Purpose: To investigate robot-assisted percutaneous cannulated screw fixation for treating slipped capital femoral epiphysis, including acute, chronic, and acute-on-chronic slips. Our study included all stable and unstable slips. Methods: Thirty-one children with unilateral SCFE were treated from October 2019 to October 2021. All 31 patients were followed up for 12–36 months, with an average follow-up time of 24.56 ± 6.73 months. The femoral epiphysis was fixed with a percutaneous cannulated screw assisted by a surgical robot. Results: All 31 femoral head epiphyses underwent successful fixation in one attempt. The average operation time and bleeding were 98.25 ± 15.13 min and 21.65 ± 11.25 ml, respectively. The average distance between the actual and planned entry points was 1.13 ± 0.58 mm and 0.91 ± 0.72 mm in the anteroposterior (AP) and lateral views, respectively. The actual insertion trajectory deviated from the planned position by 3.61 ± 1.34° and 2.33 ± 1.32° in the AP and lateral views, respectively. The average fluoroscopy time was 6.56 ± 3.23 times per screw. The Non-Arthritic Hip Score improved from 28.53 ± 9.17 preoperatively to 67.34 ± 6.21 at the last follow-up ( P < 0.05), and the Harris hip score improved from 46.47 ± 15.34 to 89.63 ± 7.52 ( P < 0.05). The wounds healed without avascular necrosis or chondrolysis of the femoral head. Conclusion: Robot-assisted percutaneous cannulated screw fixation is effective for treating pediatric SCFE. Screw fixation was accurate and safe, and clinical outcomes were satisfactory. Level of Evidence: Level 4, Case Series.

Objective:To explore the clinical manifestations, treatments, pathological features and pathogenesis of ovarian juvenile granulosa cell tumors (JGCT) with Ollier's disease (OD) in children.Methods:From October 2019 to October 2020, clinical data were retrospectively reviewed for one case of ovarian JGCT with OD.And the relevant literature reports were retrieved through the databases of PubMed and Wanfang.Results:One 4-year-old girl showed multiple skeletal deformities, bilateral breast development with chromatosis and vulvar secretion.Radiography of extremities hinted at enchondromatosis.Pelvic ultrasound and abdominal computed tomography (CT) revealed right ovarian solid mass.Wide resection of soft tissue tumor was performed in distal right femur along with artificial bone substitution and right salpingooophorectomy.Pathologic examination of bone mass confirmed enchondromatosis and right ovarian solid mass was JGCT.A c. 394C>T chr2-209113113 p. R132C mutation of IDH1 gene was detected in both ovarian JGCT and enchondromatosis.During a follow-up period of 1 year, there was no sign of recurrent enchondromatosis.There was no evidence of recurrence of ovarian JGCT over 3 months.A total of 11 cases of JGCT with OD were reported.The onset age ranged 0.5 to 36 years.The major manifestations of OD are skeletal deformities and JGCT had peripheral precocious puberty, abnormal menstruation, abdominal distension and abdominal masses.Surgery was a mainstay for two diseases.The overall prognosis was decent.Conclusion:Ovarian JGCT with OD is rare and it may be caused by IDH1 gene mutation.Surgery is a first option.Regular postoperative follow-ups are essential.

