目的 观察中医正骨手法联合B超引导下闭合复位经皮克氏针固定治疗儿童屈曲型肱骨髁上骨折的临床应用效果.方法 收集江西省儿童医院 2020 年 4 月至 2022 年 9 月收治的 25 例屈曲型肱骨髁上骨折患儿资料,全部患儿均接受中医正骨手法联合B超引导下闭合复位经皮克氏针固定治疗,患儿术后 1 个月、3 个月均接受X线平片检查,且影像学资料完整;记录患儿围手术期相关指标、骨折断端愈合时间、肘关节功能及术后并发症发生情况.结果 25 例患儿均获得随访,平均手术耗时为(43.51±3.65)min,术中透视次数为(2.14±0.35)次,术中无切开复位情况;骨折愈合时间为(5.47±1.89)周;术后 3个月时Flynn标准评估肘关节功能总优良率为 96.00%;患儿术后均无尺神经损伤、骨折畸形愈合并发症发生.结论 儿童屈曲型肱骨髁上骨折采用中医正骨手法联合B超引导下闭合复位经皮克氏针固定治疗骨折愈合时间短,透视次数少,肘关节功能恢复良好,且并发症少.

目的 总结超声引导闭合复位和弹性髓内钉固定微创治疗儿童肱骨近端骨折的疗效.方法 在 2018 年 1 月至2021 年 12 月期间,使用超声引导闭合复位和弹性髓内钉固定儿童肱骨近端骨折 14 例,Neer-HorwitzⅢ型 9 例,Ⅳ型 5 例;平均年龄 9.5 岁(7～14 岁).术中应用超声引导闭合复位、弹性髓内钉将骨折固定,必要时经皮克氏针翘拨辅助复位,超声动态检测骨折复位质量.结果 超声引导闭合复位成功 13 例,1 例术中转为有限切开复位,闭合成功率 92.86%.本组病例术后平均随访时间 13.7 个月;骨折均获一期愈合,愈合时间:4～10 w(平均 7.1 w).术后Neer肩关节功能评分:83～100(平均 94.71).弹性髓内钉钉尾软组织刺激征 2 例,无其他并发症.结论 超声引导闭合复位和弹性髓内钉固定可能是治疗儿童肱骨近端骨折较好的方法.

目的 探讨间变性大细胞淋巴瘤激酶蛋白(ALK)在外周神经母细胞性肿瘤(pNT)中的表达及意义.方法 收集46例pNT的临床病理资料,采用免疫组化方法检测ALK蛋白,荧光原位杂交技术检测N-MYC基因.结果 46例患儿临床分期:Ⅰ～Ⅱ期和Ⅲ～Ⅳ期各23例;病理诊断:神经母细胞瘤(NB)40例、节细胞性神经母细胞瘤(GNB)6例,其中预后良好型(FH型)32例、预后不良型(UH型)14例;ALK在NB和GNB中的阳性表达率分别为55％(22/40)和0(0/6),差异具有统计学意义(P=0.038).40例NB中N-MYC基因扩增阳性4例、获得7例,6例GNB均无N-MYC基因扩增和获得.15例新生儿NB中ALK蛋白阳性表达率为40％(6/15),100％N-MYC基因扩增阴性.ALK蛋白在Ⅲ～Ⅳ期、UH型和N-MYC基因异常中表达率高,差异具有统计学意义(P=0.018、0.001、0.010),在不同性别、年龄和部位间无差异表达(P=0.382、0.400、0.617).结论 儿童pNT应常规检测ALK蛋白,其阳性表达与病理分型和临床分期有一定的关系.不同年龄段NB中ALK蛋白的表达意义及机制有待进一步研究.

