Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.01.004
D. Pan, Wenya Xie, Zhongyuan Sun, X. Mu, Huifeng Liu, Min Yang, Xiaoyong Li, L. Shao
Objective To summarize the clinical characteristics, treatments and prognoses of congenital diaphagmatic hernia (CDH) in prenatal undiagnosed neonates and to explore the clinical diagnostic and therapeutic experiences of neonatal CDH at a non-tertiary center. Methods From January 2010 to December 2018, a total of 136 CDH neonates were admitted by emergency clinic. Five untreated cases due to special reasons were excluded. No prenatal diagnosis was made. There were 77 boys and 54 girls with a gestational age of (38.3±1.5)(32.0-41.0) weeks and a birth weight of (3102.8±473.6)(2000.0-4120.0) grams. The involved side was left (n=115) and right (n=16). The complications included pulmonary hypertension (n=21) and associated malformations (n=81). The preoperative status was mechanical ventilation (n=92) and spontaneous breathing (n=39). According to admission age, they were divided into two group of admission before and after 48 hours after birth. Results The specific procedures included thoracoscopy (n=58) and laparotomy (n=14). Death occurred preoperatively (n=2) and postoperatively (n=12). Two actively treated cases eventually died preoperatively and 129 cases were operated. Twelve cases died or abandoned treatment at post-operation and 117 cases (89.3%) survived. The mortality rate of ≤48 h admission group (14/90, 15.6%) was higher than that of >48 h admission group (0)(P<0.05). The mortality rate of premature infants, pulmonary hypertension and severe cardiac malformation were relatively high (P<0.05). And the values of pH and PaO2 at admission, mean postoperative pH in deceased cases were significantly lower than those in survivors. And PaCO2 at admission was significantly higher in deceased cases than that in survivors (P<0.05). Conclusions Prenatally undiagnosed neonatal CDH, especially in severe cases, may present challenges for postpartum treatment. With earlier onset and more severe condition, the higher mortality rate will be. Mortality is higher in CDH with pulmonary hypertension, preterm birth and severe cardiac malformation. Key words: Infant, newborn; Diaphragmatic hernia; Prenatal diagnosis; Therapy; Prognosis
{"title":"Clinical diagnoses and treatments of congenital diaphragmatic hernia of neonates without a prenatal diagnosis","authors":"D. Pan, Wenya Xie, Zhongyuan Sun, X. Mu, Huifeng Liu, Min Yang, Xiaoyong Li, L. Shao","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.004","url":null,"abstract":"Objective \u0000To summarize the clinical characteristics, treatments and prognoses of congenital diaphagmatic hernia (CDH) in prenatal undiagnosed neonates and to explore the clinical diagnostic and therapeutic experiences of neonatal CDH at a non-tertiary center. \u0000 \u0000 \u0000Methods \u0000From January 2010 to December 2018, a total of 136 CDH neonates were admitted by emergency clinic. Five untreated cases due to special reasons were excluded. No prenatal diagnosis was made. There were 77 boys and 54 girls with a gestational age of (38.3±1.5)(32.0-41.0) weeks and a birth weight of (3102.8±473.6)(2000.0-4120.0) grams. The involved side was left (n=115) and right (n=16). The complications included pulmonary hypertension (n=21) and associated malformations (n=81). The preoperative status was mechanical ventilation (n=92) and spontaneous breathing (n=39). According to admission age, they were divided into two group of admission before and after 48 hours after birth. \u0000 \u0000 \u0000Results \u0000The specific procedures included thoracoscopy (n=58) and laparotomy (n=14). Death occurred preoperatively (n=2) and postoperatively (n=12). Two actively treated cases eventually died preoperatively and 129 cases were operated. Twelve cases died or abandoned treatment at post-operation and 117 cases (89.3%) survived. The mortality rate of ≤48 h admission group (14/90, 15.6%) was higher than that of >48 h admission group (0)(P<0.05). The mortality rate of premature infants, pulmonary hypertension and severe cardiac malformation were relatively high (P<0.05). And the values of pH and PaO2 at admission, mean postoperative pH in deceased cases were significantly lower than those in survivors. And PaCO2 at admission was significantly higher in deceased cases than that in survivors (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Prenatally undiagnosed neonatal CDH, especially in severe cases, may present challenges for postpartum treatment. With earlier onset and more severe condition, the higher mortality rate will be. Mortality is higher in CDH with pulmonary hypertension, preterm birth and severe cardiac malformation. \u0000 \u0000 \u0000Key words: \u0000Infant, newborn; Diaphragmatic hernia; Prenatal diagnosis; Therapy; Prognosis","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"54 1","pages":"18-22"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80283244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.004
Zhe Yuan, Yiqiang Li, Min Ye, Yuanzhong Liu, Jingchun Li, F. Xun, Yanhan Liu