Background: Recurrent patellar dislocation (RPD) and habitual patellar dislocation (HPD) in flexion are frequently encountered in children and adolescents. Purpose: To compare the radiological features of RPD and HPD in children and adolescents. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Imaging data were collected from patients aged 9 to 15 years who received surgical treatment for HPD or RPD at a single institution between June 2015 and September 2020. The prevalence of trochlear dysplasia, tibial tubercle lateralization, and lower limb rotational deformity was assessed through hip/knee/ankle computed tomography (CT) using the following quantitative indicators: trochlear depth index, lateral trochlear inclination, sulcus angle, tibial tubercle–trochlear groove (TT-TG) distance, ratio of TT-TG distance to femoral width, TT-TG angle, femoral anteversion angle, and tibial external rotation angle. The morphology of trochlea and patella were graded on knee CT using the Dejour and Wiberg classification. The Insall-Salvati index and Caton-Deschamps index were used to evaluate the height of the patella on lateral view radiographs. To evaluate lower limbs malalignment, the mechanical lateral distal femoral angle and medial proximal tibial angle were measured on weightbearing full-length radiographs. The collected data were analyzed and compared between the HPD and RPD groups. Results: Enrolled were 15 patients (21 knees) diagnosed with HPD and 18 patients (22 knees) diagnosed with RPD. The age of first dislocation was significantly younger in the HPD group (7.6 ± 3.4 vs 11.2 ± 1.4 years; P = 0.003). Knees in the HPD group had a significantly higher proportion of Dejour type C dysplasia (57.1% vs 4.5%; P < .005) and Wiberg type 3 patella (66.7% vs 9.1%; P < .001). There were statistically significant differences between the groups in the trochlear depth index (HPD vs RPD: 1.1 ± 1.7 vs 2.2 ± 1.5 mm; P = .039), sulcus angle (170.3° ± 13.7° vs 157.3° ± 16.0°; P = .007), Insall-Salvati index (1.1 ± 0.2 vs 1.3 ± 0.2; P = .034), and tibial external rotation angle (31.3° ± 7.8° vs 38.4° ± 8.5°; P = .009). Conclusion: Patients in the HPD group presented with poorer trochlear and patellar development, lower patellar height, and less tibial external rotation compared with patients in the RPG group.

Objective:To explore the effectiveness of medial malleolus screw epiphyseodesis for pediatric ankle valgus correction and calculate the correction rate, and analyse the influence factors on deformity correction and the risk factors of deformity recurrence after screw removal.Methods:Medical records and radiographs of patients undergoing screw hemiepiphyseodesis of the medial physis of the distal tibia for ankle valgus between Jan 2011 and Dec 2020, at a single pediatric orthopedic department were retrospectively analyzed. A total of 41 patients (49 ankles) were included in following study, including 28 male patients and 13 female patients; with 24 left sides and 25 right sides. Median age at surgery was 10.75 (4.5, 13.9) years, and median follow-up time was 27 (12, 64) months. According to the clinical diagnosis: hereditary multiple exostoses were 23 ankles, fibula hemimelia were 5 ankles, tibia hemimelia were 2 ankles, endochondromatosis were 5 ankles, neurofibromatosis were 5 ankles, traumatic fracture were 6 ankles, and fibrous dysplasia were 3 ankles. The lateral distal tibial angle (LDTA) was measured on ankle weight-bearing X-ray to evaluate the deformity correction. Malhotra classification was used to describe shortening of the fibula at the ankle.Results:Eventually effective correction were obtained in 36 ankles, with an overall effective rate of 73.5%. Screw type (partial-thread or full-thread), screw length (whether to the contralateral cortex), washer used, clinical diagnosis, and age are not independent risk factors for effective correction. Multiple linear regression analysis ( R 2=0.67) was applied for postoperative correction amplitude in effective correction cases, and the length of correction time ( P<0.001), clinical diagnosis ( P=0.013) and preoperative LDTA ( P=0.002) were significant predictive factors after adjusting for age differences. One-way ANOVA were used to compare data between different clinical diagnosis, showed a significant difference in the mean postoperative correction rate ( F=5.05, P=0.003). Conclusion:Medial malleolus screw epiphyseodesis is an effective and reliable method for the treatment of ankle valgus deformity in children; different clinical diagnosis can produce significant differences in the correction rate of ankle valgus deformity.

目的 探讨多针留置引流联合人工骨注射治疗儿童股骨近端单纯性骨囊肿的临床疗效.方法 回顾性分析2010年1月至2018年1月在北京积水潭医院采用多针留置引流联合人工骨注射治疗的21例股骨近端单纯性骨囊肿患儿的临床资料,统计性别、年龄、囊肿部位、病灶活跃情况、手术时间、术中出血量,采用Neer标准评价治疗效果,并记录并发症发生情况.结果 21例患儿中男11例,女10例,年龄4～14岁,平均(7.51±2.75)岁.囊肿局限于股骨颈2例,囊肿位于股骨粗隆间8例,位于股骨颈和粗隆间11例.20例为活跃性病灶,1例为稳定性病灶.所有患儿均采用透视下经皮穿针留置联合人工骨注射治疗,手术时间50～85min,平均(68.2±8.3)min,术中出血量10～25ml,平均(15.8±3.6)ml.术后随访38～132个月,平均(70.10±26.65)个月,Neer评价结果显示愈合10例,部分愈合9例,病灶持续存在2例,无复发病例,治疗有效率为90.48％(19/21).1例患儿术后发生固定针退针,所有患儿均未发生感染、病理性骨折等并发症,亦无生长受限导致畸形.结论 多针留置联合人工骨注射治疗儿童股骨近端单纯性骨囊肿实用、微创、安全、高效、手术时间短,值得临床应用.

