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Long-Term Growth following Trigonocephaly Repairs: Are Overcorrections Necessary?

三头畸形修复后的长期生长: 是否需要过度校正?

  • 影响因子:1.74
  • DOI:10.1097/PRS.0000000000006576
  • 作者列表:"Fearon JA","Ditthakasem K","Chan WNJ","Herbert M
  • 发表时间:2020-03-01
Abstract

BACKGROUND:Does bifrontal width change with growth following trigonocephaly corrections? Postoperative long-term growth was assessed, along with the impacts of phenotypic severity, surgical timing, and operative technique, to determine how wide to surgically set bifrontal width. METHODS:A retrospective review of all trigonocephaly repairs was performed. Exclusion criteria included syndromic conditions, incomplete records, and follow-up under 1 year. Anthropometric measurements taken through completion of growth were evaluated and compared to sex- and age-matched normal standards for Z score conversion. RESULTS:Of 370 consecutive patients undergoing repairs, 95 had sufficient anthropometric data. The mean surgical age was 10.8 months (range, 2 months to 7 years) and mean follow-up was 54.3 months (range, 12 months to 17.8 years). Sequential measurements revealed progressive increases in bifrontal width. However, following conversion to Z scores, the initial overcorrection (mean overcorrection, 8.7 mm; mean Z score, +2.3) steadily diminished to an undercorrection (mean measurement, -5.5 mm; mean Z score, -1.1). Compared to treatment at an older age (10 to 12 months), repairs performed in those younger than 8 months showed worse growth (p = 0.004). Those more severely affected (lowest bifrontal Z scores) had growth similar to that of those more mildly impacted. Only two patients (2.1 percent) underwent secondary procedures for recurrences. No correlation was found between anthropologic measurements and observers' severity assessments. CONCLUSIONS:Subnormal bifrontal growth occurs following trigonocephaly corrections, especially with earlier corrections. Repairs performed at approximately 11 months of age had to be overcorrected by approximately 1.5 cm to produce a normal bifrontal width at maturity. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

摘要

背景: 三角头畸形校正后,双额叶宽度是否随生长而变化?评估术后长期生长,以及表型严重程度、手术时机和手术技术的影响,以确定手术设置双额宽度的宽度。 方法: 对所有头三角畸形修复进行回顾性回顾。排除标准包括综合征情况、记录不完整和 1 年以下的随访。评价生长完成后进行的人体测量,并与性别和年龄匹配的Z评分转换正常标准进行比较。 结果: 在 370 例接受修复的连续患者中,95 例有足够的人体测量数据。平均手术年龄为 10.8 个月 (范围,2 个月至 7 年),平均随访 54.3 个月 (范围,12 个月至 17.8 年)。连续测量显示双额叶宽度逐渐增加。然而,在转换到Z评分后,初始过校正 (平均过校正,8.7毫米; 平均Z评分,+ 2.3) 稳步减小到欠校正 (平均测量值,-5.5毫米; 平均Z评分,-1.1)。与年龄较大 (10 ~ 12 个月) 的治疗相比,在小于 8 个月的患者中进行的修复显示出较差的生长 (p = 0.004)。那些受影响更严重 (最低双额Z评分) 的增长与那些受影响更轻微的相似。只有 2 例 (2.1%) 患者因复发接受了二次手术。未发现人类学测量与观察者严重程度评估之间存在相关性。 结论: 三角头畸形校正后会发生亚正常的双额叶生长,尤其是早期校正。在大约 11 个月大的时候进行的修复必须过度矫正大约 1.5厘米,以在成熟时产生正常的双额宽度。 临床问题/证据水平: 治疗性,IV。

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METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.

影响因子:0.95
发表时间:2020-02-01
DOI:10.1007/s11845-019-02039-y
作者列表:["Sheridan GA","Nagle M","Howells C","Gallagher O","Kiely PJ","O'Toole P","Kelly PM","Moore DP"]

METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.

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影响因子:2.43
发表时间:2020-01-15
DOI:10.5435/JAAOS-D-16-00918
作者列表:["Grigoryan G","Korcek L","Eidelman M","Paley D","Nelson S"]

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