Objective To systematically review literature on the influencing factors related to adolescent sub-health problems. Methods We electronically searched the following four databases including CBM, VIP, CNKI and WanFang Data to collect Chinese literature on adolescent sub-health status and problems in China published before May 2012. Two reviewers independently screened literature, extracted data, and cross checked records. Then qualitative analysis was applied. Results According to the inclusion and exclusion criteria, 41 cross-sectional studies were included. The results of qualitative analysis showed that the influencing factors of adolescent sub-health could be classified into four categories including social factors, family factors, school factors, and interpersonal relationships. The main ones were social support, employment pressure, family economic conditions, learning burden, unhealthy habits, etc. Conclusions There are many influencing factors of adolescent sub-health with interaction. Due to the limitation of the included studies, more prospective cohort studies are needed to provide high quality evidence.
Objective To investigate the effectiveness of arthroscopic medial retinaculum plication (MRP) for acute patellar dislocation (APD) in adolescents. Methods Between March 2007 and June 2011, 24 adolescent patients suffering from APD were treated by arthroscopic MRP. There were 14 males and 10 females, aged 8-18 years (mean, 12.7 years). The location was the left knee in 16 cases and the right knee in 8 cases. Injury was caused by sports in 19 cases, by traffic accident in 4 cases, and by heavy bruising in 1 case. The duration from injury to operation was 3 to 21 days with an average of 7.8 days. The results of floating patella test and dislocation apprehension test were both positive. MRI examination showed the arthroedema in all cases; associated injuries included medial retinaculum injury in 20 cases, medial patellar injury in 8 cases, and meniscus tear in 5 cases. Results All incisions healed by first intention without complication of infection or neurovascular injury. All the patients were followed up 12-36 months (mean, 14.6 months). Only 2 patients suffered from patellar re-dislocation at 4 months and 6 months after operation respectively. The knee joint activity returned to normal at 12 months. The Lysholm, Kujala, and International Knee Documentation Committee (IKDC) scores at 3 and 12 months after operation were significantly higher than those before operation (P lt; 0.05), and the scores at 12 months were significantly higher than those at 3 months (P lt; 0.05). Conclusion Treatment of APD with arthroscopic MRP has the advantages of minor trauma and good knee functional improvement. The technique can decrease incidence of patellar re-dislocation in adolescent.
【Abstract】 Objective To observe the effectiveness of limited operations and Ilizarov techniques for correction of congenital clubfoot (CCF) in adolescents, and to explore the new methods and new ideas for functional reconstruction of CCF. Methods Between September 2003 and July 2010, 25 adolescent patients (40 feet) with CCF were treated. Of the 25 patients, 14 were male (20 feet) and 11 were female (20 feet) with an age range from 12 to 25 years (mean, 15.7 years). The left feet were involved in 4 cases, the right feet in 6 cases, and both feet in 15 cases. According to Qin’s clubfoot deformity scale, 9 feet were rated as degree I, 17 feet as degree II, and 14 feet as degree III. In these cases, 9 feet were accompanied by internal rotation deformities of crus and 1 case by subluxation of right hip joint. After soft tissue release and osteotomy, 9 feet (degree I) were fixed by composite external fixation instruments, 31 feet by Ilizarov external fixation instruments. The deformity was corrected from 5 to 7 days after operation with distraction of 0.5-1.0 mm/d, then distraction stopped when the ankle was corrected at a hyperextension of 5 to 10° and light valgus. The affected limb might undergo weight bearing walking with external fixation at corrected position for 4 to 6 weeks. If one had both feet deformity, staged operation should be performed with a surgery interval of 3 to 6 months (mean, 4 months). Results The fixation time was 6-12 weeks (mean, 8 weeks) in 9 feet fixed by composite external fixation instruments, and it was 6-17 weeks (mean, 13 weeks) in 31 feet fixed by Ilizarov external fixation. All 25 patients were followed up 8 months to 6 years with an average of 37 months. During distraction process, slight pin track infection occurred in 6 cases (6 feet), which were cured after expectant management. One patient had recurrence of the deformity at 2 years postoperatively, who obtained satisfactory correction after Ilizarov external fixation for 4 weeks. The satisfactory correction and foot function were achieved in the other feet with walking on full weight-bearing. According to International Clubfoot Study Group (ICFSG) score, the results were excellent in 28 feet, good in 10 feet, and fair in 2 feet, with an excellent and good rate of 95% at last follow-up. Conclusion Combined limited operation with Ilizarov technique for correcting adolescent CCF is accord with biology principle and minimally invasive surgical principle, so it is a safe，minimally invasive, and effective method. It also can broaden the operative indications and correct degree III talipes equinovarus which is unattainable by traditional orthopedic surgery.