Objective To explore the risk factors of failed reduction after closed reduction in children with developmental dysplasia of the hip (DDH). Methods Retrospective reviews were conducted for the clinical and radiographic data of DDH children undergoing closed reduction and cast immobilization from July 2015 to November 2018. The relevant clinical data were collected, including age, gender, sideness, pavlic treatment pre-reduction, appearance of epiphyseal ossification center, International Hip Dysplasia Institute (IHDI) grade, acetabular index (AI), safe zoom, inverted limbus, medial pool distance of hip (MPD) and abduction angle of hip. The risk factors of failed reduction were evaluated by Logistic regression, t test and Chi-square test and fisher exact probability. Results Sixteen hips (9.2%) failed to achieve initial stable reduction and yet 7 hips (43.8%) obtained stable reduction through a second closed reduction and modified cast immobilization. Thus the modified rate of failed closed reduction was 5.2%(9/173). Single factor Logistic regression indicated that the failure of closed reduction was associated with gender, age, AI, inverted limbus and MPD. Multiple factor Logistic regression showed that MPD and AI are the risk factors. Receiver operating characteristic curve (ROC) showed MPD >6 mm were the risk factors of failure of closed reduction for DDH. The failure rate of closed reduction in children with indistinct limbus (83.3%, 5/6) and medial pool (36.8%, 7/19) on arthrography were significantly higher than those with distinct limbus (6.5%, 11/167) and medial pool (5.8%, 9/154) on arthrography (P<0.001). According to the outcome of closed reduction, they were divided into two groups of successful closed reduction (n=157) and failed closed reduction (n=16). The difference of AI of both groups (36.8°±4.5 and 34.4°±3.7° respectively) are statistically significant (P<0.05). Conclusions AI and MPD are the risk factors of failure closed reduction. Patients with MPD >6 mm during operation significantly increase the risk of failure of closed reduction for DDH.Unclearness of limbus and medial pool of hip during arthrography hint the failure of closed reduction for DDH. Key words: Hip joint; Close reduction; Risk factor; Developmental dysplasia of the hip
{"title":"The risk factors of failure of reduction in children with developmental dysplasia of the hip treated by closed reduction and cast immobilization","authors":"Zhe Yuan, Yiqiang Li, Min Ye, Yuanzhong Liu, Jingchun Li, F. Xun, Yanhan Liu","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.004","url":null,"abstract":"Objective \u0000To explore the risk factors of failed reduction after closed reduction in children with developmental dysplasia of the hip (DDH). \u0000 \u0000 \u0000Methods \u0000Retrospective reviews were conducted for the clinical and radiographic data of DDH children undergoing closed reduction and cast immobilization from July 2015 to November 2018. The relevant clinical data were collected, including age, gender, sideness, pavlic treatment pre-reduction, appearance of epiphyseal ossification center, International Hip Dysplasia Institute (IHDI) grade, acetabular index (AI), safe zoom, inverted limbus, medial pool distance of hip (MPD) and abduction angle of hip. The risk factors of failed reduction were evaluated by Logistic regression, t test and Chi-square test and fisher exact probability. \u0000 \u0000 \u0000Results \u0000Sixteen hips (9.2%) failed to achieve initial stable reduction and yet 7 hips (43.8%) obtained stable reduction through a second closed reduction and modified cast immobilization. Thus the modified rate of failed closed reduction was 5.2%(9/173). Single factor Logistic regression indicated that the failure of closed reduction was associated with gender, age, AI, inverted limbus and MPD. Multiple factor Logistic regression showed that MPD and AI are the risk factors. Receiver operating characteristic curve (ROC) showed MPD >6 mm were the risk factors of failure of closed reduction for DDH. The failure rate of closed reduction in children with indistinct limbus (83.3%, 5/6) and medial pool (36.8%, 7/19) on arthrography were significantly higher than those with distinct limbus (6.5%, 11/167) and medial pool (5.8%, 9/154) on arthrography (P<0.001). According to the outcome of closed reduction, they were divided into two groups of successful closed reduction (n=157) and failed closed reduction (n=16). The difference of AI of both groups (36.8°±4.5 and 34.4°±3.7° respectively) are statistically significant (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000AI and MPD are the risk factors of failure closed reduction. Patients with MPD >6 mm during operation significantly increase the risk of failure of closed reduction for DDH.Unclearness of limbus and medial pool of hip during arthrography hint the failure of closed reduction for DDH. \u0000 \u0000 \u0000Key words: \u0000Hip joint; Close reduction; Risk factor; Developmental dysplasia of the hip","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"48 1","pages":"1077-1082"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78257452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.009
Ling Liu, Qiang Bai, Chao Li, Yuhui Jiang, Lingyu Zhou, Min Xi, Shudi Yang
