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Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence 被引量:1
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作者 Christof Ernst Berberich Jérome Josse +1 位作者 Frédéric Laurent Tristan Ferry 《World Journal of Orthopedics》 2021年第3期119-128,共10页
In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally grow.Therefore,in order to counteract this trend more rigid ... In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally grow.Therefore,in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance.In the absence of a"miracle weapon"priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks,the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen.Instead of a"one size fits all"philosophy,it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors.A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre.The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis. 展开更多
关键词 Prosthetic joint infection Antibiotic-loaded bone cement Single low dose antibiotic-loaded bone cement Dual high dose antibiotic-loaded bone cement Antibiotic prophylaxis Risk-for-infection patients
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Quantitative Computerized Tomography (QCT) versus Dual X-Ray Absorptiometry (DXA) in the Assessment of Bone Mineral Density of HIV-1 Infected Children 被引量:1
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作者 Joann Lin Maria Ines Boechat +5 位作者 Jaime G. Deville Diego Gilsanz Richard Stiehm Vicente Gilsanz Isidro Salusky Karin Nielsen-Saines 《World Journal of AIDS》 2012年第4期306-311,共6页
Bone studies of HIV-infected children using dual X-ray absorptiometry (DXA) suggest bone mineral density (BMD) abnormalities. Pediatric studies are often performed using DXA instead of computed tomography (CT), which ... Bone studies of HIV-infected children using dual X-ray absorptiometry (DXA) suggest bone mineral density (BMD) abnormalities. Pediatric studies are often performed using DXA instead of computed tomography (CT), which accounts for 3-dimensional differences in bone size of growing children. We evaluated whether CT would match DXA measurements in this population. For this purpose, the BMD of 16 perinatally HIV-infected patients, ages 6 to 22 was assessed. Subjects were matched by age, gender, and race to controls. BMD was assessed via DXA and QCT. Clinical anthropometric data, body mass index, immunologic and virologic parameters and laboratory markers for osteoblastic and osteoclastic activity were performed. No statistically significant differences in age and anthropometric parameters between subjects and controls were found. Individual CT and DXA z-scores were significantly different when subjects were evaluated as a group (p = 0.0002) or when males and females were analyzed independently (p = 0.001 and 0.03). DXA z-scores were below 1 SD, while CT z-scores were above the mean. 31% of subjects were identified as having poor bone mineralization by DXA while none had osteopenia/osteoporosis by CT. There was no correlation between immunologic/virologic parameters and BMD by either method. Increased osteoclastic activity was noted in 10 patients receiving tenofovir. In summary, decreased BMD diagnosed by DXA in pediatric HIV-infected subjects was not confirmed by CT. Increased bone turnover in patients on tenofovir was suggested by laboratory markers. Prospective studies using CT as the imaging standard are needed for evaluation of bone mineral changes in HIV-infected children. 展开更多