目的 探讨新生儿神经母细胞瘤(NB)的临床病理学特征.方法 收集江西省儿童医院15例新生儿NB临床病理资料并进行随访,采用免疫组化SP法检测E-cadherin、N-cadherin和ALK表达情况,荧光原位杂交检测N-MYC基因.结果 15例患儿中男童6例,女童9例;就诊手术年龄为13天～7月,平均年龄1.8月;送检标本部位为:盆腔和腹膜后6例、肾上腺4例、纵膈2例、颈部2例、右大腿1例;临床分期:I期7例、II期4例、III期2例、IV期1例、IVs期1例.15例NB中,分化差型14例,其中预后良好型13例;15例NB中ALK阳性表达率为40％(6/15);E-cadherin阴性/N-cadherin阳性8例,E-cadherin阴性/N-cadherin阴性和E-cadherin阳性/N-cadherin阳性各3例.N-MYC基因扩增阴性率为100％(14/14).结论 新生儿NB组织学以分化差型多见,总体预后较好,应提高患者治疗依从性并对其进行长期随访.ALK蛋白表达与预后无关.上皮间质转化标志物在新生儿NB中的表达机制有待进一步研究.

目的 总结采用围手术期多学科综合诊疗应用于先天性重症膈疝的治疗经验并探讨其对诊治的影响.方法 回顾分析我院2011年2月至2019年08月我院105例出生10d内出现呼吸衰竭的新生儿重症膈疝的临床资料.将采用传统非MDT治疗的25例患者为对照组,对照组中男17例,女8例,采用MDT模式治疗的80例患者作为实验组,对比两组患者术前死亡、术前达到临床稳态、达到稳态放弃例数、手术例数、术前呼吸机使用时间、手术方式、术中使用补片例数、术后呼吸机维持时间、手术后存活情况.结果 非MDT组25例患儿中7例患儿出现呼吸循环衰竭(28％),18例患儿术前达到临床稳态.MDT组80例患儿11例患儿术前出现呼吸循环衰竭(13.8％),69例患儿术前达到临床稳态.于非MDT组患儿比较,MDT组术前达到稳态放弃病例数比例更少(P=0.017).非MDT组在入院后29.33±15.39h行急诊手术治疗,MDT组病例在65.91±32.64h达到临床稳态后手术治疗,两组患儿术前呼吸机使用时间存在明显差异(P=0.002).比较两组患者手术方式、术中使用补片及术后呼吸机维持时间方面差异无统计学意义(P>0.05).非MDT组术后存活率为66.7％(6/9),MDT组术后存活率为81.5％(44/54).结论 通过开展围手术期多学科综合诊疗模式有助于建立家属治疗的信心,让更多的重症膈疝患儿得到合理及时的治疗.

目的 探讨先天性神经母细胞瘤(NB)的临床病理学特征.方法 收集7例先天性NB的临床病理资料并进行随访,采用免疫组化方法检测ZEB1、E-cadherin、N-cadherin、ALK、CD99、CK和cyclinD1的表达情况,荧光原位杂交检测N-MYC基因.结果 7例患儿中男童2例,女童5例;手术/穿刺年龄为26～142天,平均52天;送检标本部位:腹膜后和肾上腺各2例,纵膈、颈部和右大腿各1例;临床分期:Ⅰ期2例、Ⅱ期1例、Ⅲ期2例、Ⅳ期1例、Ⅳs期1例.7例NB中分化差型6例,1例穿刺标本为非特指;7例NB中ZEB1、E-cadherin、N-cadherin、ALK、CD99、CK和cyclinD1的阳性率分别为83.3％(5/6)、33.3％(2/6)、50.0％(3/6)、57.1％(4/7)、0(0/7)、0(0/6)和100.0％(5/5).N-MYC基因扩增阴性率为100％(7/7).结论 先天性NB组织学以分化差型多见,总体预后较好.ALK蛋白表达可能与预后无关.先天性NB存在上皮间质转化现象,其意义及机制有待进一步研究.

目的 探讨超声引导改良三维手法闭合复位经皮克氏针固定儿童屈曲型肱骨髁上骨折的临床疗效.方法 2018年6月至2020年12月,采用本方法治疗儿童屈曲型肱骨髁上骨折患儿17例,按Gartland分型:Ⅱb10例,Ⅲ型7例.所有患者均采用超声引导手法闭合复位经皮克氏针固定的方法治疗.术后石膏外固定4～6周,4～8周后拔出克氏针.结果 18例成功获得闭合复位,无中转切开复位者.1例失访,其余17例获得随访,平均随访时间9.71±3.9月.骨折均获一期愈合,平均愈合时间5.24±1.25周.JOA肘关节功能评分标准评价:优良率为94.12％.结论 超声检查无辐射、无创,术中可以多个平面观察并引导骨折复位及内固定植入,术中更好地维持骨折复位,提高闭合复位几率,减少神经损伤,降低医患X线辐射,是治疗屈曲型儿童肱骨髁上骨折较为理想的手术方法.