Objective To explore the feasibility and clinical efficacy of enhanced recovery after surgery (ERAS) concept of multi-disciplinary treatment (MDT) medical mode in perioperative application of congenital duodenal obstruction. Methods From June 2015 to December 2017, retrospective analysis was performed for 60 cases with congenital duodenal obstruction. According to parental wishes, they were divided into research group (ERAS of MDT mode, n=30) and control group (traditional methods, n=30), which were compared in postoperative milk for initial open time, operative duration, postoperative parenteral nutrition using days, postoperative complications, length of time and hospitalization expenses, etc. Results Time of initial milk intake, days of using parenteral nutrition and hospital stay in ERAS group were shorter than those of control group [(56.45±6.18) vs. (140.40±1.00) hours, (7.35±1.46) vs. (17.25±3.59) days and (11.2±1.76) vs. (22.3±4.15) days. And the differences were statistically significant (P 0.05). During a follow-up period of 8-12 weeks, no incisional infection or adhesive intestinal obstruction occurred in ERAS group and there was only 1 case (3.3%) of adhesive intestinal obstruction in control group. Conclusions ERAS concept of MDT medical mode is both safe and effective for perioperative management of children with congenital duodenal obstruction. It offers the advantages of reducing pains, accelerating postoperative rehabilitation and shortening hospitalization time. Key words: Infant; Duodenal obstruction; Enhanced recovery after surgery
{"title":"Application of enhanced recovery after surgery concept of multi-disciplinary treatment medical treatment for congenital duodenal obstruction during perioperative period","authors":"Ling Liu, Qiang Bai, Chao Li, Yuhui Jiang, Lingyu Zhou, Min Xi, Shudi Yang","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.009","url":null,"abstract":"Objective \u0000To explore the feasibility and clinical efficacy of enhanced recovery after surgery (ERAS) concept of multi-disciplinary treatment (MDT) medical mode in perioperative application of congenital duodenal obstruction. \u0000 \u0000 \u0000Methods \u0000From June 2015 to December 2017, retrospective analysis was performed for 60 cases with congenital duodenal obstruction. According to parental wishes, they were divided into research group (ERAS of MDT mode, n=30) and control group (traditional methods, n=30), which were compared in postoperative milk for initial open time, operative duration, postoperative parenteral nutrition using days, postoperative complications, length of time and hospitalization expenses, etc. \u0000 \u0000 \u0000Results \u0000Time of initial milk intake, days of using parenteral nutrition and hospital stay in ERAS group were shorter than those of control group [(56.45±6.18) vs. (140.40±1.00) hours, (7.35±1.46) vs. (17.25±3.59) days and (11.2±1.76) vs. (22.3±4.15) days. And the differences were statistically significant (P 0.05). During a follow-up period of 8-12 weeks, no incisional infection or adhesive intestinal obstruction occurred in ERAS group and there was only 1 case (3.3%) of adhesive intestinal obstruction in control group. \u0000 \u0000 \u0000Conclusions \u0000ERAS concept of MDT medical mode is both safe and effective for perioperative management of children with congenital duodenal obstruction. It offers the advantages of reducing pains, accelerating postoperative rehabilitation and shortening hospitalization time. \u0000 \u0000 \u0000Key words: \u0000Infant; Duodenal obstruction; Enhanced recovery after surgery","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"4 1","pages":"1108-1112"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87681025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.003
Shuai Liu, Min-gang Zhang, Tianyou Li
Objective To observe the pathological changes of re-dislocation of developmental dysplasia of the hip (DDH) undergoing pelvic osteotomy in children, to predict the outcome of Dega osteotomy assisted with three-dimensional computed tomography (3DCT) simulating osteotomy and to explore the individual therapeutics for re-dislocation of DDH. Methods From July 2012 to June 2017, retrospective analysis was conducted for a total of 28 hips in 27 children with re-dislocated DDH undergoing a second Dega osteotomy. There were 9 involved hips in 8 boys and 19 involved hips in 19 girls with an average age of 51 (28-96) months during the second operation. The involved side was left (n=17), right (n=9) and bilateral (n=1). According to the Tonnis classification scheme, the clinical types were Ⅱ (17 hips), Ⅲ (8 hips) and Ⅳ (3 hips). And the procedures included Salter osteotomy (20 hips), Dega osteotomy (1 hip), Dega osteotomy with intact inner wall (3 hips) and Pemberton osteotomy (4 hips). A simulating osteotomy by 3DCT of pelvis-femurs was performed preoperatively and Dega osteotomy with open reduction plus capsuloplasty and proximal femoral osteotomy were applied simultaneously. The preoperative and postoperative changes of acetabular index and Reimer's index were compared and P<0.01 was deemed as statistically significant. Radiological findings and improvements of extremity functions were evaluated at the latest follow-up. Results 28 involved hips were followed up successfully with an average period of 