Objective To investigate effectiveness of simplified all-arthroscopic Brostr?m technique in treatment of chronic lateral ankle instability in adolescents. Methods A clinical data of 21 adolescent patients with chronic lateral ankle instability, who met the selection criteria and were admitted between June 2023 and May 2024, was retrospectively analyzed. There were 18 males and 3 females with an average age of 16.0 years (range, 13-18 years). There were 9 cases of left ankle joint injury and 12 cases of right ankle joint injury. Anterior talofibular ligament (ATFL) injury was diagnosed by arthroscopy in all patients. There were 11 cases of cartilage injury, 5 cases of avulsion fractures, and 6 cases of ankle impingement syndrome. The time from first sprain to operation ranged from 3-60 months (mean, 12.0 months). The ATFL was repaired and the ankle joint stability was restored by simplified all-arthroscopic Brostr?m technique. Visual analogue scale (VAS) score, Tegner score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson ankle function scale (KAFS) score, Foot and Ankle Outcome Score (FAOS) were used to evaluate ankle pain and function. MRI was used to evaluate the ligament healing. Results All patients were followed up 8-15 months (mean, 12.6 months). After operation, 1 patient suffered from superficial peroneal nerve injury, 1 patient developed anterior scar impingement on the ankle, 2 patients had superficial wound infection, and 1 patient suffered from sprain again. The VAS score, Tenger score, AOFAS score, KAFS score, and FAOS score significantly improved when compared with the preoperative scores (P<0.05). MRI examination showed the ligament healing and good tension. Conclusion For adolescent patients with chronic lateral ankle instability, using simplified all-arthroscopic Brostr?m technique to repair ATFL can effectively alleviate ankle pain, improve stability, and achieve good effectiveness.
ObjectiveTo evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability.MethodsThe clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness.ResultsAll 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient’s hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one (t=－10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation (t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%.ConclusionModified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.
ObjectiveTo evaluate the effectiveness of Ilizarov technique combined with soft tissue release and muscle strength balance in the treatment of spastic clubfoot in adolescents with cerebral palsy.MethodsA retrospective analysis of clinical data of 29 cases (33 feet) of cerebral palsy spastic clubfoot deformity conformed to the selection criteria between June 2011 and September 2016. Among them, 17 were male (20 feet) and 12 were female (13 feet) with an age range from 13 to 28 years (mean, 17.6 years). According to Diméglio classification, 19 feet were rated as gradeⅡ and 14 feet as grade Ⅲ. All patients were treated with soft tissue release and muscle balance, while using Ilizarov technique to correct varus deformity. Began to gradually adjust the external fixator after 5-7 days of operation, until to reach satisfactory foot ankle form. Orthopedic brace was used after removal of external fixator, and the wearing time gradually reduced to completely abandon the brace.ResultsAll 29 patients (33 feet) were followed up 12-22 months with an average of 18 months. All patients restored line plantar foot without needle infection and nerve or vessel injury. One foot had a mild relapse of deformity at 6 months after removal of external fixator, and the gait restored to normal after symptomatic treatment. The rest of 32 feet had no deformity recurrence during the follow-up. At last follow-up, International Club Foot Study Group (ICFSG) score (5.21±3.91) was significantly lower than the preoperative score (36.73±4.80), and the difference was significant (t=47.227, P=0.000). The results were excellent in 27 feet, good in 3 feet, and fair in 3 feet, and the excellent and good rate was 90.91%. The patients were very satisfied in 27 feet and satisfied in 6 feet by self-evaluation of effectiveness.ConclusionIlizarov technique is effective in treatment of clubfoot. And it is also a feasible method to treat spastic clubfoot in adolescents with cerebral palsy when combined with appropriate soft tissue surgery according to the patient’s symptoms and signs.