目的 探讨超声引导再改良Métaizeau法治疗儿童严重移位不稳定的桡骨颈骨折的临床疗效.方法 自2018年1月至2020年1月应用超声引导再改良Métaizeau法治疗儿童桡骨颈骨折9例:JudetⅢ型4例,JudetⅣ型5例.术中采用2枚克氏针撬拨+Métaizeau法将骨折复位,弹性髓内钉和克氏针联合固定;术后长臂前后石膏托固定4-6周,4周拔除克氏针,2-3个月拔除弹性髓内钉.结果 9例患儿均成功获得闭合复位,没有中转开放复位;所有骨折均获一期愈合,平均愈合时间为5.6周;平均随访时间12.3个月.按Métaizeau标准对术后X线片评估;优良率100％;按Mayo评分标准(MEPS)评定术后肘关节功能:优良率100％.结论 超声引导再改良Métaizeau法治疗儿童严重移位不稳定的桡骨颈骨折,具有辐射低、创伤小、固定稳定、并发症少等优点,可能是治疗儿童桡骨颈骨折的理想方法之一.

Objective To investigate the clinical effects ofpercutaneous two Kirschner wires leverage reduction combined with Métaizeau's technique in the treatment of children with Judet type Ⅳ radial neck fractures.Methods From January 2013 to June 2016, 16 cases of Judet type Ⅳ radial neck fractures were treated by association of percutaneous two Kirschner wires leverage reduction and Métaizeau's technique.According to the Judet classification, 8 cases were type Ⅳ a and 8 cases were type Ⅳ b.After the operation, the affected arm was fixed using long arm plaster for 3 to 4 weeks.The elastic intramedullary nail was removed 2 to 3 months after the operation.Results All the patients were follow-up for 12 to 39 months with an average of 19 months.Fracture healing time was 4 to 10 weeks with the average being 5.4 weeks.No complications such as avascular necrosis of the radial head, early closure of the epiphyseal plate of proximal radius and bone nonunion occurred.According to Métaizeau's standard, the postoperative X-ray was rated as excellent in 12 cases and good in 4 cases.According to the MEPS elbow function score, the results were excellent in 10 cases,good in 5 cases and fair in 1 case.Conclusion The association of percutaneous two Kirschner wires leverage reduction and Métaizeau's technique in the treatment of children with Judet type Ⅳ radial neck fractures can significantly improve the rate of minimally invasive reduction, with advantages of less trauma, fewer complications, good effect and safety.

Objective To investigate the protective effect of pulmonary artery perfusion with hypothermic solution during cardiopulmonary bypass(CPB) on lung function.Methods Twentyseven patients undergoing mitral or aortic valve replacement were randomly assigned to receive pulmonary artery perfusion with either hypothermic protective solution(observation group,n =12) or cardioplegic solution(control group,n=15).Aortic clamp time,mechanical ventilation duration,ICU stay and hospital stay were recorded in both groups.Furthermore,oxygenation index was monitored at the end of surgery and 6,12 and 24 hours after surgery.Plasma levels of malondialdehyde(MDA),tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were examined before surgery,at the end of surgery,and 6,12 and 24 hours after surgery.Moreover,pathological changes of lung tissue were observed.Results There were no significant differences in aortic clamp time and preoperative MDA,IL-6 and TNF-α levels between the two groups (P＞ 0.05).Compared with control group,pulmonary artery perfusion with hypothermic solution shortened mechanical ventilation duration,ICU stay and hospital stay,increased oxygenation index,and decreased plasma MDA,IL-6 and TNF-α levels.Optical microscopy showed inflammatory cell infiltration,pulmonary interstitial edema and small blood vessel hyperemia and hemorrhage in control group.However,pulmonary structure was normal and no obvious neutrophil aggregation and exudation occurred in observation group.Conclusion Pulmonary artery perfusion with hypothermic protective solution during CPB can attenuate lung injury and has a protective effect on lung function.