目的 探讨弹性髓内针固定联合人工骨注射治疗儿童肱骨单纯性骨囊肿的疗效.方法 2015年6月～2019年6月,对31例儿童肱骨单纯性骨囊肿,在C臂机透视下,在肱骨内、外上髁分别做1 cm切口,由肱骨远端向近端置入2枚弹性髓内针固定,经皮穿刺注射人工骨填充病灶.结果 手术时间60～95 min,(68.0±10.5)min;术中出血量20～50 ml,(34.7±8.7)ml.31例随访36～65个月,(49.6±10.8)月.按改良Neer标准,Ⅰ级(愈合)22例,Ⅱ级(部分愈合)8例,Ⅲ级(持续存在)1例,无Ⅳ级(复发),治疗有效率96.8％(30/31).无感染、病理性骨折.结论 采用弹性髓内针固定联合经皮穿刺人工骨注射治疗儿童肱骨单纯性骨囊肿疗效满意.

目的:观察色努支具治疗青少年特发性脊柱侧凸的疗效,探究影响疗效的相关因素.方法:2016年1月～2018年6月采用色努支具治疗的青少年特发性脊柱侧凸患者49例,其中女性46例,男性3例,治疗初始年龄12.6±1.3岁(10～15岁),初始主弯Cobb角32.5°±6.9°(20°～45°),初始Risser征2.2±1.6.收集患者的临床资料:年龄、每日佩戴时间等信息;影像学资料:初始、佩戴支具即刻和随访的系列脊柱全长X线片.通过佩戴支具即刻X线片计算初始支具矫正率.评估治疗后结果:Cobb角减少≥6.定义为"改善",Cobb角变化5°以内定义为"稳定",Cobb角增大≥6°定义为"进展",前两者为治疗成功.观察初始支具矫正率在各组结果中的差异;分析畸形进展的患者相关因素:畸形严重程度(20°～29°,30°～39°及40°～45°三组)、Risser征(0～4)和侧凸类型(胸弯、胸腰弯/腰弯、双主弯三种类型);并分析影响初始支具矫正率的可能因素.结果:49例患者平均治疗2.0±1.0年,所有患儿每天支具佩戴时间在18～20h以上,依从性良好.随访2.0±1.0年(1～5年),末次随访时年龄14.6±1.4岁,Risser征4.2±0.6,末次随访Cobb角28.5°±9.6°;其中畸形改善31例,畸形稳定14例,支具治疗的总体成功率为91.8％(45/49);畸形进展4例,其中3例畸形超过45°.初始支具矫正率平均(64.9±23.6)％,其在改善组、稳定组和进展组分别为(69.5±23.2)％、(61.5±23.7)％和(42.5±10.0)％,初始支具矫形率和各组结果存在中等强度相关性(相关系数0.318,P=0.026);有序多分类Logistic回归显示支具矫正率对结果存在正向影响,差异有统计学意义(P=0.045).分析畸形进展的患者相关因素发现;畸形严重和骨骼成熟度低是畸形进展的危险因素(P=0.016和P=0.010),不同侧凸类型的畸形进展率没有统计学差异(P=0.124),但4例进展患儿均发生在胸段侧凸(3例胸弯,1例双主弯),胸腰弯/腰弯无进展病例.多因素分析显示,畸形程度越低,初始支具矫正率越高(P=0.001);侧凸类型和Risser征对矫正率无显著影响(P＞0.05).结论:色努支具是治疗青少年特发性脊柱侧凸的有效方法,初始支具矫正率是影响结果的重要因素,初始支具矫正率越高治疗效果越优;畸形程度严重(＞40°)和骨骼成熟度低(Risser 0)的胸段侧凸患儿,畸形进展的可能性更大.