33(18-38) months. Acetabular index improved from (31°±8°) to (11°±4°) and Reimer's index decreased (0.78±0.21) to (0.16±0.03) with statistically significant differences in both acetabular and Reimer's indices pre-reoperation and at the latest follow-up (P<0.01). Disrupted preoperative Shenton lines in all hips became continuous during follow-ups. No postoperative re-dislocation was seen. Based upon the modified Severin classification scheme, the outcomes were excellent (19 hips), good (7 hips) and moderate (2 hips). And the excellent-good rate was 93%(26/28); based upon the modified McKay classification scheme, the outcomes were excellent (20 hips), good (7 hips) and moderate (1 hip). And the excellent-good rate was 96%(27/28). There was no occurrence of infection, fracture or vascular/nervous injury. Conclusions With more precise designs, meticulous operations and intuitive outcomes may be achieved with an aid of 3DCT. The short-term effect of Dega osteotomy plus open reduction, capsuloplasty and proximal femoral osteotomy for re-dislocated of DDH undergoing pelvic osteotomyis is definite. And it should be further popularized clinically in children. Key words: Osteotomy; Three-Dimensional; Developmental dysplasia of the hip
{"title":"Dega osteotomy assisted with three-dimensional computed tomography for re-dislocation of developmental dysplasia of the hip in children","authors":"Shuai Liu, Min-gang Zhang, Tianyou Li","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.003","url":null,"abstract":"Objective \u0000To observe the pathological changes of re-dislocation of developmental dysplasia of the hip (DDH) undergoing pelvic osteotomy in children, to predict the outcome of Dega osteotomy assisted with three-dimensional computed tomography (3DCT) simulating osteotomy and to explore the individual therapeutics for re-dislocation of DDH. \u0000 \u0000 \u0000Methods \u0000From July 2012 to June 2017, retrospective analysis was conducted for a total of 28 hips in 27 children with re-dislocated DDH undergoing a second Dega osteotomy. There were 9 involved hips in 8 boys and 19 involved hips in 19 girls with an average age of 51 (28-96) months during the second operation. The involved side was left (n=17), right (n=9) and bilateral (n=1). According to the Tonnis classification scheme, the clinical types were Ⅱ (17 hips), Ⅲ (8 hips) and Ⅳ (3 hips). And the procedures included Salter osteotomy (20 hips), Dega osteotomy (1 hip), Dega osteotomy with intact inner wall (3 hips) and Pemberton osteotomy (4 hips). A simulating osteotomy by 3DCT of pelvis-femurs was performed preoperatively and Dega osteotomy with open reduction plus capsuloplasty and proximal femoral osteotomy were applied simultaneously. The preoperative and postoperative changes of acetabular index and Reimer's index were compared and P<0.01 was deemed as statistically significant. Radiological findings and improvements of extremity functions were evaluated at the latest follow-up. \u0000 \u0000 \u0000Results \u000028 involved hips were followed up successfully with an average period of 33(18-38) months. Acetabular index improved from (31°±8°) to (11°±4°) and Reimer's index decreased (0.78±0.21) to (0.16±0.03) with statistically significant differences in both acetabular and Reimer's indices pre-reoperation and at the latest follow-up (P<0.01). Disrupted preoperative Shenton lines in all hips became continuous during follow-ups. No postoperative re-dislocation was seen. Based upon the modified Severin classification scheme, the outcomes were excellent (19 hips), good (7 hips) and moderate (2 hips). And the excellent-good rate was 93%(26/28); based upon the modified McKay classification scheme, the outcomes were excellent (20 hips), good (7 hips) and moderate (1 hip). And the excellent-good rate was 96%(27/28). There was no occurrence of infection, fracture or vascular/nervous injury. \u0000 \u0000 \u0000Conclusions \u0000With more precise designs, meticulous operations and intuitive outcomes may be achieved with an aid of 3DCT. The short-term effect of Dega osteotomy plus open reduction, capsuloplasty and proximal femoral osteotomy for re-dislocated of DDH undergoing pelvic osteotomyis is definite. And it should be further popularized clinically in children. \u0000 \u0000 \u0000Key words: \u0000Osteotomy; Three-Dimensional; Developmental dysplasia of the hip","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"107 1","pages":"1071-1076"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91192609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.015
Ningning Yang, Qian Zhang, Ji Li, Lei Wang, Meng Su
{"title":"Three cases of polyrchidism","authors":"Ningning Yang, Qian Zhang, Ji Li, Lei Wang, Meng Su","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.015","url":null,"abstract":"","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"4 1","pages":"1134-1136"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89368168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.013
Xiaoliang Chen, Zhi-guo Zhou, Xiong-tao Li, Ji Wu, Ping Zhang