关键词 bone MinERAL Density HIV-inFECTED children CT DXA
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Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty–should we use antibiotic-loaded bone cement?
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作者 Diana Crego-Vita Daniel Aedo-Martín +3 位作者 Rafael Garcia-Cañas Andrea Espigares-Correa Coral Sánchez-Pérez Christof Ernst Berberich 《World Journal of Orthopedics》 2022年第2期150-159,共10页
BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture(FNF).Prosthetic joint infection(PJI)is one of the most feared and frequent complications... BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture(FNF).Prosthetic joint infection(PJI)is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track surgery.Therefore,priorities should lie in effective preventive strategies to mitigate this burden.AIM To determine how much the implementation of the routine use of antibioticloaded bone cement(ALBC)as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty cohort.METHODS We retrospectively assessed all demographic,health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017;241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation period.The PJI rate as diagnosed on basis of the Musculoskeletal Infection Society(MSIS)criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem fixation.Patients were split into a group receiving a plain bone cement in the period from January 2011 to June 2013(non-ALBC group)and into a group receiving an ALBC in the period July 2013 to December 2017(ALBC group).Data analysis was performed with statistical software.We further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the inhospital infection related treatment costs with the extra costs of use of ALBC.RESULTS In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective study.There were 8 PJI cases identified in the ALBC group among n=94 patients,whereas 28 PJI cases were observed in the non-ALBC group among n=147 patients.The statistical analysis showed an infection risk reduction of 55.3%(in particular due to the avoidance of chronic delayed infections)in the ALBC group(95%CI:6.2%-78.7%;P=0.0025).The cost-evaluation analysis demonstrated a considerable cost saving of 3.500€per patient,related to the implementation of routine use of ALBC in this group.CONCLUSION Use of ALBC is a potent infection preventive factor in FNF patients receiving cemented hemiarthroplasties.It was further found to be highly cost-effective. 展开更多
关键词 prosthetic joint infection Femoral neck fracture patients HEMIARTHROPLASTY Antibiotic-loaded bone cement PROPHYLAXIS Cost-efficacy
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Polymethylmethacrylate bone cements and additives: A review of the literature 被引量:11
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作者 Manit Arora Edward KS Chan +1 位作者 Sunil Gupta Ashish D Diwan 《World Journal of Orthopedics》 2013年第2期67-74,共8页
Polymethylmethacrylate(PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950 s to the recent advent of nanoparticle additives. Additives have been trialed to address problem... Polymethylmethacrylate(PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950 s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index(< 15%) vitamin E and low index(< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan(15% w/w PMMA) and silver(1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties. 展开更多