Objective To explore the effectiveness of arthroscopic medial retinaculum pl ication (MRP) for recurrent patellar dislocation in adolescents. Methods Between March 2000 and October 2007, 30 adolescent patients with recurrent patellar dislocation underwent arthroscopic MRP, and 28 of them (12 left knees and 16 right knees) completed thefinal follow-up and were enrolled. There were 5 males and 23 females with an average age of 14.7 years (range, 12-19 years). The dislocation duration was 4 to 39 months with an average of 18.8 months. All patients experienced 2-4 episodes of dislocation. Before operation, all the patients showed positive apprehension test; the degree of lateral patellar translation was (2.9 ± 0.7)° and there was no hardness termination in lateral translation. The International Knee Documentation Committee (IKDC), Lysholm, Kujala, and Tegner scores were 47.7 ± 3.7, 52.6 ± 4.9, 66.7 ± 5.9, and 3.1 ± 1.3, respectively. All patients underwent arthroscopic MRP procedure. Results All incisions healed by first intention without compl ication. All the patients were followed up 2-7 years (4.8 years on average). During the follow-up, more and more patients showed positive apprehension test, and at 24 months of follow-up, 12 patients showed positive apprehension test; less and less patients had hardness termination in lateral translation, only 3 patients at 24 months of follow-up; the degree of lateral patellar translation increased, (2.3 ± 1.1)° at 24 months of follow-up. There were significant differences in positive apprehension test and hardness termination between preoperation and 24 months of follow-up (P lt; 0.05). Moreover, 6 patients suffered from redislocation, and 23 patients experienced patella instabil ity. The IKDC, Lysholm, Kujala, and Tegner scores at 24 months of follow-up were 62.5 ± 6.2, 70.7 ± 5.1, 76.6 ± 4.8, and 3.9 ± 0.7, respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). CT examination showed that the congruence angle, lateral patellar angle, and patellar tilt angle were recovered to normal level after operation immediately, however, the final patellar position at 24 months of follow-up was not significantly betterthan that before surgery (P gt; 0.05). There was significant difference in the lateral patellar displacement between preoperation and 24 months of follow-up (P lt; 0.05). Conclusion Arthroscopic MRP is not rel iable for maintaining the corrected position of the patella for recurrent patellar dislocation in adolescents, though functional improvements are significant.
Objective To analyze the cl inical results of different surgical approaches in treating hallux valgus deformity in children and adolescents. Methods From April 2000 to April 2007, 18 cases of hallux valgus deformity (30 feet) were treated. According to different ages, they were divided into children group ( 10 years) and adolescent group (11-18 years). In children group, 4 female patients included 2 bilateral and 2 unilateral hallux valgus deformity (2 left feet, 4 right feet). Each patient underwent a combination of Austin osteotomy and McBride procedure. The American Orthopaedic Foot and AnkleSociety-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) score was 55.0 ± 15.0, and the visual analogue scale (VAS) score was 6.0 ± 2.0. The hallux valgus angle (HVA) and 1st-2nd intermetatarso-phalangeal angle (IMA) were (35.0 ± 4.0)° and (14.4 ± 2.0)°. In adolescent group, 14 patients included 3 males (4 feet) and 11 females (20 feet), 10 bilateral and 4 unilateral hallux valgus deformity (10 left feet, 14 right feet). Each patient underwent the modified Mitchell osteotomy. The AOFAS-HMI score was 55.6 ± 14.0, and the VAS score was 7.0 ± 1.0. The HVA and IMA were (38.5 ± 5.0)° and (15.0 ± 3.0)°. Results All incisions healed primarily. The patients of two groups were followed up 12-32 months (21 months on average). In adolescent group, pain of metatarsophalangeal joint occurred in 1 case and the symptom disappeared after 3-month physical therapy; 1 case recurred after 21 months of operation and achieved satisfactory results after Lapidus operation. In children group, the AOFASHMI score was 92.1 ± 5.0, the VAS score was 1.0 ± 0.6, HVA was (14.7 ± 3.0)°, and IMA was (5.5 ± 2.0)°; showing significant differences (P lt; 0.05) when compared with those before operation. In adolescent group, the AOFAS-HMI score was 90.0 ± 6.0, the VAS score was 1.0 ± 0.6, HVA was (13.7 ± 3.0)°, and IMA was (6.8 ± 2.0)°; showing significant differences (P lt; 0.05) when compared with those before operation. Conclusion It has the advantages of rapid bone heal ing, short course of treatment, and less compl ication to treat hallux valgus deformity in children with a combination of Austin osteotomy and McBride procedure and in adolescent with the modified Mitchell osteotomy.