Objective To explore the efficacies of arthroscopic treatment for aged anterior tibial spine fracture with polydioxanone (PDS-II) suture fixation in children and to provide an effective, safe, reliable and mini-invasive treatment for old anterior tibial spine fracture. Methods Retrospective analysis was performed for 7 children with old tibial intercondylar spine fracture from January 2014 to January 2017. There were 5 boys and 2 girls. According to the Meyers & McKeever classification scheme, the fractures were divided into type Ⅱ (n=3) and type Ⅲ (n=4). All of them underwent arthroscopic reduction and PDS-Ⅱ absorbable suture for fixation. Gypsum was removed at 4 weeks postoperatively and functional exercises began. Weight was partially loaded at 6 weeks post-operation and completely loaded at 12 weeks postoperatively. Lysholm knee score was employed for evaluating knee functions before operation and at the last follow-up. At the last follow-up, standing plain films of both lower extremities were taken for recording the length of both lower extremities and the presence of varus deformity of knee joint. Results The average follow-up period was 15.3(12-18) months. All of them achieved primary healing within 3 months. The average motion range of knee joints normalized at 3 months postoperatively. There was no limitation of knee extension/flexion, pain or swelling of knee joint. Both anterior drawer and Lachman tests were negative. The average Lysholm score at the last follow-up was (93.8±3.1) as compared with the preoperative Lysholm score of (42.7±2.7). And the difference was statistically significant (t=63.96, P<0.01). Conclusions Arthroscopic fixation with absorbable suture is both safe and effective for old tibial intercondylar spine fracture in children. As a mini-invasive procedure, its curative effect is satisfactory and wider popularization is recommended. Key words: Arthroscopy; Tibial spine fracture; Old fracture
{"title":"Arthroscopic treatment for aged anterior tibial spine fracture with absorbable suture fixation in children","authors":"Xiaoliang Chen, Zhi-guo Zhou, Xiong-tao Li, Ji Wu, Ping Zhang","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.013","url":null,"abstract":"Objective \u0000To explore the efficacies of arthroscopic treatment for aged anterior tibial spine fracture with polydioxanone (PDS-II) suture fixation in children and to provide an effective, safe, reliable and mini-invasive treatment for old anterior tibial spine fracture. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for 7 children with old tibial intercondylar spine fracture from January 2014 to January 2017. There were 5 boys and 2 girls. According to the Meyers & McKeever classification scheme, the fractures were divided into type Ⅱ (n=3) and type Ⅲ (n=4). All of them underwent arthroscopic reduction and PDS-Ⅱ absorbable suture for fixation. Gypsum was removed at 4 weeks postoperatively and functional exercises began. Weight was partially loaded at 6 weeks post-operation and completely loaded at 12 weeks postoperatively. Lysholm knee score was employed for evaluating knee functions before operation and at the last follow-up. At the last follow-up, standing plain films of both lower extremities were taken for recording the length of both lower extremities and the presence of varus deformity of knee joint. \u0000 \u0000 \u0000Results \u0000The average follow-up period was 15.3(12-18) months. All of them achieved primary healing within 3 months. The average motion range of knee joints normalized at 3 months postoperatively. There was no limitation of knee extension/flexion, pain or swelling of knee joint. Both anterior drawer and Lachman tests were negative. The average Lysholm score at the last follow-up was (93.8±3.1) as compared with the preoperative Lysholm score of (42.7±2.7). And the difference was statistically significant (t=63.96, P<0.01). \u0000 \u0000 \u0000Conclusions \u0000Arthroscopic fixation with absorbable suture is both safe and effective for old tibial intercondylar spine fracture in children. As a mini-invasive procedure, its curative effect is satisfactory and wider popularization is recommended. \u0000 \u0000 \u0000Key words: \u0000Arthroscopy; Tibial spine fracture; Old fracture","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"30 1","pages":"1128-1131"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89952630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.008
Xin Li, Chen Yu, Wei Gao, Xiao-li Hu, J. Zhan
Objective To explore the pathological changes of intrahepatic bile duct development and liver fibrosis in children with biliary dysplasia at different ages and to explore the effect of intrahepatic bile duct development on liver fibrosis. Methods From January 2015 to January 2019, a total of 16 hospitalized children with biliary dysplasia at Municipal Children's Hospital and First Central Municipal Hospital were recruited and divided into two groups according to age, i. e. <180 days (G1, n=8) and ≥180 days (G2, n=8). Liver biopsy specimens were harvested intraoperatively for routine hematoxylin & eosin and immunohistochemical staining (CK19 & EMA). The major histopathological changes of liver, such as ratio of interlobular bile duct to portal area, diameter of interlobular bile duct, ductal proliferation, liver fibrosis, cholestasis, bile plugs in ductules and an infiltration of inflammatory cells in portal region, were analyzed. Results The