’efficacité immédiate pour les céphalées secondaires aux brèches dure-mériennes

Objective

The aim of this study was to evaluate if bed rest during 2 h in a supine posture is required to improve the efficacy of the blood-patch procedure.

Patients and methods

Patients whose postdural puncture headache remained distressing 48 to 72 h after dural tap despite the use of stage II WHO painkillers were included in this prospective single center study lasted for a 2-year period. The patient's own blood injection in the epidural space was performed until discomfort or pain in the lumbar area occurred or was limited to 20 ml if no such sensation was observed. After blood had been injected, the patient was allowed to stand up as soon as desired, under close observation. The patient was then discharged to the ward for a 48 h follow-up.

Results

Nine female and 12 male patients (age: 16–35 years) were included. Headache occurred after spinal anaesthesia in 16 cases, epidural analgesia for delivery in two cases and lumbar puncture by during neurological workup in three cases. Autologous blood volume injected was 20 ml in 19 patients and was reduced to 18 and 16 ml, respectively, in two patients due to lumbar pain. All blood-patches were technically uneventful and led to immediate headache relief, associated with a feeling of wellbeing and desire to stand up. The 48 following hours were without any incident and painkillers were no more needed.

Conclusion

In this prospective study, blood-patch was mainly performed after spinal anaesthesia and was associated with a high rate success. This encouraging result suggests that recumbent position maintained for 2 h after the blood-patch is performed might not be necessary to obtain full efficacy.     

膝内翻引起胫骨平台内侧骨质增生的模拟

本研究首先采用非线性骨再造速率方程和有限元方法相结合，引入拓扑优化思想，从不确定外形出发，模拟了正常力学环境下的胫骨上端外部形状和内部结构。然后以得到的正常力学环境下的胫骨上端外部形状和内部结构为初始模型，根据骨质增生形成的过程，提出膝内翻时胫骨平台上所受压力的分布随内翻角度的变化以及骨质增生过程中平台上受力分布和骨刺上压力分布改变的假设。模拟了膝内翻引起胫骨平台内侧的骨质增生。在模拟的过程中，总结出了一种符合骨质增生生理过程的模拟方法。     

数字化设计导航模板辅助儿童肘内翻截骨术的应用研究进展

目的:总结数字化设计导航模板在儿童肘内翻矫形截骨术中的研究进展。方法:在中国知网、万方数据库、中国生物医学文献数据库和Web of Science、PubMed、EMBASE数据库上进行文献检索,分别以"3D打印""导航模板""数字化""三维重建""矫形""肘内翻"和"3D printing""navigational...     

建立骨折后迟缓肘内翻畸形动物模型的方法

目的建立缓发型肘内翻畸形动物模型.方法53只未发育成熟兔左肱骨下端内侧骨骺部形成不完全骨折.结果造模后内翻程度平均达6.759°;且经7批次造模,每批次内翻程度间未发现有显著性差异(P＞0.05).结论该造模方法具有可行性与可重复性.由于其内翻畸形是在40d内逐渐完成,故相当于儿童肘部骨折后出现的继发性内翻畸形.