[目的]比较两种固定方法治疗儿童肱骨近端移位骨折的临床疗效.[方法]回顾性分析本院2010年8月-2018年5月接受闭合复位内固定治疗严重移位肱骨近端骨折71例患者的临床资料.根据医患沟通结果,将患者分为两组,34例采用经皮克氏针固定术治疗(克氏针组),37例采用逆行弹性髓内钉固定术治疗(髓内钉组).比较两组围手术期、随访及影像资料.[结果]两组患者均顺利完成手术,未发生血管、神经损伤等并发症.克氏针组手术时间、切口长度、透视时间均优于髓内钉组,差异均具有统计学意义(P＜0.05).所有病例术后均获得骨性愈合,无畸形愈合及骺早闭发生.术后3个月及末次随访时,两组的肩关节活动范围、DASH评分和Constant-Murley评分差异均无统计学意义(P＞0.05).影像方面,两组复位质量及骨折愈合时间的差异无统计学意义(P＞0.05).与术前相比,两组术后颈干角均显著增加(P＜0.05),相应时间点两组间颈干角的差异无统计学意义(P＜0.05).[结论]闭合复位克氏针或弹性髓内钉都是治疗儿童肱骨近端严重移位骨折的适当方法,临床效果相当.

目的 探讨肱骨远端等腰三角形截骨矫形克氏针张力带内固定治疗儿童肘内翻畸形的疗效.方法 2020年3月至2021年6月北京积水潭医院小儿骨科采用肱骨远端等腰三角形截骨矫形克氏针张力带内固定治疗肘内翻畸形15例;男11例,女4例;年龄为4.03～10.01(6.26±1.96)岁.术前内翻畸形8.45°～40.28°(19.27°±7.66°).术前测量双侧提携角,计算所需矫正角度,在PACS 系统上进行肱骨远端等腰三角形截骨设计.患儿均行肱骨远端等腰三角形截骨矫形克氏针张力带内固定术和术后石膏外固定.结果 手术时间为55～90(69.1±12.1)min.术中即刻提携角为14.63°～20.51°(16.59°±1.97°).15例患者均获得6～20(10.1±3.4)个月随访.截骨处均获骨性愈合;愈合时间为4～8(6.7±0.5)周.末次随访时提携角为14.36°～20.06°(16.53°±1.81°).末次随访Mayo 肘关节功能评估手术疗效优良率为93.33％.结论 肱骨远端等腰三角形截骨矫形克氏针张力带固定是矫正儿童肘内翻畸形的一种简易、实用、安全、有效的手术方式.

我国小儿骨科源起于 20 世纪 50 年代,中华人民共和国成立后,曾经在欧美国家接受过现代骨科学教育的中国骨科奠基人孟继懋、叶衍庆、方先之等学者们先后在北京、上海、天津等大城市组建了骨科为主的医院或研究所:北京积水潭医院、上海瑞金医院伤骨科研究所、天津骨科医院等,专门诊治骨科患者并进行教学和科研培训,早期主要治疗骨髓炎、骨结核、骨折等疾病 [1].

目的 比较两种切开复位内固定治疗青少年胫骨远端前外侧骨骺骨折(Tillaux骨折)的疗效.方法 采用切开复位内固定治疗32例青少年Tillaux骨折患者,按照内固定方式不同分为空心螺钉组(20例)和克氏针组(12例).记录手术时间、骨折愈合时间、术后并发症发生情况.采用AOFAS踝-后足评分评价患肢关节功能.结果 患者均获得随访,空心螺钉组随访时间12～60(28.55±14.89)个月,克氏针组随访时间16～56(26.17±11.00)个月.两组切口均甲级愈合,术后均无感染、血管神经损伤、骨骺早闭、关节畸形及踝关节功能障碍等并发症发生.手术时间、骨折愈合时间及末次随访时AOFAS踝-后足评分两组比较差异均无统计学意义(P>0.05).末次随访时两组患侧踝关节均可正常负重活动,踝关节活动度均恢复至正常范围.结论 切开复位空心螺钉和克氏针内固定均为治疗青少年Tillaux骨折的安全、有效方法.