Objective To analyze the cl inical features of scol iosis associated with Chiari I malformation in adolescent patients, and to explore the val idity and safety of one-stage posterior approach and vertebral column resection for the correction of severe scol iosis. Methods Between October 2004 and August 2008, 17 adolescent patients with scol iosis associated with Chiari I malformation were treated with surgical correction through posterior approach and pedicle instrumentation. There were 9 males and 8 females with an average age of 15.1 years (range, 12-19 years). The MRI scanning showed that 16 of 17 patients had syringomyel ia in cervical or thoracic spinal cord. Apex vertebra of scol iosis were located atT7-12. One-stage posterior vertebral column resection and instrumental correction were performed on 9 patients whose Cobb angle of scol iosis or kyphosis was more than 90°, or who was associated with apparent neurological deficits (total spondylectomy group). Other 8 patients underwent posterior instrumental correction alone (simple correction group). All patients’ fixation and fusion segment ranged from upper thoracic spine to lumbar spine. Results The operative time and the blood loss were (384 ± 65) minutes and (4 160 ± 336) mL in total spondylectomy group, and were (246 ± 47) minutes and (1 450 ± 213) mL in simple correction group; showing significant differences (P lt; 0.05). In total spondylectomy group, coagulation disorder occurred in 1 case, pleural perforation in 4 cases, and lung infection in 1 case. In simple correcction group, pleural perforation occurred in 1 case. These patients were improved after symptomatic treatment. All patients were followed up 24-36 months (32.5 months on average). Bony heal ing was achieved at 6-12 months in total spondylectomy group. No breakage or pull ingout of internal fixator occurred. The angles of kyphosis and scol iosis were significantly improved at 1 week after operation (P lt; 0.01) when compared with those before operation. The correction rates of scol iosis and kyphosis (63.4% ± 4.6% and 72.1% ± 5.8%) in total spondylectomy group were better than those (69.4% ± 17.6% and 48.8% ± 19.3%) in simple correction group. Conclusion Suboccipital decompression before spine deformity correction may not always be necessary in adolescent scol iosis patients associated with Chiari I malformation. In patients with severe and rigid curve or apparente neurological deficits, posterior vertebral column resection would provide the opportunity of satisfied deformity correction and decrease the risk of neurological injury connected with surgical correction.
Objective To explore the effect of arthroscopy in diagnosis and treatment of osteochondritis dissecans of elbow joint in adolescent. Methods From May 2003 to February 2006, 11 patients with osteochondritis dissecans of elbowjoint were diagnosed and treated with arthroscopy. There were 6 males and 5 females, aging from 13 to 19 years. The left joints were involved in 4 cases and right joints in 7 cases. Seven patients had obvious history of injury. The interval of injury and operation was from 7 months to 12 years. The score of VAS was 80±10, the range of flexion and extend of joint 80±10°, the range of rotation of joint 100±5° preoperatively. The brachial plexus anesthesia, the elbow hung to traction, soft spot, interna and extrapathway were given to explore and debride elbow joint and remove corpus liberum. Results All patients recovered daily life and work 7 to 12 dayspostoperatively. There were no complications of blood vessel and nerve injuries. Eleven cases were followed up for 6 to 18 months (mean 12-5 months). The results wereexcellent in 7 and good in 4 according to HSS scoring system. At the final followup, the score of VAS was 32±15, showing statistically significant difference when compared with preoperation (Plt;0.05). The range of flexion and extend of joint was 110±10°，the range of rotation of joint was 120±5° postoperatively, showing statistically significant differences when compared with preoperation (Plt;0.05). Conclusion The elbow arthroscopy might be a reliable methodto diagnose and treat osteochondritis dissecans of elbow joint in adolescent with minor trauma，quick recovery，significant improving function and less complications.