pathological changes of G1 and G2 groups showed that the degree of liver fibrosis in G2 group was higher than that in G1 group [0.5(0, 1) vs. 4(2.25, 4)]. The inter-group difference was statistically significant (Z=3.467, P<0.001); The ratio of interlobular bile duct to portal area was lower in G2 group than that in G1 group [0.25(0.16, 0.34) vs. 0]. The inter-group difference was statistically significant (Z=2.663, P<0.05); The degree of ductal proliferation showed that G2 group was significantly higher than G1 group [1(0.25, 2) vs. 2.5(2, 3.75)]. The inter-group difference was statistically significant (Z=2.867, P<0.05). The expression of EMA was significantly lower in G2 group than that in G1 group [(0.034±0.012) vs. (0.082±0.009)]. The inter-group difference was statistically significant (t=9.432, P<0.001); The expression of CK19 was significantly higher in G2 group than that in G1 group [(0.201±0.016) vs. (0.135±0.010)]. There was significant inter-group difference (t=9.615, P<0.001). Correlation analysis of intrahepatic bile duct development revealed: ratio of interlobular bile duct to portal area and age of children (rs=-0.714, P=0.002), ductal proliferation (rs=-0.610, P=0.012) and liver fibrosis (rs=-0.533, P<0.05) showed a significant negative correlation. Conclusions With the aging of the patients, interlobular bile duct of children with biliary dysplasia decreases gradually. And the degree of hepatic fibrosis continues aggravating with a poor prognosis. Key words: Hepatic fibrosis; Interlobular bile duct; Deficiency symptom; Bile duct; Hyperplasia
{"title":"Relationship between intrahepatic bile duct development and hepatic fibrosis in children with biliary dysplasia","authors":"Xin Li, Chen Yu, Wei Gao, Xiao-li Hu, J. Zhan","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.008","url":null,"abstract":"Objective \u0000To explore the pathological changes of intrahepatic bile duct development and liver fibrosis in children with biliary dysplasia at different ages and to explore the effect of intrahepatic bile duct development on liver fibrosis. \u0000 \u0000 \u0000Methods \u0000From January 2015 to January 2019, a total of 16 hospitalized children with biliary dysplasia at Municipal Children's Hospital and First Central Municipal Hospital were recruited and divided into two groups according to age, i. e. <180 days (G1, n=8) and ≥180 days (G2, n=8). Liver biopsy specimens were harvested intraoperatively for routine hematoxylin & eosin and immunohistochemical staining (CK19 & EMA). The major histopathological changes of liver, such as ratio of interlobular bile duct to portal area, diameter of interlobular bile duct, ductal proliferation, liver fibrosis, cholestasis, bile plugs in ductules and an infiltration of inflammatory cells in portal region, were analyzed. \u0000 \u0000 \u0000Results \u0000The pathological changes of G1 and G2 groups showed that the degree of liver fibrosis in G2 group was higher than that in G1 group [0.5(0, 1) vs. 4(2.25, 4)]. The inter-group difference was statistically significant (Z=3.467, P<0.001); The ratio of interlobular bile duct to portal area was lower in G2 group than that in G1 group [0.25(0.16, 0.34) vs. 0]. The inter-group difference was statistically significant (Z=2.663, P<0.05); The degree of ductal proliferation showed that G2 group was significantly higher than G1 group [1(0.25, 2) vs. 2.5(2, 3.75)]. The inter-group difference was statistically significant (Z=2.867, P<0.05). The expression of EMA was significantly lower in G2 group than that in G1 group [(0.034±0.012) vs. (0.082±0.009)]. The inter-group difference was statistically significant (t=9.432, P<0.001); The expression of CK19 was significantly higher in G2 group than that in G1 group [(0.201±0.016) vs. (0.135±0.010)]. There was significant inter-group difference (t=9.615, P<0.001). Correlation analysis of intrahepatic bile duct development revealed: ratio of interlobular bile duct to portal area and age of children (rs=-0.714, P=0.002), ductal proliferation (rs=-0.610, P=0.012) and liver fibrosis (rs=-0.533, P<0.05) showed a significant negative correlation. \u0000 \u0000 \u0000Conclusions \u0000With the aging of the patients, interlobular bile duct of children with biliary dysplasia decreases gradually. And the degree of hepatic fibrosis continues aggravating with a poor prognosis. \u0000 \u0000 \u0000Key words: \u0000Hepatic fibrosis; Interlobular bile duct; Deficiency symptom; Bile duct; Hyperplasia","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"4 1","pages":"1102-1107"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80024799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.014
Ting Li
{"title":"Large twisted ovarian fibroma in a 4-year-old girl: One case report","authors":"Ting Li","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.014","url":null,"abstract":"","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"81 3 1","pages":"1132-1133"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73209355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.006
JianPing Wu, Yiqiang Li, Jingchun Li, Zhe Yuan, F. Xun, Yanhan Liu, Yuanzhong Liu