目的：探讨使用温血逆行灌注技术对瓣膜置换同期冠脉搭桥术患者的心肌保护作用。方法40例行瓣膜置换手术加冠状动脉搭桥手术患者随机分为两组：研究组（温血逆行灌注组）和对照组（常规灌注组），各20例。对照组常规冷晶体氧合血顺行灌注，研究组在温晶体氧合血的基础上给于逆行灌注。观察两组术中心脏复苏情况，分别于转流前、主动脉开放后10min、术后2h、术后4h和24h，采集动脉血标本，检查心肌肌钙蛋白T(cTnT)、心肌肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)。结果转流前及主动脉阻断开放后10min，两组心肌酶学指标无明显差别(P>0.05)。而术后2h、4h和24h研究组cTnT、CK和CK-MB指标低于对照组(P<0.05)；且两组分别与转流前相比差异均有统计学意义(P<0.05)。结论温血逆行灌注对瓣膜置换同期冠状动脉搭桥手术患者有较好的心肌保护作用。

[目的]探讨Métaizeau法治疗儿童桡骨颈骨折的临床效果.[方法]2008年2月～2012年12月,本院应用Métaizeau法治疗儿童桡骨颈骨折15例,按Steele分型,Ⅱ型9例,Ⅲ型6例,男10例,女5例,右上肢8例,左上肢7例.平均年龄9.4岁(5～15岁).术后长臂双面石膏夹板固定3周,3周后拆除石膏行功能锻炼,2～3个月拔除弹性髓内针.[结论] 11例行闭合复位弹性髓内针固定,3例经皮克氏针撬拨辅助复位弹性髓内针复位固定,1例切开复位弹性髓内针固定.15例患儿获得随访,随访时间平均为17个月(12 ～ 59个月).骨折愈合时间平均为5.2周(4～8周).15例患儿中,除1例有皮肤软组织激惹,其他无并发症.术后X线片按Métaizeau整复标准优良率100％,按JOA肘关节功能评分进行肘关节功能评定,优良率93.33％.[结论]Métaizeau法具有创伤小、并发症少、效果好等优点,是治疗儿童桡骨颈骨折良好的方法.

目的：探讨单泵双管选择性顺行脑灌注在主动脉瘤手术中应用效果。方法选择主动脉瘤患者25例，行bentall 手术13例，行 bentall＋全弓置换＋降主动脉支架植入手术3例，行 bentall＋次全弓置换6例，行升主动脉置换3例。均经右侧股动脉、右侧腋动脉插管，深低温停循环时钳夹股动脉插管，经右侧腋动脉行选择性顺行性脑灌注，流量控制在10～15 mL·kg－1·min－1。结果25例患者中，体外循环时间118～376（197．6±42．5）min，主动脉阻断时间78～264（141．7±32．3）min，选择性顺行性脑灌注时间12～38（23．2±10．3）min。升主动脉开放后，8例心脏自动复跳，17例行电击除颤复跳。25例患者术后4～73 h 内神志清醒。术后死亡2例，其中1例死于多器官功能障碍综合征，1例死于恶性心律失常。结论在主动脉瘤手术中采用单泵双管行选择性顺行性脑灌注可以提供有效的脑保护。

目的 总结和分析冠脉搭桥术中应用冠状静脉窦逆行灌注并桥灌技术进行心肌保护的效果.方法 28例三支病变、稳定型心绞痛、首次进行冠脉搭桥术的患者,均经冠状静脉窦逆行灌注并桥灌心肌停搏液体外循环下行冠脉搭桥术.结果 所有患者术中转流平稳,血流动力学稳定,术后无多巴胺等正性肌力药物依赖和严重心律失常,患者恢复良好.结论 在冠脉搭桥术中,采用冠状静脉窦逆行灌注并桥灌注心肌停搏液进行心肌保护,可取得良好效果.

