问题 多项选择题 案例分析题

病历摘要;患儿,女性,5岁,因右下肢跛行三年而入院。患儿2岁方学会走路,当时被发现右下肢行走不稳,升降步态,无外伤史。体检:体温36.5℃右下肢无红肿、无压痛,下肢肌力正常,皮肤感觉正常,右髋关节屈伸正常,外展稍受限,其余关节活动正常。详细阅读病历摘要,可归纳以下特点:①5岁女童;②2岁学会走路,迟于正常儿童;③学会走路时即有被拐,且无外伤史,宜多考虑为先天因素;④体温正常,局部无红肿,无压痛,可排除炎症性病变;⑤下肢肌力正常,皮肤感觉正常,可排除神经性病变;⑥仅右髋关节外展稍受限,可优先考虑右髋关节病变。综上所述,可初步将思路引入右髋关节病变,为先天性可能性大,且可初步排除神经性、肌源性和感染性病变。

患儿Allis征(+),Trendelenburg试验(+),X线摄片示:右Shenton氏线不连,髋臼指数50°,股骨头位于Perkins合方格的外上象限,且发育差,变小,但密度正常,前倾角80°,臼头无破坏,颈干角140°。对此患儿,拟如何实施治疗?()

A.立即切开复位及髋臼成形术

B.手法整复,蛙式石膏固定

C.先保守治疗9个月,若无效再酌情行单纯切开复位

D.手法整复,特制Rosen夹架制动

E.先松解髂腰肌及内收肌,将股骨头牵引至髋臼水平,再行切开复位,髋臼成形术(即Penberton手术)

F.还须行股骨旋转截骨术,以矫正股骨颈前倾角

答案

参考答案:C, F

单项选择题

Many theories concerning the causes of juvenile delinquency(crimes committed by young people) focus either on the individual or on society as the major contributing influence. Theories (91) on the individual suggest that children engage in criminal behavior (92) they were not sufficiently penalized for previous misdeeds or that they have learned criminal behavior through (93) with others. Theories focusing on the role of society suggest that children commit crimes in (94) to their failure to rise above their socioeconomic status, (95) as a rejection of middle, class values.
Most theories of juvenile delinquency have focused on children from disadvantaged families, (96) the fact that children from wealthy homes also commit crimes. The latter may commit crimes (97) lack of adequate parental control. All theories, however, are tentative and are (98) to criticism.
Changes in the social structure may indirectly (99) juvenile crime rates. For example, changes in the economy that (100) to fewer job opportunities for youth and rising unemployment (101) make gainful employment increasingly difficult to obtain. The resulting discontent may in (102) lead more youths into criminal behavior.
Families have also (103) changes these years. More families consist of one-parent households or two working parents; (104) , children are likely to have less supervision at home (105) was common in the traditional family (106) . This lack of parental supervision is thought to be an influence on juvenile crime rates. Other (107) causes of offensive acts include frustration or failure in school, the increased (108) of drugs and alcohol, and the growing (109) of child abuse and child neglect. All these conditions tend to increase the probability of a child committing a criminal act, (110) a direct causal relationship has not yet been established.

A.contrarily

B.consequently

C.similarly

D.simultaneously

填空题