ObjectiveTo investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.MethodsBetween 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.ResultsAll patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.ConclusionThe proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.
ObjectiveTo evaluate the effectiveness of Cross-Union surgery for the treatment of pseudarthrosis of the tibia (PT) with neurofibromatosis type 1 (NF1). MethodsThe clinical data of 8 children of PT with NF1 who met the selection criteria between January 2018 and December 2023 was retrospectively analyzed. There were 5 boys and 3 girls, and the operative age ranged from 1.8 to 13.3 years with a median age of 3.5 years. According to Paley classification, there were 2 cases of type 2a, 2 cases of type 3, 2 cases of type 4a, and 2 cases of type 4c. There were 5 cases of first operation and 3 cases of re-fracture after previous operation. Six cases had leg length discrepancy before operation, and 2 of them had shortening over 2.0 cm. Except for 1 case of ankle fusion, the other 7 cases had ankle valgus. Preoperative coronal/sagittal angulation was recorded. Postoperative pseudarthrosis healing and refracture were observed. Leg length discrepancy and tibiotalar angle were measured and recorded before operation and at last follow-up. Inan imaging evaluation criteria was used to evaluate the imaging effect. ResultsAll patients were followed up 12-37 months (mean, 23.5 months). One pseudarthrosis failed to heal at 12 months after operation and healed at 3 months after reoperation, while the other pseudarthrosis healed with a healing rate of 87.5% and a healing time of 4-8 months (mean, 5.3 months). No refracture occurred during the follow-up. At last follow-up, there were 2 new cases with leg length discrepancy, which were 0.7 cm and 1.3 cm, respectively. In 2 cases with the leg length discrepancy more than 2.0 cm before operation, the improvement was from 4.1 cm and 12.6 cm to 2.1 cm and 9.0 cm, respectively. There was no significant difference in leg length discrepancy between pre- and post-operation in 8 cases (P>0.05). At last follow-up, 6 patients still had ankle valgus, and there was no significant difference in the tibiotalar angle between pre- and post-operation (P>0.05); the tibial coronal/sagittal angulation significantly improved when compared with that before operation (P<0.05). According to Inan imaging evaluation criteria, 1 case was good, 6 cases were fair, and 1 case was poor. Conclusion Cross-Union surgery is an effective method for the treatment of PT with NF1 in children, can achieve good bone healing results with a low risk of re-fracture. The surgery may not have significant effects on leg length discrepancy and ankle valgus, and further treatment may be required.
After Wenchuan earthquake, the West China Second University Hospital immediately started the preparation of emergency pharmaceutical administration. The pharmaceutical department effectively controlled the provision, purchasing, utilization and donation of medications through a double-track operation system. In this way, the medication supply was ensured for both the patients suffering from the disaster and routine patients, which guaranteed the rationality in medication and promoted the utilization of the donated drugs so that more than 80 000 drug cost was saved for the hospital.
ObjectiveTo explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children.MethodsThe clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.ResultsA total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor.ConclusionMinimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.
Acetabuloplasty was used to treat 62 cases (76 hips) of congenital dislocation of hip in older children, with a period of follow-up for 1 to 7 years. The good results from operation rated 81.7 percent. It was considered that this type of operation could fulfil the physiological requirements, as the femoral head replaced into the acetabulum would accomplish the following benefits from establishing a stable joint, reducing the lumbar lordosis and minimizing development of hip and low back pain. The technique ...
ObjectiveTo investigate the knowledge of drug safety among parents of some children with epilepsy in Henan Province, and to provide a basic advice for drug safety and health education for children with epilepsy.sMethodUsing a questionnaire to parents of epilepsy children from the Children's Hospital in Henan Province and the First Affiliated Hospital of Zhengzhou University in July 2019, a total of 336 questionnaire were conducted by the professionals responsible for after the training, including parents and children basic situation, drug habits and attitudes, medication safety consciousness and antibiotic drug use knowledge.Results320 questionnaire were collected, 314 of which were valid questionnaires, with an effective rate of 98.1%. 66 (21%) of parents chose juice or milk for oral administration, and 87 (27.7%) of parents chose sugar water. 104 (33.1%) of the parents chose to stop the medication immediately after the child's condition improved. 126 (40.1%) of parents believe that combination of two or more antibiotics is more effective, 178 (56.7%) of parents will give their children antibiotics when they have a cold or fever, and more than 254 (80%) of parents are not aware of adverse reactions to antibiotics.ConclusionIn the investigation, the parents of children with epilepsy in Henan Province still have insufficient knowledge of safe drug use, and there are many non-standard drug use behaviors. Local medical professionals for epilepsy should be strengthened to guide and monitor the children and their parents.
Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Results Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) (t=−11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. ConclusionThe perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.
