6岁以上先天性肌性斜颈患儿48例诊疗体会

目的探讨6岁以上大龄儿童先天性肌性斜颈治疗的体会。方法采用胸锁乳突肌双极松解和肌腱部分切除术,术后行枕颌吊带牵引,配戴胸颈联合支具联合治疗,随访3-10 a、平均6.13 a。结果疗效优良者45例（93.75%）;1例出现一过性乳突切口周围皮肤麻木感。结论对6岁以上大龄先天性肌性斜颈患者,行双极松解结合术后有效的枕颌吊带牵引及配戴矫形支具是较有效的治疗方法。     

早期伸展运动治疗婴儿先天性肌性斜颈126例

先天性肌性斜颈（CMT）是常见的婴儿颈部畸形。其病因尚不完全清楚。2000年1月～2004年12月,我们对126例CMT患儿早期行被动伸展运动法（PSE）治疗,疗效满意。现报告如下。     

先天性上斜肌麻痹致眼性斜颈的手术治疗

对38例有代偿头位的先天性上斜肌麻痹致眼性斜颈患儿行下斜肌减弱术或配偶肌的下直肌后徙术及麻痹眼上直肌后徙术.术后28例代偿头位消失,8例代偿头位好转,2例无效.认为先天性上斜肌麻痹致眼性斜颈手术治疗效果可靠.     

经腹腔镜治疗婴儿先天性肥厚性幽门环肌狭窄及先天性巨结肠

目的 总结使用腹腔镜治疗新生儿、婴儿先天性肥厚性幽门环肌狭窄及先天性巨结肠的经验。方法 20例患儿年龄16－120d，体重2.7-8kg。先天性肥厚性幽门狭窄和先天性巨结肠各10例。在气管插管加单次髓管阻滞麻醉上，建立CO2气膜，注气压力为1.6-1.9kPa，流量为3L／min。置入腹腔镜，并根据不同的病种在不同的部位置入操作钳，完成幽门环肌切开术和辅助巨结肠根治术。结果 手术时间为25－150min，术后3－7d出院。均无并发症发生。结论 腹腔镜技术在新生儿、婴儿应用安全可靠，手术打击小。     

先天性高肩胛症的外科治疗

对１０例先天性高肩胛症患儿行手术治疗，效果良好，但不同年龄患儿的术后畸形及功能改善有一定差异，最佳手术年龄为２－４岁；年龄较大或合并Ｋｌｉｐｐｅｌ－Ｆｅｉｌ综合征并非手术禁忌：单纯肩胛骨内上角切除加局部皮肤整形可以改善外观。     

小切口心脏不停跳心内直视手术治疗先天性心脏病

目的总结小切口心脏不停跳心内直视手术治疗先天性心脏病的优点。方法2001年1月至2005年2月共完成小切口心脏不停跳心内直视手术76例,包括房间隔缺损48例、室间隔缺损22例、肺动脉狭窄4例、单心房2例。合并畸形包括二尖瓣关闭不全、三尖瓣关闭不全、部分肺静脉异位引流等。结果本组患者体外循环时间(43.1±12.4)min,术后机械通气时间(3.0±1.1)h,术后引流量(3.2±1.5)ml/kg,术后住院(7.2±1.1)d。全组无1例死亡。所有患者随访14～65个月,无并发症。结论小切口剖胸矫治先天性心脏病具有创伤小、不破坏胸廓的完整性、切口隐蔽美观、恢复快等优点。     

儿童陈旧性孟氏骨折的手术治疗

1989～1992年我们收治儿童陈旧孟氏骨折12例,均采用手术治疗,现报告如下。1 临床资料 男10例,女2例;年龄5～11岁,平均9.3岁。右侧8例,左侧4例,均由间接暴力所致。受伤至手术时间4个月至3年,平均1年2个月。前臂均不同程度旋转受限,其中3例因损伤时间长,肘关节屈曲轻度受限。全部病人均挠骨头向前外侧脱出,尺骨上端骨折愈合,向挠侧成角。2 手术方法 采用基础及臂丛神经麻醉。上止血带,取肘及前臂上端外后侧入路。术中见挠骨头均向前脱出,环状韧带不完整,与周围瘢痕     