背景:多发性内生软骨瘤病(Ollier病)致小腿畸形的治疗方法多样,疗效不一.目的:探讨应用Ilizarov技术治疗Ollier病致小腿成角和短缩畸形的治疗效果.方法:回顾性分析2009年3月至2016年9月采用小切口胫腓骨截骨及Ilizarov技术治疗21例Ollier病致小腿成角和短缩畸形患者的临床资料,男12例,女9例;年龄3～16岁,平均(9.7±3.1)岁.对术前和术后的胫骨短缩长度、小腿畸形角度、胫骨近端内侧角(MPTA)、胫骨远端外侧角(LDTA)、瘤体与正常骨干横径比及纵径比的变化进行比较分析.结果:21例患者全部获得随访,随访时间24～38个月,平均(31.3±4.6)个月;外固定器留置时间8～24个月,平均(15.2±4.3)个月.与术前比较,外固定器拆除术后的胫骨短缩长度、小腿畸形角度、MPTA、LDTA明显改善,瘤体与正常骨干横径比值明显减小,差异有统计学意义(P<0.05);瘤体与正常骨干纵径比值无明显变化,差异无统计学意义(P>0.05).结论:Ilizarov技术治疗Ollier病致小腿成角及短缩畸形安全有效.

发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是髋臼发育不良、髋关节半脱位及髋关节脱位疾患的统称[1].20世纪80年代之前,该疾病被称为先天性髋关节脱位,由于该疾患与生长发育密切相关,1992年北美骨科年会将其更名为DDH.DDH是小儿骨科最常见的髋关节疾患,出生后髋关节脱位发生率为1‰～2‰,地域间有差异性.DDH的发病有其内在因素和外在因素,其中臀位产是最为确定的诱因.此外,家族史、头胎、孕期羊水过少、襁褓等也被认为是可能影响DDH的危险因素[1].

目的 评价超声检查在儿童膝关节骨折诊断中的作用.方法 对2015年9月至2019年3月北京大学第四临床医学院北京积水潭医院小儿骨科收治的膝关节骨折患儿27例临床资料进行回顾性分析.其中男18例,女9例;平均年龄7岁4个月(9个月～13岁5个月).所有患儿在伤后2周内接受患侧膝关节X线和MRI检查以及双侧膝关节超声检查.以MRI结果作为诊断标准,将X线和超声检查结果分别与MRI结果进行比较.结果 MRI诊断结果为关节内骨折14例(胫骨髁间嵴骨折8例、髌骨骨折4例、膝关节骨软骨骨折2例),关节外骨折13例(股骨远端骺损伤6例、胫骨近端骺损伤6例、股骨远端骺损伤合并胫骨近端骨折1例).X线诊断准确率为96％(26/27).超声检查诊断准确率为74％(20/27),对关节内骨折和关节外骨折的诊断准确率分别为57％(8/14)和92％(12/13).超声与X线联合诊断的准确率为100％.结论 超声检查可准确诊断儿童股骨远端骨折、胫骨近端骨折和髌骨骨折,但是对儿童胫骨髁间嵴骨折和膝关节骨软骨骨折等关节内骨折的诊断准确率较低;辅以超声检查可提高X线检查对儿童膝关节骨折诊断的准确率;当X线和超声检查均未发现骨折而超声提示有膝关节积液(血)时,应进一步行CT或MRI检查,以免漏诊儿童膝关节内骨折.

