目的建立儿童发育性髋关节发育不良(developmental dysplasia of the hip,DDH)闭合复位术后结局预测模型,并利用该模型指导DDH闭合复位术后残余髋臼发育不良(residual acetabulalr dysplasia,RAD)手术时机的选择。方法回顾性分析国内多...目的建立儿童发育性髋关节发育不良(developmental dysplasia of the hip,DDH)闭合复位术后结局预测模型,并利用该模型指导DDH闭合复位术后残余髋臼发育不良(residual acetabulalr dysplasia,RAD)手术时机的选择。方法回顾性分析国内多个医疗中心2004-2015年采用闭合复位术治疗的449例(522髋)DDH患儿临床资料,患儿年龄(16.3±5.1)个月。术前在骨盆正位X线片上评估脱位程度的国际髋关节发育不良协会(International Hip Dysplasia Institute,IHDI)分型、股骨头骨化核以及髋臼指数(acetabular index,AI)。术后测量第1、2、3、4年及末次随访时的AI、中心边缘角(centre-edge angle of Wiberg,CEA)和Reimer指数(Reimer's index,RI),评估股骨头缺血性坏死(avascular necrosis of the femoral head,AVN)情况。根据末次随访时Severin影像学评级以及是否接受二期骨盆截骨术,将患儿分成两组:SeverinⅠ、Ⅱ级为痊愈组,SeverinⅢ、Ⅳ级或接受了骨盆截骨术者为RAD组。利用Cox回归构建DDH闭合复位术后痊愈预测模型,并用受试者操作特征(receiver operating characteristic,ROC)曲线进行内部验证。结果522髋中,IHDI分型为Ⅱ型70髋(13.4%),Ⅲ型223髋(44.6%),Ⅳ型219髋(42%)。复位前410髋(78.5%)已出现股骨头骨化核。总体AVN(Ⅱ型以上)发生率为12.8%。痊愈组329髋(63%),痊愈时间(33.3±14.7)个月(8.4~111.4个月),93.6%(308/329)的痊愈患儿痊愈时间在术后5年以内。Cox回归分析显示,IHDI分型、股骨头骨化核、复位年龄、当前AI、CEA、RI、AVN是DDH闭合复位术后累积痊愈概率的影响因素,利用上述影响因素,本研究成功构建了DDH闭合复位术后痊愈预测模型。该模型中所有因素的总分为-11~17分,对应痊愈概率为0.02~1.0。在该模型下,ROC曲线分析显示,术后第1、2、3、4年总分小于2.5、1.5、2.5、1.5分时,患儿痊愈概率显著较高(81.4%~96.1%),ROC曲线下面积为0.808~0.910,Kappa系数为0.497~0.618。相反,当总分大于1.5~2.5分时,RAD发生率显著升高,建议行骨盆截骨术。结论本研究构建的痊愈预测模型可以有效预测RAD,并指导骨盆截骨手术时机的选择。在该模型下,如果术后第1、2、3、4年时模型中所有因素总分大于2.5、1.5、2.5、1.5分,则RAD发生率显著升高。展开更多
BACKGROUND： The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent compli...BACKGROUND： The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed. OBJECTIVE： To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy. DESIGN： A case-controlled analysis. SETTING： Qilu Children＇s Hospital of Shandong University. PARTICIPANTS： Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children＇s Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0-2 years old, 47 cases of 2-4 years and 36 cases of 4-6 years. Informed contents were obtained from relatives of all the children. METHODS： ① Comprehensive rehabilitation treatment： Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub, pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ② Prognosis assessment： The gross motor functional grading of the children with cerebral palsy at admission was assessed using the Chinese version of gross motor function classification system （GMFCS）. The gross motor functions of the children with cerebral palsy were assessed before rehabilitation treatment and 12 months after rehabilitation treatment by using gross motor function measure （GMFM）. The improved GMFM total score was calculated. Developmental quotient was evaluated using Gesell developmental schedules （GDS） after 12-month rehabilitation treatment. Univariate analysis of variance was performed using the improved GMFM total score with age, GMFCS grade and developmental level （developmental quotient）. MAIN OUTCOME MEASURES： Effects of age started to accept rehabilitation treatment, GMFCS grade and developmental level on the recovery of gross motor function in children with cerebral palsy. RESULTS： All the 138 children with cerebral palsy were involved in the analysis of results. The improved GMFM total scores were significantly different among the children with cerebral palsy of different ages started to accept treatment, GMFCS grades and developmental levels （F=13.464, 37.283, 30.814, P 〈 0.01）. The younger the children started to accept treatment, the lower the their GMFCS grades and the higher their developmental levels, then the higher their improved GMFM total scores. CONCLUSION： The recovery of gross motor function is better in younger children started to accepted treatment with cerebral palsy with lower GMFCS grades and higher developmental levels.展开更多
In the present paper the author reviews the viewpoint of 'preventive treatment of diseases' in the ancient literature of traditional Chinese medicine (TCN) and its clinical application from (1) prevention firs...In the present paper the author reviews the viewpoint of 'preventive treatment of diseases' in the ancient literature of traditional Chinese medicine (TCN) and its clinical application from (1) prevention first before the occurrence of diseases; and (2) preventing development after onset of diseases. In the preventive treatment of diseases, the ancient Chinese doctors usually (1) regulated qi of both Conception Vessel and Governor Vessel for health care; (2) performed regular moxibustion; and (3) applied plaster to the acupoint in summer for treating winter-diseases. In the treatment of diseases after onset, the ancient Chinese usually (1) tried best to make early diagnosis and early treatment; and (2) strengthened the related internal organ in advance to check their development; and (3) employed appropriate remedies to recuperate the patient's health.展开更多