关键词 POLYMETHYLMETHACRYLATE bone CEMENT CEMENT nanoparticle Vitamin E ADDITIVE ARTHROPLASTY Artificial joint fixation POST-OPERATIVE infection Mechanical WEAKNESS Fat ADDITIVE Antibiotics
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Nuclear medicine and the failed joint replacement: Past, present, and future 被引量:6
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作者 Christopher J Palestro 《World Journal of Radiology》 CAS 2014年第7期446-458,共13页
Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prostheti... Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again.By providing the anatomic information lacking in conventional radionuclide studies,there is renewed interest in bone scintigraphy,performed as a SPECT/CT procedure,for detecting joint instability,mechanical loosening and component malpositioning.Fluoride-PET may provide new insights into periprosthetic bone metabolism.The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements. 展开更多
关键词 bone scintigraphy Positron emission tomography 18F-fluorodeoxyglucose F-18 Fluoride-positron emission tomography GALLIUM infection Labeled leukocytes Prosthetic joint
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Viral infections in orthopedics: A systematic review and classification proposal
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作者 Konstantinos Sidiropoulos Savvas Ilias Christofilos +5 位作者 Konstantinos Tsikopoulos Dimitrios Kitridis Lorenzo Drago Gabriele Meroni Carlo Luca Romanò Venu Kavarthapu 《World Journal of Orthopedics》 2022年第11期1015-1028,共14页
BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systemati... BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.METHODS We searched MEDLINE,Cochrane Central Register of Controlled Trials(CENTRAL),the Reference Citation Analysis(RCA),and Scopus for completed studies published before January 30,2021,to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries.Quality assessment was performed using SYRCLE's risk of bias tool for animal studies,Moga score for case series,Wylde score for registry studies,and Newcastle-Ottawa Scale for case-control studies.RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis.Hepatitis C virus was implicated in several peri-and post-operative complications in patients without cirrhosis after major orthopedic surgery.Herpes virus may affect the integrity of lumbar discs,whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis.Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms.Therefore,based on our literature search,the proposed clinical and pathogenetic classification scheme is as follows:(1)Viral infections of bone or joint;(2)Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues;and(3)Viral infection as a risk factor for post-surgical bacterial infection. 展开更多
关键词 Viral infection Musculoskeletal system bone and joint manifestations CHIKUNGUNYA Zika Hepatitis C virus HERPESVIRIDAE Ross River virus CROSS-REACTIVITY Classification
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Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements:A state-of-the-art review 被引量:1
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作者 Gladius Lewis 《World Journal of Orthopedics》 2022年第4期339-353,共15页