Objective: To present the technique and clinic effect of the combined method of proximalization of the patella and double boundle reconstruction of medial patellofemoral ligament (MPFL) with adductor magnus tendon autograft for the treatment of habitual dislocation of patella (HDP) in adolescent. Methods: From August 2016 to August 2018, a total of 33 consecutive skeletally immature adolescent patients (37 knees) with HDP were surgically treated in Beijing Jishuitan Hospital and were retrospectively reviewed. Among them, 10 patients (12 knees) with severe quadriceps contracture underwent the index comprehensive procedure. There were 4 males and 6 females with a mean age of (12.1±1.4) years (10 to 14 years old) at the operation. Before surgery and at the final follow-up, subjective symptoms were scored by Lysholm knee score, physical examination and radiological assessment were performed. Results: of patellar tracking were assessed by congruence angle and lateral patellofemoral angle. Results Patients were followed up for an average period of 23 months (12-36 months). No infection, patella redislocation were observed in all cases. Lysholm scores improved from 77±9 before surgery to 96±6 at the final follow-up (t= -23.155, P<0.05). There was a statistically significant improvement in the congruence angle, from 72.4°±17.2° preoperatively to -7.5°±4.8° at the final follow-up (t=21.392, P<0.01) and in the lateral patellofemoral angle, from -64.6°±9.4° preoperatively to 6.5°±3.7° at the final follow-up (t=-22.874,P<0.01). Conclusion: In this short term study, the novel comprehensive procedure, including proximalization of the patella and double boundle reconstruction of MPFL with adductor magnus tendon autograft, treats HDP effectively in skeletally immature adolescent patients with severe quadriceps contracture.

[目的]介绍普通牵引床牵引双入路关节镜辅助治疗难复性小儿发育性髋关节脱位(DDH)的手术技术与临床效果.[方法] 2016年1月～2017年12月对5例(5髋)难复性小儿发育性髋关节脱位行关节镜辅助治疗闭合复位术.采用护皮膜绷带协助固定患儿双下肢于普通牵引床牵引,前外及外侧双入路观察操作,镜视下切除肥厚的圆韧带、清理髋臼底部纤维脂肪组织,盂唇内翻者行外2/3放射状切开、松解缩窄关节囊及髋臼横韧带.清理完毕后关节镜监视下手法复位,双髋人类位石膏外固定,术后6～8周更换二期石膏.[结果]全部5髋在关节镜松解下复位成功.所有患儿随访18～36个月.安全角由术前的(16.54±4.85)°增至术后的(65.98±6.56)°,差异有统计学意义(P＜0.05);股骨头内侧化率由术前的(65.66±20.67)％增至镜下清理后的(106.45±15.55)％,差异有统计学意义(P＜0.05).髋臼角由术前的(41.66±5.27)°降至末次随访时(27.43±5.24)°,差异有统计学意义(P＜0.05).末次随访时,1例患者出现Kalamchi-MacEwen分型Ⅰ型股骨头缺血性坏死,1例残留有髋臼发育不良,其他患儿骺板内无骨桥形成,股骨头形状修复满意.[结论]普通牵引床牵引双入路关节镜辅助下髋臼清理闭合复位术是治疗难复性小儿发育性髋关节脱位安全有效的方法.

BACKGROUND Developmental dislocation of the hip (DDH) results in osteoarthritis in infants and children. This study aimed to investigate the effects of a single approach to arthroscopic reduction and debridement on clinical outcome in 12 infants with DDH. MATERIAL AND METHODS Twelve infants with irreducible DDH underwent single approach arthroscopic reduction and debridement followed by the use of a frog-leg position plaster cast with fixed flexion and abduction of the hips combined with external fixation for 6-8 weeks. Magnetic resonance imaging (MRI) or plain X-ray images were analyzed. Intra-articular obstructive factors for reduction were evaluated. The safety angle, medialization rate of the femoral head, and the acetabular angle were measured before and after arthroscopic reduction. RESULTS Imaging showed that the signs of DDH were significantly improved following arthroscopic reduction. Obstructive factors included hypertrophy of the round ligament, fibrous tissue and fat in the acetabular base, arthrocapsular constriction, and varus deformity of the hip. The safety angle was significantly increased following arthroscopic reduction (53.5°) compared with the safety angle before treatment (18.5°) (p<0.05). Medialization of the femoral head was significantly increased (127%) compared with that before treatment (72%) (p<0.05). Arthroscopic reduction significantly reduced the acetabular angle (25°) compared with that before treatment (37.5°) (p<0.05). CONCLUSIONS Single approach arthroscopic reduction and debridement was an effective method for treating DDH that significantly improved the medialization rate of the femoral head, acetabular angle, and the outcome of external fixation when a plaster cast was used with fixed flexion and abduction of the hips.