文摘目的建立儿童发育性髋关节发育不良(developmental dysplasia of the hip,DDH)闭合复位术后结局预测模型,并利用该模型指导DDH闭合复位术后残余髋臼发育不良(residual acetabulalr dysplasia,RAD)手术时机的选择。方法回顾性分析国内多个医疗中心2004-2015年采用闭合复位术治疗的449例(522髋)DDH患儿临床资料,患儿年龄(16.3±5.1)个月。术前在骨盆正位X线片上评估脱位程度的国际髋关节发育不良协会(International Hip Dysplasia Institute,IHDI)分型、股骨头骨化核以及髋臼指数(acetabular index,AI)。术后测量第1、2、3、4年及末次随访时的AI、中心边缘角(centre-edge angle of Wiberg,CEA)和Reimer指数(Reimer's index,RI),评估股骨头缺血性坏死(avascular necrosis of the femoral head,AVN)情况。根据末次随访时Severin影像学评级以及是否接受二期骨盆截骨术,将患儿分成两组:SeverinⅠ、Ⅱ级为痊愈组,SeverinⅢ、Ⅳ级或接受了骨盆截骨术者为RAD组。利用Cox回归构建DDH闭合复位术后痊愈预测模型,并用受试者操作特征(receiver operating characteristic,ROC)曲线进行内部验证。结果522髋中,IHDI分型为Ⅱ型70髋(13.4%),Ⅲ型223髋(44.6%),Ⅳ型219髋(42%)。复位前410髋(78.5%)已出现股骨头骨化核。总体AVN(Ⅱ型以上)发生率为12.8%。痊愈组329髋(63%),痊愈时间(33.3±14.7)个月(8.4~111.4个月),93.6%(308/329)的痊愈患儿痊愈时间在术后5年以内。Cox回归分析显示,IHDI分型、股骨头骨化核、复位年龄、当前AI、CEA、RI、AVN是DDH闭合复位术后累积痊愈概率的影响因素,利用上述影响因素,本研究成功构建了DDH闭合复位术后痊愈预测模型。该模型中所有因素的总分为-11~17分,对应痊愈概率为0.02~1.0。在该模型下,ROC曲线分析显示,术后第1、2、3、4年总分小于2.5、1.5、2.5、1.5分时,患儿痊愈概率显著较高(81.4%~96.1%),ROC曲线下面积为0.808~0.910,Kappa系数为0.497~0.618。相反,当总分大于1.5~2.5分时,RAD发生率显著升高,建议行骨盆截骨术。结论本研究构建的痊愈预测模型可以有效预测RAD,并指导骨盆截骨手术时机的选择。在该模型下,如果术后第1、2、3、4年时模型中所有因素总分大于2.5、1.5、2.5、1.5分,则RAD发生率显著升高。
文摘BACKGROUND： The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed. OBJECTIVE： To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy. DESIGN： A case-controlled analysis. SETTING： Qilu Children＇s Hospital of Shandong University. PARTICIPANTS： Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children＇s Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0-2 years old, 47 cases of 2-4 years and 36 cases of 4-6 years. Informed contents were obtained from relatives of all the children. METHODS： ① Comprehensive rehabilitation treatment： Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub, pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ② Prognosis assessment： The gross motor functional grading of the children with cerebral palsy at admission was assessed using the Chinese version of gross motor function classification system （GMFCS）. The gross motor functions of the children with cerebral palsy were assessed before rehabilitation treatment and 12 months after rehabilitation treatment by using gross motor function measure （GMFM）. The improved GMFM total score was calculated. Developmental quotient was evaluated using Gesell developmental schedules （GDS） after 12-month rehabilitation treatment. Univariate analysis of variance was performed using the improved GMFM total score with age, GMFCS grade and developmental level （developmental quotient）. MAIN OUTCOME MEASURES： Effects of age started to accept rehabilitation treatment, GMFCS grade and developmental level on the recovery of gross motor function in children with cerebral palsy. RESULTS： All the 138 children with cerebral palsy were involved in the analysis of results. The improved GMFM total scores were significantly different among the children with cerebral palsy of different ages started to accept treatment, GMFCS grades and developmental levels （F=13.464, 37.283, 30.814, P 〈 0.01）. The younger the children started to accept treatment, the lower the their GMFCS grades and the higher their developmental levels, then the higher their improved GMFM total scores. CONCLUSION： The recovery of gross motor function is better in younger children started to accepted treatment with cerebral palsy with lower GMFCS grades and higher developmental levels.
文摘In the present paper the author reviews the viewpoint of 'preventive treatment of diseases' in the ancient literature of traditional Chinese medicine (TCN) and its clinical application from (1) prevention first before the occurrence of diseases; and (2) preventing development after onset of diseases. In the preventive treatment of diseases, the ancient Chinese doctors usually (1) regulated qi of both Conception Vessel and Governor Vessel for health care; (2) performed regular moxibustion; and (3) applied plaster to the acupoint in summer for treating winter-diseases. In the treatment of diseases after onset, the ancient Chinese usually (1) tried best to make early diagnosis and early treatment; and (2) strengthened the related internal organ in advance to check their development; and (3) employed appropriate remedies to recuperate the patient's health.