Objective To explore the size of femoral head and its influencing factors in children with developmental dysplasia of the hip (DDH) and to examine the effect of size of femoral head and ossific nucleus on the development of avascular necrosis of femoral head (AVN) after closed reduction (CR). Methods Retrospective reviews were conducted for a consecutive series of DDH children undergoing CR. A total of 124 hips (111 children; mean age: 15.6±3.6 months) were included. The diameter (including anteroposterior, transverse & axial) and height of femoral head and ossific nucleus were assessed by magnetic resonance imaging (MRI) on coronal plane. And AVN was evaluated by the criteria of Kalamchi-MacEwen. Results The anteroposterior diameter of femoral head (1.91±0.27) cm, transverse diameter of femoral head (1.82±0.26) cm, height of femoral head (1.08±0.18) cm, anteroposterior of ossific nucleus (0.59±0.35) cm, transverse of ossific nucleus (0.49±0.28) cm, height of ossific nucleus (0.36±0.20) cm at contralateral side including 124 hips were significantly less developed than those at dislocated side including 98 hips (2.21±0.30), (2.27±0.19), (1.33±0.16), (1.06±0.33), (1.01±0.28) and (0.68±0.18) cm (P<0.001). AVN occurred in 21/124 hips (16.9%). According to the age, we divided the children into three groups. Group A: 6 ~ 12 months (20 hips), Group B: 13 ~ 18 months (77 hips), Group C: 19 ~ 24 months (27 hips). The rate of AVN was 30.0% (6/20) at group A, 18.2% (14/77) at group B and 3.7% (1/27) at group C. And the rate of AVN between the three groups was statistically different (χ2=6.800, P=0.033). For hip with AVN after closed reduction, anteroposterior diameter of femoral head (1.79±0.24) cm, transverse diameter of femoral head (1.69±0.19) cm and the anteroposterior diameter of ossific nudes(0.44±0.33)cm were less developed than those without AVN (1.98±0.27) cm, (1.89±0.28) cm and (0.62±0.36)cm (P<0.05). Spearman's correlation analysis showed that diameter of femoral head, diameter/height of ossific nucleus significantly increased with age but not height of femoral head; age was negatively correlated with the incidence of AVN (r=-0.274, P=0.002). The diameter of femoral head has significantly negative association with AVN grade (P<0.005). No significant association was observed between AVN grade and height of femoral head, presence of ossific nucleus, diameter/height of ossific nucleus and ratio of ossific nucleus to femoral head. Conclusions The size of femoral head at dislocated side is significantly worse than at contralateral side. And diameter of femoral head and diameter/height of ossific nucleus increase with advancing age. A significantly negative association exists between rate of AVN and diameter of femoral head. And it is unrelated with height of femoral head or size of ossific nucleus. Key words: Femoral head; Hip Joint; Closed reduction; Avascular necrosis of femoral head
{"title":"Size of femoral head and its impact on the incidence of avascular necrosis in patients with developmental dysplasia of the hip after closed reduction","authors":"JianPing Wu, Yiqiang Li, Jingchun Li, Zhe Yuan, F. Xun, Yanhan Liu, Yuanzhong Liu","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.006","url":null,"abstract":"Objective \u0000To explore the size of femoral head and its influencing factors in children with developmental dysplasia of the hip (DDH) and to examine the effect of size of femoral head and ossific nucleus on the development of avascular necrosis of femoral head (AVN) after closed reduction (CR). \u0000 \u0000 \u0000Methods \u0000Retrospective reviews were conducted for a consecutive series of DDH children undergoing CR. A total of 124 hips (111 children; mean age: 15.6±3.6 months) were included. The diameter (including anteroposterior, transverse & axial) and height of femoral head and ossific nucleus were assessed by magnetic resonance imaging (MRI) on coronal plane. And AVN was evaluated by the criteria of Kalamchi-MacEwen. \u0000 \u0000 \u0000Results \u0000The anteroposterior diameter of femoral head (1.91±0.27) cm, transverse diameter of femoral head (1.82±0.26) cm, height of femoral head (1.08±0.18) cm, anteroposterior of ossific nucleus (0.59±0.35) cm, transverse of ossific nucleus (0.49±0.28) cm, height of ossific nucleus (0.36±0.20) cm at contralateral side including 124 hips were significantly less developed than those at dislocated side including 98 hips (2.21±0.30), (2.27±0.19), (1.33±0.16), (1.06±0.33), (1.01±0.28) and (0.68±0.18) cm (P<0.001). AVN occurred in 21/124 hips (16.9%). According to the age, we divided the children into three groups. Group A: 6 ~ 12 months (20 hips), Group B: 13 ~ 18 months (77 hips), Group C: 19 ~ 24 months (27 hips). The rate of AVN was 30.0% (6/20) at group A, 18.2% (14/77) at group B and 3.7% (1/27) at group C. And the rate of AVN between the three groups was statistically different (χ2=6.800, P=0.033). For hip with AVN after closed reduction, anteroposterior diameter of femoral head (1.79±0.24) cm, transverse diameter of femoral head (1.69±0.19) cm and the anteroposterior diameter of ossific nudes(0.44±0.33)cm were less developed than those without AVN (1.98±0.27) cm, (1.89±0.28) cm and (0.62±0.36)cm (P<0.05). Spearman's correlation analysis showed that diameter of femoral head, diameter/height of ossific nucleus significantly