目的 分析Pavlik吊带治疗6个月以内发育性髋关节发育不良(DDH)的疗效以及评价超声的诊疗价值.方法 回顾性研究DDH患髋119髋,GrafⅡc型48髋,D型3髋,Ⅲ型27髋,Ⅳ型41髋,首次确诊后立即佩戴Pavlik吊带,超声随访疗效.结果 Pavlik吊带总体治愈率69.75％.各型治愈率:Ⅱc型97.9％,D型100％,Ⅲ型88.9％和Ⅳ型22.0％,差异有统计学意义(x2 =68.4,P＜0.000 1).不同天龄组差异有统计学意义(x2=32.8,P＜0.000 1),“≤42 d”组达100％.结论 Pavlik吊带对于GrafⅡc及D型治愈率高,Ⅲ型居中,Ⅳ型最低,其疗效与首诊天龄相关;建议患儿能够在42 d龄内诊断治疗.超声在早期筛查、诊断及动态评估Pavlik吊带疗效中作用显著.

目的 探讨发育性髋关节发育不良(DDH)切开复位、骨盆截骨术后再脱位的原因和手术治疗方法.方法 回顾分析2004年1月至2016年1月北京积水潭医院小儿骨科收治的DDH切开复位、骨盆截骨术后再脱位行翻修手术的患者48例(53髋)的病历资料.其中,男7例,女41例.根据切开复位、骨盆截骨术后出现再脱位的时间,将患者分为2组,分析切开复位失败的原因.针对患者的年龄及病理变化,采用相应的治疗方案.结果 翻修手术平均年龄6.1(2.8～13.5)岁.术后3个月内再脱位组32例(35髋),其中因手术未达到稳定中心复位导致去除外固定后再脱位24例(26髋),因截骨支撑物移位、碎裂、截骨端移位导致再脱位3例(3髋),因骨盆截骨后覆盖不良、髋关节复位不稳定导致去除石膏后出现半脱位2例(3髋),因股骨近端形态异常或前倾角过度矫正、复位不稳定导致去除石膏后出现半脱位2例(2髋),因术后感染导致再脱位1例(1髋);术后3个月及以上再脱位组16例(18髋),其中因髋臼成形后截骨端吸收出现半脱位或脱位7例(8髋),因髋臼外缘发育严重受损导致股骨头膨大出现半脱位6例(7髋),因骨盆Y形软骨损伤或发育异常、髋臼内壁增厚逐渐出现半脱位3例(3髋).22例(26髋)采用再次切开复位、单独髋臼成型或髋臼成型+股骨短缩去旋转截骨治疗,16例(17髋)采用切开复位、骨盆Salter截骨内固定+股骨截骨治疗,5例(5髋)采用骨盆内移截骨治疗,3例(3髋)采用髋臼周围旋转截骨(Ganz截骨)治疗,1例(1髋)采用髋关节切开复位、股骨短缩截骨、磨臼造盖、关节囊成型(Colonna)治疗,1例(1髋)采用骨盆三联截骨+髋臼成型+股骨短缩去旋转截骨翻修手术治疗.翻修术后平均随访3.8(3.0～15.0)年,未出现再脱位的情况.末次随访时,髋关节Harris评分平均82分.结论 DDH术后再脱位是非常严重的并发症,会加大再次手术的复位难度,对关节功能及使用寿命影响极大,临床医生需加深对该病的认识,了解失败的原因,尽量避免其发生.

目的 探讨经皮克氏针固定治疗儿童桡骨远端开放骨折的临床疗效.方法 回顾分析2008年6月至2017年5月在北京积水潭医院小儿骨科接受经皮克氏针固定治疗的19例桡骨远端骨折患儿的病历资料.年龄(9.7±2.4)(6～14)岁.Gustilo分型:Ⅰ型8例,Ⅱ型9例,Ⅲ型2例.分析其病例特点并评估临床疗效.结果 随访时间1.8(1～3)年.18例获得临床骨性愈合及正常关节活动度.1例出现延迟愈合,1例发生关节活动受限,2例出现针道感染.结论 经皮克氏针固定治疗桡骨远端开放骨折患儿安全有效.