ObjectiveTo compare the efficacy of totally transanal endorectal pull-through and laparoscopic assistance endorectal pull-through in the treatment of Hirschsprung’s disease (HD).MethodsPubMed, EMBASE, The Cochrane Library, CNKI, Wanfang, and VIP Database were searched to screen out the comparative studies published between January 1998 and May 2020 on the treatment of HD with totally transanal endorectal pull-through and laparoscopic assistance endorectal pull-through. Then two reviewers independently completed the literatures screening, data extraction, and quality evaluation. The Review Manager 5.3 software was used to combine the effect size of the postoperative effect indicators included in the literatures. Stata 14.0 software was used to perform Begg’s and Egger’s tests on the publication bias of the included literatures.ResultsA total of 8 clinical studies conforming to the standards were included and 702 cases of children undergoing HD radical resection were recorded, including 335 cases in the totally transanal endorectal pull-through group and 367 cases in the laparoscopic assistance endorectal pull-through group. Compared with the laparoscopic assistance endorectal pull-through group, the totally transanal endorectal pull-through group had an advantage in the incidence of postoperative faecal incontinence/soiling [OR=0.20, 95%CI was (0.07, 0.54), P=0.001], and the postoperative constipation recurrence rate was higher than the laparoscopic assistance endorectal pull-through group [OR=2.39, 95%CI was (1.05, 5.42), P=0.04]. There were no statistically significant differences between the two groups in terms of postoperative enterocolitis [OR=1.01, 95%CI was (0.59, 1.75), P=0.96], postoperative adhesion intestinal obstruction [OR=0.74, 95%CI was (0.28, 1.95), P=0.54], and postoperative anastomotic stenosis [OR=1.14, 95%CI was (0.51, 2.56), P=0.74].ConclusionsCompared with laparoscopic assistance endorectal pull-through, the totally transanal endorectal pull-through can reduce the incidence of postoperative faecal incontinence/soiling, but the rate of recurrence of postoperative constipation is higher. The two surgical procedures for HD have similar incidences of postoperative enterocolitis, anastomotic stenosis, and adhesive intestinal obstruction.
Objective To assess the global situation of off-label drug use in outpatient children.Methods A search was conducted in PubMed, EMbase, CBM, CNKI and VIP for collecting studies on off-label drug use in outpatient children aged 0 to 18 years, and the publication language was limited to English and Chinese. The quality assessment was based on Crombie Criteria for cross-sectional studies, and the descriptive analysis was performed to analyze the incidence of off-label drug use at all levels of medical institutes and different age groups, the common types of off-label used drugs, and the constitution ratio of off-label use drugs. Results A total of 20 cross-sectional studies were included, involving 1 933 760 children and 5 262 573 prescriptions. The results of descriptive analysis showed: a) The incidence of off-label drug use in outpatient children in primary care and tertiary care institutes were 19.5% (IQR 13.5%, 24.5%) and 26.0% (IQR 24.0%, 35.0%), respectively; b) The primary studies reported that neonate, infant and adolescent had the highest incidence of off-label drug use, while the other children had the lowest incidence; c) Drugs for respiratory system, anti-infection, sensory organs, and dermatosis were listed as the top 5 frequently used off-label drugs by more than half of the studies; d) The studies with issue of “lack of instruction for children” showed it was exactly the type with highest incidence of off-label use, while other studies without that issue showed the highest incidence was over aged off-label use. Conclusion a) Off-label drug use is common in outpatient children. The incidence of off-label drug use may be higher in tertiary care institutes than primary care institutes, and it is higher in neonate, infant and adolescent rather than other age groups of children; b) Incidence of off-label use may be higher in inpatient children than outpatient ones; c) Drugs for respiratory system, anti-infection, sensory organs, and dermatosis were most common types of off-label use; and d) Off-label use due to both “lack of instruction for children” and “over aged use” is more common. So it suggests that further studies trials should focus on fields in which clinical trials of drugs are totally absent.
Objective To investigate the effects of children’s crawling-promotion-training-robot on gross motor function and cognitive function in children with global developmental delay (GDD). Methods A total of 40 children with GDD admitted to the Department of Rehabilitation Medicine, Children’s Hospital of Nanjing Medical University were selected as the research subjects. By envelope method, the children were randomly and equally divided into experimental group and control group, with 20 cases in each group. The experimental group received children’s crawling-promotion-training-robot combined with conventional rehabilitation therapy, while the control group received manual crawling training combined with conventional rehabilitation therapy. Before and after treatment, the scores of Gross Motor Function Measure Scale-88 (GMFM-88) and Gesell Developmental Scale (GDS) were respectively used to evaluate gross motor function and cognitive function. Results There was no significant difference in gender (χ2=0.100, P=0.752) and age (t=0.053, P=0.962) between the two groups. Before treatment, there was no significant difference in GMFM-88 and GDS scores between the two groups (P>0.05). After treatment, there were statistically significant differences in GMFM-88 and GDS scores between the two groups (P<0.05). The comparison within the group showed that there were statistically significant differences in GMFM-88 and GDS scores between the two groups before and after treatment. Conclusion Children’s crawling-promotion-training-robot is more effective than manual crawling training in improving gross motor function and cognitive function in children with GDD.