Prosthetic joint infection(PJI)is the most serious complication following total joint arthroplasty,this being because it is associated with,among other things,high morbidity and low quality of life,is difficult to pre... Prosthetic joint infection(PJI)is the most serious complication following total joint arthroplasty,this being because it is associated with,among other things,high morbidity and low quality of life,is difficult to prevent,and is very challenging to treat/manage.The many shortcomings of antibiotic-loaded poly(methyl methacrylate)(PMMA)bone cement(ALBC)as an agent for preventing and treating/managing PJI are well-known.One is that microorganisms responsible for most PJI cases,such as methicillin-resistant S.aureus,have developed or are developing resistance to gentamicin sulfate,which is the antibiotic in the vast majority of approved ALBC brands.This has led to many research efforts to develop cements that do not contain gentamicin(or,for that matter,any antibiotic)but demonstrate excellent antimicrobial efficacy.There is a sizeable body of literature on these socalled“antibiotic-free antimicrobial”PMMA bone cements(AFAMBCs).The present work is a comprehensive and critical review of this body.In addition to summaries of key trends in results of characterization studies of AFAMBCs,the attractive features and shortcomings of the literature are highlighted.Shortcomings provide motivation for future work,with some ideas being formulation of a new generation of AFAMBCs by,example,adding a nanostructured material and/or an extract from a natural product to the powder and/or liquid of the basis cement,respectively. 展开更多
关键词 Periprosthetic joint infection Poly(methyl methacrylate)bone cement Antibiotic-loaded poly(methyl methacrylate)bone cement bone cement Antibiotic-free antimicrobial poly(methyl methacrylate)bone cement bone cement
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Comprehensive meta-analysis of antibiotic-impregnated bone cement versus plain bone cement in primary total knee arthroplasty for preventing periprosthetic joint infection 被引量:3
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作者 Ting Xu Ke-Liang Wu Ke Jie 《Chinese Journal of Traumatology》 CAS CSCD 2022年第6期325-330,共6页
Purpose:Antibiotic-loaded bone cement(ALBC)was usually used to prevent periprosthetic joint infection(PJI)in primary total knee arthroplasty(PTKA),but whether to use ALBC or plain bone cement in PTKA remains unclear.W... Purpose:Antibiotic-loaded bone cement(ALBC)was usually used to prevent periprosthetic joint infection(PJI)in primary total knee arthroplasty(PTKA),but whether to use ALBC or plain bone cement in PTKA remains unclear.We aimed to compare the occurrence rate of PJI using two different cements,and to investigate the efficacy of different antibiotic types and doses administered in preventing surgical site infection(SSI)with ALBC.Methods:The availability of ALBC for preventing PJI was evaluated by using a systematic review and meta-analysis referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Existing articles until December 2021 involving PTKA patients with both ALBC and plain bone cement cohorts were scanned by searching"total knee arthroplasty","antibiotic-loaded cement","antibiotic prophylaxis","antibiotic-impregnated cement"and"antibiotic-laden cement"in the database of PubMed/MEDLINE,Embase,Web of Science and the Cochrane Library.Subgroup analysis included the effectiveness of different antibiotic types and doses in preventing SSI with ALBC.The modified Jadad scale was employed to score the qualities of included articles.Results:Eleven quantitative studies were enrolled,including 34,159 knees undergoing PTKA.The meta-analysis results demonstrated that the use of prophylactic ALBC could significantly