ObjectiveTo summarize the clinicopathological characteristics of papillary thyroid cancer (PTC) in adolescents and analyze the risk factors affecting lateral lymph node metastasis and prognosis. MethodsIn retrospectively, 150 adolescent PTC patients admitted to the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2022 and meeting the inclusion and exclusion criterias were collected as the study subjects (adolescent group), and 100 adult PTC patients were selected as adult group. Statistical analysis was performed with SPSS 25.0 software to compare the clinicopathological characteristics of the patients in the two groups, and to explore the risk factors for lateral lymph node metastasis and recurrence in adolescent PTC patients by using logistic regression and Cox proportional hazards regression models, respectively. ResultsAdolescents with PTC were more prone to extrandular invasion [30.0% (45/150) versus 17.0% (17/100), P=0.020], neck lymph node metastasis [79.3% (119/150) versus 48.0% (48/100), P<0.001], central lymph node metastasis [78.7% (118/150) versus 48.0% (48/100), P<0.001], lateral lymph node metastasis [44.0% (66/150) versus 12.0% (12/100), P<0.001]; and had a greater maximum tumor diameter (1.75 cm versus 0.75 cm, P＜0.001) and higher ratio of greater maximum tumor diameter ＞2 cm [45.3% (68/150) versus 8.0% (8/100), P＜0.001] in adolescent PTC patients. In adolescent PTC patients, extraglandular invasion (OR=2.654, P=0.022), multifoci (OR=4.860, P<0.001) and maximum tumor diameter>2 cm (OR=3.845, P=0.001) were risk factors for lateral lymph node metastasis; lateral lymph node metastasis (RR=10.105, P=0.040) and distant metastasis (RR=7.058, P=0.003) were predictors of postoperative recurrence in adolescent PTC patients. ConclusionsCompared with adult PTC patients, adolescent PTC patients have more aggressive tumors. Adolescent PTC with extraglandular invasion, multilesions, and maximum tumor diameter>2 cm should be considered for lateral lymph node dissection; and adolescent PTC patients with lateral lymph node metastasis and distant metastasis should pay close attention to their recurrence status.
Objective To explore effectiveness of suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents. Methods Between June 2013 and October 2016, 18 adolescent patients suffered from tibial eminence avulsion fracture of anterior cruciate ligament were treated by suture-bridge fixation under arthroscopy. There were 11 males and 7 females with an average age of 12.5 years (range, 5-17 years). The injury caused by bruise in 6 cases, by sprain in 4 cases, and by sport injury in 8 cases. The interval between injury and admission ranged from 2 hours to 10 months (median, 2 months). The results of preoperative Lachman and anterior drawer tests were positive. There were 10 cases of knee pain, 4 cases of knee extension limitation, and 4 cases of knee extension without strength. According to the Meyer-McKeever classification criteria, 12 cases were type Ⅱ and 6 cases were type Ⅲ. Results All incisions healed by first intention. All 18 patients were followed up 10-18 months after operation, with an average of 12 months. Postoperative X-ray films showed that all fractures healed after 6-12 weeks (mean, 8 weeks). The results of postoperative Lachman and anterior drawer tests were negative. At last follow-up, the Lysholm knee score was 90.1±5.0 and 93.1±6.2 for affected and unaffected sides, respectively, showing no signifi cant difference (t=0.669, P=0.184). There was no premature closure of skeleton or leg length discrepancy deformity. Conclusion For tibial eminence avulsion fracture of anterior cruciate ligament in adolescents, the suture-bridge fixation under arthroscopy is an effective method with many advantages, such as minimal invasion, reliable fixation, good fracture healing, and no need for second operation to remove implants.
ObjectiveTo compare the effects of aerobic exercise, resistance exercise, aerobic combined with resistance exercise, routine nursing and no intervention on depression and anxiety in adolescents by means of network meta-analysis. MethodsA computer search was conducted in CNKI, WanFang Data, VIP, CBM, Web of Science, EBSCO, PubMed, Cochrane Library and Embase to collect randomized controlled trials (RCTs) related to exercise intervention for depression and anxiety in children and adolescents from inception to April 2023. After two researchers independently screened the literature, extracted data and evaluated the methodological quality of the included studies, Stata 14.0 and RevMan 5.3 software were used for statistical analysis. ResultsFinally 27 RCTs were included, covering 3 210 children and adolescents. The results of the network meta-analysis showed that in terms of improving depression, resistance exercise (SMD=?0.37, 95%CI ?0.64 to ?0.10, P<0.05) and aerobic exercise (SMD=?0.19, 95%CI ?0.34 to ?0.04, P<0.01) were significantly better than the no intervention group; in relieving anxiety, aerobic exercise (SMD=?0.29, 95%CI ?0.54 to ?0.03, P<0.05) was significantly better than the no intervention group. In improving self-worth, aerobic combined with resistance exercise (SMD=0.26, 95%CI 0.01 to 0.52, P<0.05) was statistically different from the no intervention group. The results of SUCRA probability sequence showed that in reducing depression, resistance exercise (95.0%) > aerobic exercise (64.4%) > aerobic combined with resistance exercise (60.7%) > routine nursing (22.9%) > no intervention (7.0%). In relieving anxiety, aerobic exercise (72.4%) > routine nursing (69.0%) > aerobic combined with resistance exercise (55.3%) > no intervention (3.4%). In improving self-worth, aerobic combined with resistance exercise (94.0%) > resistance exercise (67.3%) > aerobic exercise (35.1%) > no intervention (32.7%) > routine nursing (21.0%). ConclusionLimited evidence suggests that resistance exercise has advantages in improving depression in children and adolescents, aerobic exercise has advantages in relieving anxiety in children and adolescents, and aerobic combined with resistance exercise has advantages in improving self-worth in children and adolescents. Due to the limitation of the number and quality of included studies, more high-quality studies are needed to verify the above conclusions.