交变电震磁治疗先天性肌性斜颈

1980～1992年,我们采用改良电磁治疗机治疗75例先天性肌性斜颈患儿,疗效显著。1.临床资料:本组年龄7天至6个月,有难产史43例,臂位及产钳助产各8例。患儿出生后头颈均偏向一侧,其中左侧31例,右侧44例;胸锁乳突肌中下部触及肿块68例,直径1.5～4.5cm不等。肌挛缩5例。     

External treatment of herbal medicine with tuina in congenital muscular torticollis: A protocol for systematic review and meta-analysis

Background:This study is the protocol to evaluate the clinical evidence for external treatments using herbal medicine (ETHM) with tuina as a congenital muscular treatment (CMT) in pediatrics.Methods:Eleven databases will be searched until June 2022, without any language restrictions: four English databases (MEDLINE, Pubmed, EMBASE, and The Cochrane Central Register of Database of Controlled Trials), three Chinese databases (China National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan Fang Database), and four Korean electronic databases (Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, National Digital Science Links, and Research Information Sharing Service). This review will include randomized clinical trials (RCTs) of ETHM with tuina as an intervention versus the same tuina. All published RCTs for any ETHM for CMT will be included. Non-RCTs, RCT protocol, animal studies, case reports, reviews, and surveys will be excluded. The methodological quality assessment will be performed using the Cochrane risk of bias (ROBs). Review Manager version 5.4. will be used for the data synthesis and quantitative analysis.Results and discussions:The systematic review and meta-analysis will provide evidence for ETHM as a treatment of CMT. The evidence can help clinicians and patients recognize more effective therapeutic and safe inventions.INPLASY registration number:INPLASY202210017.     

Chinese massage (Tuina) combline with paraffin therapy versus tuina or paraffin therapy alone for the treatment of congenital muscular torticollis: A protocol for systematic review and Bayesian network meta-analysis

Background:Current studies in patients with congenital muscular torticollis (CMT) have predominantly focused on the role of tuina or paraffin therapy alone. This systematic review with Bayesian network meta-analysis will be performed to sum up the existing evidence on the effects and safety of tuina plus paraffin therapy for CMT in infants and children.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes reporting guidelines will be followed to conduct this study. The electronic databases of PubMed, Cochrane Library, PsycINFO, EMBASE, the Chinese Scientific Journal Database, China National Knowledge Infrastructure, WanFang Data, Taiwan Electronic Periodical Services, and Web of Science will be searched from the inception to November 2021 using the following key terms: “Tuina,” “traditional Chinese medicine massage,” “paraffin,” and “congenital muscular torticollis,” for all relevant studies. We impose no language restrictions. We include reports on randomized controlled trials (RCTs) and quasi-RCTs of Tuina combline with paraffin therapy for the treatment of CMT in children and adolescents. We include studies that assessed effective rate, symmetry, improvements of range of motion, muscle length, and sternocleidomastoid tumor thickness, quality of life, and adverse events. The Cochrane Bias Risk Tool, which considers sequence generation, allocation concealment, and blinding and other aspects of bias, will be used to assess the risk of bias in studies.Results:A Bayesian network meta-analysis is an appropriate statistical method to compare all treatment options by statistically simulating the estimated results of a comprehensive trial, and to compare treatments by common and associated comparators. In addition, Bayesian network meta-analysis can produce ranking probabilities of treatments, which may contribute to clinicians’ clinical decision-making.Registration number:10.17605/OSF.IO/K5EGN.     