reduce the prevalence of deep incisional SSI after PTKA,whereas there was no significant reduction in the rate of superficial incisional SSI.Moreover,gentamicin-loaded cement was effective in preventing deep incisional SSI,and the use of high-dose ALBC significantly reduced the rate of deep incisional SSI after PTKA.Besides,no significant adverse reactions and complications were stated during the use of ALBC in PTKA.Conclusion:The preventive application of ALBC during PTKA could reduce the rates of deep PJI.Furthermore,bone cement containing gentamicin and high-dose ALBC could even better prevent deep infection after PTKA.However,the existing related articles are mostly single-center and retrospective studies,and further high-quality ones are needed for confirmation. 展开更多
关键词 Surgical site infection Antibiotic-loaded cement Plain bone cement Periprosthetic joint infection Primary total knee arthroplasty META
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正骨十四法联合小夹板外固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折临床疗效观察 被引量:2
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作者 李金烨 黎清斌 +4 位作者 黄雨寒 李慧 王文静 梁泳彤 张兆华 《广州中医药大学学报》 CAS 2023年第10期2513-2518,共6页
【目的】探讨正骨十四法联合小夹板外固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的临床疗效。【方法】回顾性分析2016年1月至2022年6月佛山市中医院骨科收治的58例GartlandⅡ、Ⅲ型肱骨髁上骨折患儿临床资料,按治疗方法的不同分为保守组... 【目的】探讨正骨十四法联合小夹板外固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的临床疗效。【方法】回顾性分析2016年1月至2022年6月佛山市中医院骨科收治的58例GartlandⅡ、Ⅲ型肱骨髁上骨折患儿临床资料,按治疗方法的不同分为保守组(正骨十四法联合小夹板外固定)28例和手术组(闭合复位克氏针内固定)30例,观察2组患儿的骨折愈合时间、Baumann角、提携角、肘关节活动度、前臂旋转活动度以及并发症发生情况,并运用Flynn肘关节功能评分评价2组患儿的临床疗效。【结果】(1)治疗后,保守组的优良率为92.9%(26/28),手术组为90.0%(27/30),2组患儿的临床疗效比较(秩和检验),差异无统计学意义(P>0.05)。(2)2组患儿的骨折愈合时间及前臂旋前、前臂旋后、肘伸、肘屈活动度比较,差异均无统计学意义(P>0.05)。(3)手术组患儿的Baumann角略小于保守组,提携角略大于保守组,组间比较,差异均有统计学意义(P<0.05)。(4)在并发症方面,保守组的并发症发生率为7.1%(2/28),明显低于手术组的30.0%(9/30),差异有统计学意义(P<0.05)。【结论】两种治疗方式治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折均可获得满意疗效和肘关节功能恢复,闭合复位克氏针内固定骨折复位更好,而正骨十四法联合小夹板外固定治疗损伤更少,并发症发生率更低。 展开更多
关键词 正骨十四法 小夹板固定 肱骨髁上骨折 儿童 骨折愈合 肘关节功能 并发症
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Total hip revision with custom-made spacer and prosthesis:A case report 被引量:1
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作者 Yang-Bo Liu Hao Pan +4 位作者 Li Chen Hao-Nan Ye Cong-Cong Wu Peng Wu Lei Chen 《World Journal of Clinical Cases》 SCIE 2021年第25期7605-7613,共9页
BACKGROUND Both periprosthetic joint infections(PJIs)and severe femoral segmental defects are catastrophic complications of total hip arthroplasty(THA),and both present a significant challenge in revisional surgery.Th... BACKGROUND Both periprosthetic joint infections(PJIs)and severe femoral segmental defects are catastrophic complications of total hip arthroplasty(THA),and both present a significant challenge in revisional surgery.There are limited data available to guide clinical decision making when both occur concurrently.CASE SUMMARY A 61-year-old woman presented with a 6-mo history of a sinus tract at the site of her original THA incision.Radiological imaging revealed a total hip joint implant with an ipsilateral segmental femoral defect.Based on histological,radiological,laboratory,and clinical features,a diagnosis of concurrent chronic PJI and segmental femoral defect(Type IIIB,Paprosky classification)was made.After multidisciplinary team discussion,three-dimensional(3D)-printed,custom-made antibiotic spacers were created that could be used to mold antibiotic-loaded cement spacer.These were