Objective To study the mid-term and long-term postoperative results of Bentall procedure in patients with Marfan syndrome. Methods From February 2009 to July 2016, ten adolescent patients (mean age of 12.30±2.31 years ranged 9-16 years, mean height of 172.50±12.55 mm, mean weight of 48.60±17.08 kg) underwent Bentall procedure in our hospital. All these teenage patients were with Marfan syndrome, 6 boys and 4 girls. Five of them underwent mitral valve replacement procedure at the same time while 2 of them with tricuspid valvuloplasty. Results No mortality was found in hospitalization. One patient suffered respiratory failure after surgery. No renal failure, mediastinal infection or re-operation caused by bleeding were observed. All were well followed up for 62 months. One died of malignant arrhythmia, the other were in good condition with the latest interview. Conclusion Teenage patients with Marfan syndrome who underwent Bentall procedure have favorable outcomes in mid-term and long-term follow-up, they probably will not suffer anti-coagulation complications and restriction of growth.
Objective To evaluate the effect of mindfulness therapy on sleep problems in adolescents. Methods We searched PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, Chongqing VIP and SinoMed for relevant randomized controlled trials on mindfulness intervention to improve adolescents’ sleep. The retrieval time was from the establishment of the databases to October 21, 2022. The results were meta-analysed with RevMan 5.4 software. Results A total of 11 randomized controlled trials were included, with a total sample size of 870 cases. The types of mindfulness therapy include mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness meditation, group mindfulness sleep intervention, body scanning and other mindfulness technologies. The duration of single intervention was different. The included studies showed that the mindfulness intervention can effectively improve the sleep problems of adolescents and the accompanying daytime sleepiness, anxiety, depression and other negative emotions compared with the control intervention. Meta-analysis of six studies showed that the sleep quality of adolescents in the mindfulness intervention group was improved [mean difference=?1.21, 95% confidence interval (?1.58, ?0.83), P<0.00001]. Conclusion Mindfulness therapy has a good effect on improving adolescents’ sleep problems, but whether it can achieve long-term benefits still needs to be further evaluated by high-quality, multicenter long-term follow-up trials.
ObjectiveTo review the advances in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery.MethodsRegular analgesics, drug administrations, and analgesic regimens were reviewed and summarized by consulting domestic and overseas related literatures about perioperative pain management of pediatric and adolescent spinal deformity corrective surgery in recent years.ResultsAs for perioperative analgesis regimens of pediatric and adolescent spinal deformity corrective surgery, regular analgesics include non-steroidal anti-inflammatory drugs, opioids, antiepileptic drugs, adrenergic agonists, and local anesthetic, etc. Besides drug administration by mouth, intravenous injection, and intramuscular injection, the administration also includes patient controlled analgesia, epidural injection, and intrathecal injection. Multimodal analgesia is the most important regimen currently.ConclusionHeretofore, a number of perioperative pain managements of pediatric and adolescent spinal deformity corrective surgery have been applied clinically, but the ideal regimen has not been developed. To design a safe and effective analgesic regimen needs further investigations.
In order to explore effective ways to reduce non-suicidal self-injury (NSSI) among female adolescents, a total of 45 female adolescent patients with NSSI in West China Hospital of Sichuan University and Guizhou Second Provincial People's Hospital from June 2021 to June 2024 were selected randomly that divided into groups A, B and C, with 15 cases in each group. Group A was treated with repeated transcranial magnetic stimulation (rTMS) and bipolar depression triple therapy, and group B was treated with bipolar depression triple therapy to compare the effectiveness and safety. Group C received bipolar depression triple therapy combined with sham stimulation which only produced stimulating sounds but no stimulating magnetic field as a control in the study. After treatment, the Hamilton Anxiety Score (HAMA), Hamilton Depression Score (HAMD) and Nurses’ Global Assessment of Suicide Risk (NGASR) in group A were significantly lower than those in group B and C (P < 0.01). rTMS combined with bipolar depression triple therapy has a definite effect on reducing NSSI in female adolescents, which can reduce the incidence rate of short-term NSSI behavior in patients.