Effect of physical therapy intervention on thickness and ratio of the sternocleidomastoid muscle and head rotation angle in infants with congenital muscular torticollis: A randomized clinical trial (CONSORT)

Background:Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical therapy modality to improve the sternocleidomastoid (SCM) muscle thickness, the ratio of the SCM muscle thickness on the affected side to that on the non-affected side (A/N ratio), and head rotation in infant under 3 months of age diagnosed with CMT.Methods and analysis:A single-blind, randomized clinical trial was conducted. Participants were assigned in one of the 3 study groups through randomization. The treatment was performed 3 times a week for 30 minutes until the head tilt was ≤5 degrees. Group 1 was treated by handling for active or active-assist movement, group 2 was treated with passive stretching, and group 3 was treated with thermotherapy. For general characteristics, a χ² test and 1-way analysis of variance were used. Intragroup differences were analyzed using a paired t test, and intergroup differences were analyzed using an age-adjusted analysis of covariance.Results:After the intervention, there was no significant difference between groups in terms of SCM thickness on the affected side and A/N ratio (P > .05). Degree of head rotation on the affected side showed significant differences between groups (P < .05), with Group 2 showing significantly better results than group 1 and group 3 (P < .05, both).Conclusion:Passive stretching treatment was more effective than other treatments of this study for improvement in degree of head rotation in CMT infants under 3 months of age.Trial registration:The trial is registered at the Institutional Review Board of Sahmyook University (IRB number, 2-7001793-AB-N-012019103HR) and the Clinical Research Information Service (CRiS; registry number, KCT0004862)     

52例先天性冠状动脉瘘的外科治疗

目的　总结 5 2例先天性冠状动脉瘘的外科治疗效果。方法　全组 5 2例中 ,年龄 9个月～ 5 8岁 ,平均 (15 7± 16 4)岁。 36例为单纯的先天性冠状动脉瘘 ,16例合并有其他心脏外科疾病。5 2例中 ,右冠状动脉瘘占 71 2 % ,左冠状动脉瘘占 2 8 8%。瘘口于右室 ,右房 ,左室 ,左房及肺动脉分别为 42 3% ,30 8% ,11 5 % ,5 8%和 9 6 %。结果　手术均在体外循环下进行 ,10例切开冠状动脉闭合瘘口 ,2 6例经心腔闭合瘘口 ,16例分别闭合在冠状动脉内和在心腔内的瘘口 ;16例合并其他心脏病变同期矫治。心腔内发现二个瘘口者有 6例 ,三个瘘口者 3例 ,余 43例为单一瘘口。全组无死亡及残余漏。 37例随防 1个月～ 8年 ,平均 3 5年 ,均无症状。一例有ST T改变。结论　外科治疗先天性冠状动脉瘘是安全和有效的方法 ,合并有其他心脏外科疾病应同时矫治。准确判断瘘口的位置和确切可靠的缝合技术是防止残余漏的关键。     

先天性心脏病合并感染性心内膜炎的个体化治疗

目的：探讨先天性心脏病（CHD）合并感染性心内膜炎（IE）的个体化治疗。方法：本组病例共73例,主要表现为发热、贫血、栓塞等;血培养及赘生物培养阳性17例（23.3%）,以草绿色链球菌居多,病原体菌种呈现多样化趋势。超声心动图检查阳性率83.6%（61例）。病灶分布以主动脉瓣病变（33例）,二尖瓣病变（21）例为多。所有患者均经外科手术清除感染病灶及赘生物,并相应纠治瓣膜病变和心脏畸形。其中择期手术54例（74.0%）,急诊手术19例（26.0%）。血培养阳性病例应用大剂量敏感广谱抗生素4～8周。结果：本组无手术死亡,均经手术及抗生素治疗后临床痊愈出院。术后随访心功能改善,仅1例1年后心内膜炎复发。结论：大剂量敏感广谱抗生素治疗与积极的相应外科治疗相结合的个体化处理是治疗先天性心脏病合并感染性心内膜炎的重要手段,对提高存活率、降低病死率有着重要的意义。     