placed following PJI debridement in the first stage of revision surgery.After the PJI was eliminated,a 3D-printed,custom-made,femoral prosthesis was created to repair the considerable femoral defect.After 20-mo follow-up,the patient had excellent functional outcomes with a near-normal range of hip movement.So far,neither evidence of recurrent infection nor loosening of the prosthesis has been observed.CONCLUSION We describe a case of“two-stage,custom-made”total hip revision to treat PJI with a concurrent segmental femoral defect.Use of a personalized,3D-printed spacer and proximal femoral prosthesis led to satisfactory hip function and no early postoperative complications.Use of a customized implant provides surgeons with an alternative option for patients where no suitable spacer or implant is available.However,the long-term function,longevity,and cost-effectiveness of the use of custom-made prostheses have yet to be fully explored. 展开更多
关键词 Total hip arthroplasty joint revision Prosthesis-related infections bone loss bone cement ANTIBIOTICS Case report
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唐氏手法复位小夹板与高分子绷带联合外固定治疗儿童Gartland III型肱骨髁上骨折的临床研究 被引量:6
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作者 彭真灵 周根云 +3 位作者 朱莹莹 徐战兵 罗娟 唐鹏飞 《中医临床研究》 2020年第34期98-100,共3页
目的:探讨唐氏手法复位小夹板与高分子绷带联合外固定治疗儿童Gartland III型肱骨髁上骨折的临床疗效和安全性。方法:选择2015年9月-2019年9月在我院住院的70例儿童Gartland III型肱骨髁上骨折患者,随机分为两组。非手术组采用唐氏手法... 目的:探讨唐氏手法复位小夹板与高分子绷带联合外固定治疗儿童Gartland III型肱骨髁上骨折的临床疗效和安全性。方法:选择2015年9月-2019年9月在我院住院的70例儿童Gartland III型肱骨髁上骨折患者,随机分为两组。非手术组采用唐氏手法复位小夹板与高分子绷带联合外固定固定治疗;手术组采用闭合或有限切开复位克氏针内固定治疗。观察记录患者住院时间、住院治疗费用、骨折临床愈合时间和血管危象、携带角丢失等情况;随访观察患者功能恢复和肘内翻并发症发生情况,并采用肘关节Flynn临床功能评定标准评定总体疗效。结果:两组患者住院时间比较,差异无统计学意义;两组患者骨折均获得良好愈合,两组患者骨折临床愈合时间、住院治疗费用比较,差异均有统计学意义;两组治疗早期血管危象发生率比较,组间差异无统计学意义。至随访观察6个月时,两组患者肘内翻畸形发生率比较,差异无统计学意义;两组总体临床疗效比较,组间差异无统计学意义。结论:采用唐氏手法复位小夹板与高分子绷带联合外固定可以有效治疗儿童Gartland III型肱骨髁上骨折,其住院时间、并发症发生、总体疗效和安全性与克氏针内固定手术治疗相当,但其骨折愈合时间更短、治疗费用更低。 展开更多
关键词 肘关节 肱骨骨折 正骨手法 小夹板固定 高分子绷带 儿童 临床试验
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宏基因组二代测序在骨关节感染病原学诊断中的应用价值
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作者 宋燕华 周子博 闫亚芳 《河南医学研究》 CAS 2024年第24期4471-4474,共4页
目的 分析宏基因组二代测序(mNGS)在骨关节感染病原学诊断中的应用价值。方法 将郑州市骨科医院2020年4月至2023年4月收治的63例疑似骨关节感染患者作为研究对象。均行传统培养法、mNGS检测,以临床综合诊断结果为“金标准”,统计传统培... 目的 分析宏基因组二代测序(mNGS)在骨关节感染病原学诊断中的应用价值。方法 将郑州市骨科医院2020年4月至2023年4月收治的63例疑似骨关节感染患者作为研究对象。均行传统培养法、mNGS检测,以临床综合诊断结果为“金标准”,统计传统培养法、mNGS检测骨关节感染的检测结果和检测灵敏度;比较传统培养法、mNGS检测方法鉴定病原菌类型的结果;比较骨关节感染患者不同治疗方案治疗前和治疗后白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)变化。结果 63例疑似骨关节感染患者,临床综合诊断确诊阳性41例、阴性22例;传统培养法培养出真阳性25例、真阴性19例;采用mNGS检测出真阳性34例,真阴性20例。mNGS检测灵敏度[82.93%(34/41)]高于传统培养法[60.98%(25/41)](P<0.05)。传统培养法培养出43株病原菌,mNGS检测出51株病原菌,均以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主,其次为阴沟肠杆菌、肠球菌、布氏杆菌、链球菌、结核分枝杆菌。基于mNGS结果的靶向治疗方案治疗后WBC、ESR、CRP水平低于经验性治疗方案(P<0.05)。结论 mNGS检测应用于骨关节感染病原学诊断中,可提高诊断灵敏度,准确鉴定感染病原菌类型,有利于提高抗感染治疗效果。 展开更多
关键词 骨关节感染 宏基因组二代测序 病原学
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抗生素骨水泥增强胫骨横向骨搬运治疗感染创面的能力 被引量:1
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作者 刘俊鹏 要星晨 +5 位作者 赵会 徐子彧 吴岳 裴福春 张林 杜心如 《中国组织工程研究》 CAS 北大核心 2024年第29期4599-4604,共6页
背景:糖尿病足伴创面感染的患者群体庞大,目前尚无满意的治疗方案。目的:探讨改良胫骨横向骨搬运技术联合抗生素骨水泥治疗顽固性糖尿病足溃疡的临床疗效。方法:选择2020年1月至2023年1月首都医科大学附属北京朝阳医院和北京朝阳中西医... 背景:糖尿病足伴创面感染的患者群体庞大,目前尚无满意的治疗方案。目的:探讨改良胫骨横向骨搬运技术联合抗生素骨水泥治疗顽固性糖尿病足溃疡的临床疗效。方法:选择2020年1月至2023年1月首都医科大学附属北京朝阳医院和北京朝阳中西医结合急诊抢救医院收治的46例糖尿病足溃疡患者,男27例,女19例,平均年龄64.37岁,均接受改良胫骨横向骨搬运手术联合抗生素骨水泥治疗。记录胫骨横向骨搬运术前及术后3个月患者的踝肱指数、伤口/缺血/足部感染分级(WIFi分级)、目测类比评分与溃疡面积。结果与结论:①46例患者溃疡平均愈合时间为(58.07±24.82)d,46例患者胫骨横向骨搬运术后3个月的踝肱指数、目测类比评分、溃疡面积、WIFi分级均较术前明显改善(P<0.05)。随访期间,2例患者出现钉道感染,未出现溃疡或感染复发。②结果显示,改良胫骨横向骨搬运术联合抗生素骨水泥可有效缓解糖尿病足溃疡患者的疼痛、改善下肢血运、控制感染并促进溃疡的愈合。 展开更多