increased with age but not height of femoral head; age was negatively correlated with the incidence of AVN (r=-0.274, P=0.002). The diameter of femoral head has significantly negative association with AVN grade (P<0.005). No significant association was observed between AVN grade and height of femoral head, presence of ossific nucleus, diameter/height of ossific nucleus and ratio of ossific nucleus to femoral head. \u0000 \u0000 \u0000Conclusions \u0000The size of femoral head at dislocated side is significantly worse than at contralateral side. And diameter of femoral head and diameter/height of ossific nucleus increase with advancing age. A significantly negative association exists between rate of AVN and diameter of femoral head. And it is unrelated with height of femoral head or size of ossific nucleus. \u0000 \u0000 \u0000Key words: \u0000Femoral head; Hip Joint; Closed reduction; Avascular necrosis of femoral head","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"31 1","pages":"1090-1096"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85248024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2019.12.012
Yao-xi Liu, Kun Liu, Ge Yang, G. Zhu, Q. Tan, Jiang-yan Wu, W. Ye, A. Yan, Jin Tang
Objective To explore the preliminary effect of telescopic rod during combined surgical technique for congenital pseudarthrosis of the tibia (CPT) in children. Methods A retrospective study was performed for 15 children with Crawford type IV CPT undergoing combined surgical technique and telescopic rod from January 2017 to May 2018. There were 12 boys and 3 girls with an average operative age of 51.6 (16-126) months. The lesions were left (n=7) and right (n=8). The concurrent conditions were proximal tibia dysplasia (n=7) and neurofibromatosis type 1 (n=12). Combined surgical technique and telescopic rod included excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov's fixator, tibio-fibular cross union and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus and limb length discrepancy (LLD) were recorded during an average follow-up period of 23.3(12-28) months. Results All children achieved primary union. The average primary union time was 4.5(4.0-5.6) months. Nine cases showed LLD with an average extremity length of 1.1(0.5-2.0) cm; ankle valgus (n=1; 18°) and proximal tibial valgus (n=3; 10°, 5° & 6°), telescopic rod displacement (n=6) and epiphyseal plate tethered (n=2). There was no instance of refracture during follow-ups. Movements of ankle joint were all normal with an average dorsiflexion 24°(20°~30°) and with an average plantar flexion 43°(40°~50°) and the function of ankle joint was normal. Conclusions The primary healing rate of CPT in children is high by operating with telescopic rod. However, intramedullary rod displacement still occurs. Key words: Children; Congenital pseudarthrosis of tibia; Telescopic rod; Initial effect
{"title":"Application of telescopic rod during combined surgical technique for congenital pseudarthrosis of the tibia in children","authors":"Yao-xi Liu, Kun Liu, Ge Yang, G. Zhu, Q. Tan, Jiang-yan Wu, W. Ye, A. Yan, Jin Tang","doi":"10.3760/CMA.J.ISSN.0253-3006.2019.12.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2019.12.012","url":null,"abstract":"Objective \u0000To explore the preliminary effect of telescopic rod during combined surgical technique for congenital pseudarthrosis of the tibia (CPT) in children. \u0000 \u0000 \u0000Methods \u0000A retrospective study was performed for 15 children with Crawford type IV CPT undergoing combined surgical technique and telescopic rod from January 2017 to May 2018. There were 12 boys and 3 girls with an average operative age of 51.6 (16-126) months. The lesions were left (n=7) and right (n=8). The concurrent conditions were proximal tibia dysplasia (n=7) and neurofibromatosis type 1 (n=12). Combined surgical technique and telescopic rod included excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov's fixator, tibio-fibular cross union and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus and limb length discrepancy (LLD) were recorded during an average follow-up period of 23.3(12-28) months. \u0000 \u0000 \u0000Results \u0000All children achieved primary union. The average primary union time was 4.5(4.0-5.6) months. Nine cases showed LLD with an average extremity length of 1.1(0.5-2.0) cm; ankle valgus (n=1; 18°) and proximal tibial valgus (n=3; 10°, 5° & 6°), telescopic rod displacement (n=6) and epiphyseal plate tethered (n=2). There was no instance of refracture during follow-ups. Movements of ankle joint were all normal with an average dorsiflexion 24°(20°~30°) and with an average plantar flexion 43°(40°~50°) and the function of ankle joint was normal. \u0000 \u0000 \u0000Conclusions \u0000The primary healing rate of CPT in children is high by operating with telescopic rod. However, intramedullary rod displacement still occurs. \u0000 \u0000 \u0000Key words: \u0000Children; Congenital pseudarthrosis of tibia; Telescopic rod; Initial effect","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"294 1","pages":"1123-1127"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76879216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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