The usefulness,reliability, and quality of YouTube video clips on congenital muscular torticollis: A STROBE compliant study

This study aimed to evaluate the usefulness, reliability, quality, and related characteristics of YouTube video clips on congenital muscular torticollis (CMT). This cross-sectional study analyzed 47 YouTube video clips on CMT. They were classified as either useful or misleading by 2 rehabilitation doctors. The modified DISCERN tool and the Global Quality Scale (GQS) were used to evaluate their reliability and quality. An analysis was conducted using the characteristics, such as presenters, ownership of YouTube channel accounts, countries, contents, and the video popularity. Of the 47 YouTube video clips, 8 (17%) were evaluated as misleading, which indicated that they included at least one scientifically unproven piece of information on CMT or more. They were less reliable and of lower quality than the useful video clips. The video clips presented by healthcare professionals were more useful compared to those presented by others (P = .015). However, the video popularity was not related to its usefulness. The reliability and quality (3.70 ± 0.82 vs 0.75 ± 0.50 and 2.95 ± 1.21 vs 1.50 ± 1.00) assessed by the modified DISCERN tool and GQS, respectively, were significantly higher in the video clips presented by healthcare professionals compared to those presented by others. There were misleading YouTube video clips on CMT. Video clips presented by healthcare professionals could be more useful, reliable, and of better quality. The popularity of the video clips does not indicate more usefulness, reliability, and better quality. YouTube viewers should be aware of these findings. We recommend that the viewers preferentially choose video clips on CMT presented by healthcare professionals, not by the video popularity.     

60岁以上老年肺癌的外科治疗

目的在分析60岁以上老年人肺癌手术适应证、并发症及围手术期处理,并对其外科治疗的方法、结果和特殊性进行探讨。方法全组77例,年龄60～78岁,平均64岁;Ⅱa期23例,Ⅱb期29例,Ⅲa期18例,Ⅲb期7例,行全肺切除4例,肺叶切除67例,肺段切除2例。其中6例行支气管袖状切除成形。2例在胸腔镜辅助小切口下完成肺段或肺楔形切除术。结果全组无手术死亡,手术切除率为94.8%,术后并发症发生率为24.6%。随访率为87%,1、3、5年生存率分别为86.5%、47.7%、31.3%。结论在严格选择手术适应证的前提下,结合术中肺功能保护及周密的围术期处理,老年患者术后可获得相对良好的远期预后,应采取积极的手术治疗。     

主动脉左心室通道的外科治疗

目的 总结9例主动脉左心室通道的外科诊治经验.方法 回顾性分析我院2002年7月至2008年8月收治主动脉左心室通道患者9例,术前心功能(NYHA):Ⅱ级7例,Ⅲ级2例.9例患者中8例术前通过经胸超声心动图诊断,全部经术中食道超声确诊.结果 9例均于术中确诊并行手术治疗,主动脉侧直接缝合2例,其中1例缝合通道后行主动脉瓣置换术;自体心包片或涤纶片衬心包从主动脉侧修补5例,其中1例修补通道后行主动脉瓣置换术;自体心包从主动脉侧及左室侧修补1例;切开主动脉左心室通道行主动脉瓣置换术1例.1例术后2个月因感染性心内膜炎、急性心力衰竭死亡;随访3个月至6年,随访7例,失访1例,心功能(NYHA标准)Ⅰ级患者3例,Ⅱ级3例,Ⅲ级1例.超声心动图示主动脉瓣无或微量反流2例,1例少量反流,2例少到中量反流,主动脉瓣功能正常1例,瓣周漏1例,远期无死亡.结论 主动脉左心室通道是一类非常罕见的先天性心脏病,超声心动图在本病诊断方面有着明显的优势;手术是治疗的有效方式,单纯修补效果良好.