Objective To systematically evaluate and comparatively analyze the mental health status of adolescents with different genders in middle schools of China, and to provide scientific evidence for the improvement of adolescents’ mental health level. Methods Such databases as CNKI, VIP, WanFang Data, and CBM (1989 to Dec, 2009) were searched. Data were extracted from the included literature and RevMan 4.2 software was used for meta-analyses. Results Twenty-seven original literatures were included. The results of meta-analyses showed: the total anxious trend of girls was higher than that of boys (OR= –?2.14, 95%CI –?2.93 to –?1.35, Plt;0.000 01); the result of each scale displayed that girls scored higher than boys in terms of study-anxiety (OR= –?0.53, 95%CI –?0.67 to –?0. 39, Plt;0.00001), social-anxiety (OR= –?0.30, 95%CI –?0.45 to –?0.15, Plt;0.000 1), self-accusation trend (OR= –?0.30, 95%CI –?0.46 to –?0.13, Plt;0.000 6), allergy trend (OR= –?0.18, 95%CI 0.31 to –?0.05, P=0.008), body symptom (OR= –0.21, 95%CI –0.34 to –0.08, P=0.001), and phobia trend (OR= –?0.80, 95%CI –?0.91 to –?0.68, Plt;0.000 01); No significant differences were identified between boys and girls in terms of solitude trend (OR=0.09, 95%CI –?0.04 to 0.22, P=0.2) and actuation trend (OR=0.06, 95%CI –?0.15 to 0.28, P=0.56). Conclusion Targeted measures should be taken for adolescent mental health education, especially for girls.
Objective To explore the association between behavioral, emotional problems and life events among adolescents, and to determine which factors of life events correlate most highly with the behavioral, emotional problems. Method A total of 1 325 adolescents were investigated with Youth Self-Report (YSR) of Achenbach’s behavior checklist and Adolescent Self-Rating Life Events Checklist (ASLEC), and the data were analyzed with canonical correlation analysis. Results Canonical correlation was statistically significant. The correlation coefficients of the first pair of canonical variables in the male and female group were 0.631 3 and 0.621 1, respectively, and the cumulative proportion of the first two pairs of canonical variables was above 0.95. In the first pair of canonical variables, the loadings of anxious/depressed, interpersonal sensitivity and study pressure were higher, while in the second pair, withdrawal and punishment were the most important factors. Conclusions The effects of life events on emotional problems mainly contributed to interpersonal sensitivity and study pressure.
ObjectiveTo investigate the effectiveness and technical key points of limb salvage surgery by allotransplantation of cryopreservated vascularized bone in children and adolescents with osteosarcoma. MethodsA retrospective analysis was made on the clinical data of 21 children and adolescents with osteosarcoma receiving limb salvage surgery by allotransplantation of cryopreservated vascularized bone from their relatives between February 2004 and April 2012. There were 13 males and 8 females, aged from 7 to 16 years (mean, 12.6 years). According to Enneking stage system, 15 cases were rated as stage ⅡA and 6 cases as stage ⅡB. The tumors located at the distal femur in 10 cases, at the proximal femur in 1 case, at the proximal tibia in 8 cases, at the proximal humerus in 1 case, and at the distal radius in 1 case. Imaging examination showed that epiphyseal extension of malignant bone tumors in 7 cases. The iliac bone allograft with deep iliac vessels was obtained from their lineal consanguinity. After preservation by a twostep freezing schedule, the iliac bone allograft with deep iliac vessels was implanted into the bone defect area after tumor resection. The size of iliac bone flap was 8.0 cm×3.0 cm×2.0 cm-14.0 cm×5.0 cm×2.5 cm. Reserved joint surgery was performed on 16 cases and joint fusion surgery on 5 cases, and external fixation was used in all cases. The chemotherapy was given according to sequential high-dose methotraxate, adriamycin, and cisplatine before and after operation. ResultsAll 21 cases were followed up from 5 months to 11 years (mean, 6.4 years). At 2 weeks after operation, the erythrocyte rosette forming cells accounted for 56.7%±3.9%, showing no significant difference when compared with that of normal control (58.3%±4.3%) (t=1.56, P=0.13), which suggested no acute rejection. At 4 weeks after operation, single photon emission computerized tomography bone scan indicated that the blood supply of bone graft was rich, and the metabolism was active. At 12 weeks after operation, the digital subtraction angiography showed the artery of iliac bone flap kept patency. X-ray films showed that malunion and non-union occurred at 5 and 6 months after operation in 1 case, respectively. The bone graft healed in the other patients, and the healing time was 3.2-6.0 months (mean, 4.4 months). At last follow-up, American Musculoskeletal Tumor Society (MSTS) score was significantly improved to 26.80±2.14 from preoperative value (17.15±1.86) (t=-4.15, P=0.00). The survival rate was 85.7% (18/21) and the recurrence rate was 9.5% (2/21). ConclusionAllotransplantation of cryopreservated vascularized bone from the relatives provides a new method for the treatment of osteosarcoma in children and adolescents. A combination of allotransplantation and chemotherapy can achieve the ideal treatment effect. The correct cutting, preservation, and transplantation of the donor bone, and indication are the key to improve the effectiveness.