肺动脉栓塞的治疗以往以内科溶栓治疗为主,体外循环技术的日益成熟,为肺动脉栓塞的治疗提供了一个更加安全有效的新途径.2009年1月11日,南昌大学第一附属医院成功地完成了江西省首例体外循环下肺动脉栓塞血栓摘除手术,报告如下.

<正>病例1,女,27岁,因烦渴、多饮、多尿6个月,行走不稳10d入院。患者于6个月前出现烦渴、多饮、多尿,在当地医院多次查血糖高于正常,2个月治疗中血糖一直未能控制。入院前10d出现双下肢乏力。入院查体:生命体征平稳,内科查体无特殊。神经科查体:神志淡漠,双

Three cases of terminal stage heart disease received orthotopic heart transplantation at the Department of Cardiothoracic Surgery, the First Hospital of Nanchang University between August 2001 and December 2003. These three cases were all female and died of brain death. Body weight difference between donor and recipient was less than 20%. All three cases underwent superior and inferior vena cave osculation and received immunosuppressive therapy of cyclosporine A, prednisone, and mycophenolate postoperatively. They were successfully discarded. Heart function recovered to grade Ⅰ-Ⅱ(NYHA). No infection or serious rejection was found during the surgery. These results indicate that good donor heart preservation, consummate perioperative processing, and proper immunosuppressiva therapy are the key measures of successful heart transplantation.

Objective To explore changes of CT Perfusion imaging in adult temporal lobe epilepsy(TLE)of unilateral and bilateral interictal discharges.Methods Twenty-one adult patients with temporal lobe epilepsy including eleven TLE of unilateral interictal discharges and ten TLE of bilateral interictal discharges according to video-electroencephalography(VEEG)underwent CT perfusion imaging.Perfusion parameters compassing Cerebral blood flow(CBF)、Cerebral blood volume(CBV)and Mean transit time(MTT)in bilateral temporal lobes were measured for each patient and their asymmetry index(AI)values were calculated.CBF、CBV and MTT were compared between bilateral temporal lobe in each group.AI values of CBF、CBV and MTT were compared between two groups.Results The results of CT scan indicated no abnormal findings from cranial structures of each patient.There were no significant differences in terms of CBF、CBV and MTT between bilateral temporal lobe in each group(P>0.05).There was significant difference in terms of their AI values of CBF between two groups(t=2.269,P=0.035).However,no significant differences were found in terms of AI values of CBV and MTT(P>0.05).In unilateral interictal discharges patients' group,the perfusion tended to be lower in the unilateral temporal lobe restricted to the area of interictal electroencephalography(EEG)abnormality than in the contralateral temporal lobe.The CBF of unilateral temporal lobe,however,was not significantly different from that of contralateral temporal lobe(t=-2.093,P=0.063).Conclusion CT perfusion indicates that cerebral blood flow in temporal lobe is more asymmetric in unilateral TLE than in bilateral TLE.

患者,女,87岁,因发作性晕厥1周,加重3 d于2008年12月27日人院.患者近1周来常于坐位或站立时出现晕厥,每次持续10～20 min,平卧数分钟后症状缓解,严重时伴有肢体抽搐及大小便失禁,至我院门诊,行脑电图检查提示额颞区不对称性尖波、尖慢波发放,拟"症状性癫痫"给予卡马西平(50 mg,3次/d),服药后上述症状未改善,仍有每天发作4～5次,为进一步明确诊断门诊拟"抽搐原因待查"收入我院神经科.

OBJECTIVE To evaluate the effect of hydroxyethy1 starch,dextran 40 and amino acids injection on effect of postoperative lung function of children with congenital heart disease under cardiopulmonary bypass(CPB).METHODS29 children undergoing CPB were randomly divided into control group(n=7),Dextran 40 and amino acids injection group(n=11)and hydroxyethyl starch(130/0.4)group(n=11).OI,P(A-a)O2,SaO2 and PaCO2 were measured in the trial groups at 1 hour,3 hours postoperatively and just before stoping mechanical ventilator.RESULTSThere were significant difference between the groups at every time points(P0.05).CONCLUSIONDextran 40 and amino and hydroxyethyl starch priming of cardioplumonary bypass improve effectively postoperative lung function of children with congenital heart disease,and hydroxyethyl starch is most efficient.