关键词 胫骨横向骨搬运术 抗生素骨水泥 糖尿病足溃疡 血运重建 感染控制 踝关节 组织工程研究 糖尿病并发症
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不同年龄骨关节感染患者的病原学特点及耐药性分析
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作者 郝娜 王艳 +3 位作者 程翔 宋萍萍 童静 梁倩 《标记免疫分析与临床》 CAS 2024年第4期596-601,共6页
目的分析不同年龄骨关节感染患者的病原菌分布特点及其耐药性,为临床预防及治疗骨关节感染提供参考和依据。方法回顾性分析2016年1月至2022年12月本院骨关节感染病原学培养阳性病例,按照年龄将患者分为儿童组(≤16岁)、成人组(17~60岁)... 目的分析不同年龄骨关节感染患者的病原菌分布特点及其耐药性,为临床预防及治疗骨关节感染提供参考和依据。方法回顾性分析2016年1月至2022年12月本院骨关节感染病原学培养阳性病例,按照年龄将患者分为儿童组(≤16岁)、成人组(17~60岁)及老年人组(≥60岁),采用全自动仪器法对临床分离株进行体外药敏试验,按照CLSI2022年标准判断结果。结果共计分离1010株病原菌,排前5位病原菌分别为金黄色葡萄球菌(31.1%)、表皮葡萄球菌(12.2%)、大肠埃希菌(9.5%)、阴沟肠杆菌(6.8%)和铜绿假单胞菌(5.8%)。儿童和成人均以金黄色葡萄球菌为首位分离菌,老年人以大肠埃希菌为首位分离菌。老年人的MRSA检出率为56.7%,成人的MRSE检出率为81.8%,未发现万古霉素和利奈唑胺耐药的葡萄球菌。铜绿假单胞菌对碳青霉烯类、头孢吡肟和头孢他啶的耐药率均低于15.0%。成人中阴沟肠杆菌和老年人中大肠埃希菌对头孢曲松的耐药率最高,分别为43.9%和54.5%。未检出对碳青霉烯类药物耐药的肠杆菌科细菌。结论不同年龄组骨关节感染的病原菌分布不同,其对抗菌药物的耐药率存在差异,临床可以根据患者年龄结合药敏试验结果选择适当的抗菌药物进行治疗。 展开更多
关键词 骨关节 感染 年龄 病原学 耐药
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幼年型特发性关节炎儿童膝关节骨髓水肿的磁共振影像分析
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作者 崔鹏翔 杨凯华 杨昕 《国际医药卫生导报》 2024年第2期218-222,共5页
目的分析幼年型特发性关节炎儿童膝关节骨髓水肿的磁共振成像(MRI)影像表现。方法采用回顾性分析法,对2020年6月至2022年6月期间河南省儿童医院126例幼年型特发性关节炎儿童膝关节骨髓水肿的MRI影像进行分析,其中男性98例,女性28例,年龄... 目的分析幼年型特发性关节炎儿童膝关节骨髓水肿的磁共振成像(MRI)影像表现。方法采用回顾性分析法,对2020年6月至2022年6月期间河南省儿童医院126例幼年型特发性关节炎儿童膝关节骨髓水肿的MRI影像进行分析,其中男性98例,女性28例,年龄(7.85±2.11)岁,病程(8.65±1.05)个月,均为单侧膝关节病变。分析滑膜增厚和血管翳情况、关节囊渗出积液情况、骨质异常情况、关节软骨病变情况、腘窝淋巴结肿大情况、半月板及韧带异常情况、关节软骨内血管影情况。结果幼年型特发性关节炎儿童多发血管翳覆盖关节股骨表面[66例(52.38%)],T1W以低信号为主[96例(76.19%)],T2W以均匀等信号为主[66例(52.38%)]。126例幼年型特发性关节炎儿童均存在少量滑液,其中102例(80.95%)存在髌上囊积液;骨髓水肿以T1W低信号[48例(38.10%)]、T2W片状模糊信号[41例(32.54%)]为主要类型,多发干骺端以骺软骨为基底部的背向关节腔的“火焰”样的骨髓水肿[81例(64.29%)];关节软骨病变以表面毛糙[60例(47.62%)]、局部变薄[36例(28.57%)]为主其中42例患儿存在膝关节腘窝肿大淋巴结影,T1W呈低信号,T2W呈低信号/略低信号,SPIR/3D/FFE呈高信号;患儿半月板以前角/后角变形[45例(35.71%)]、塌陷碎裂[15例(11.90%)]为主,且多发膝关节前后交叉韧带肿胀/局部波浪状改变[21例(16.67%)];72例患儿膝关节软骨内可见与股骨髁关节软骨面垂直排列的辐射状强化的血管影。结论幼年型特发性关节炎儿童的膝关节MRI表现中,多发滑膜增厚、关节腔积液、骨髓水肿,部分患儿伴随软骨破坏和软骨下骨质侵袭。 展开更多
关键词 幼年型特发性关节炎 儿童 膝关节 骨髓水肿 磁共振成像
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弹性髓内钉治疗儿童股骨干骨折钢板固定失效病例 被引量:22
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作者 王华明 陈志龙 +2 位作者 李卫平 裴生太 陈世海 《中国组织工程研究》 CAS CSCD 2013年第26期4819-4825,共7页
背景:弹性髓内钉固定通过三点支撑使骨折实现弹力固定,适用于儿童横形和短斜形四肢长管状骨折。文章针对儿童股骨干骨折钢板失效病例,探讨采用弹性钉技术治疗的优势所在。目的:观察儿童股骨干骨折钢板固定失效后进行弹性髓内钉技术治疗... 背景:弹性髓内钉固定通过三点支撑使骨折实现弹力固定,适用于儿童横形和短斜形四肢长管状骨折。文章针对儿童股骨干骨折钢板失效病例,探讨采用弹性钉技术治疗的优势所在。目的:观察儿童股骨干骨折钢板固定失效后进行弹性髓内钉技术治疗的临床效果及预后分析。方法:回顾性分析甘肃省中医院小儿骨科自2008年3月至2012年8月收治的21例儿童股骨干骨折行钢板固定后出现断裂及失效患者,术中均在原切口处取出断裂钢板,断端清理后,自股骨远端髌上1.0-2.0cm处内外侧逆行经皮穿入弹性钉固定骨折。术后3-6个月根据影像学资料评估愈合情况取出弹性钉,按照2001年Flynn骨折愈合评判标准进行疗效分析。结果与结论:21例均获得随访,平均随访10个月。优19例,良2例,差0例,骨折愈合优良率100%。随访10个月,2例患侧肢体过度生长,不等长<1.0cm,1年内下肢不等长消失,3例为膝关节活动受限30°-50°,经功能练习1年后,2例膝关节活动受限<15°,1例膝关节活动受限>30°,无弹性钉断裂和骨不连现象发生。与切开复位治疗相比,弹性髓内针固定后骨折临床愈合恢复快,并发症少,是儿童股骨骨折内固定治疗的有效方法。 展开更多
关键词 骨关节植入物 骨科植入物 弹性针 儿童 股骨干骨折 钢板 断裂 失效
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旋转铰链式人工假体置换:治疗股骨远端恶性骨肿瘤后肢体功能和生存率评价 被引量:13
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作者 江正 尹宗生 +2 位作者 胡勇 刘必全 王伟 《中国组织工程研究》 CAS CSCD 2014年第4期523-528,共6页
背景:股骨远端是原发性骨肿瘤的好发部位,目前大部分都选用保肢治疗。国内外有很多关于股骨远端肿瘤型人工膝关节假体早期和中期功能及预后的报道,但对其长期功能及预后的报道尚少。目的:探讨行国产型股骨远端肿瘤型旋转铰链式膝关节假... 背景:股骨远端是原发性骨肿瘤的好发部位,目前大部分都选用保肢治疗。国内外有很多关于股骨远端肿瘤型人工膝关节假体早期和中期功能及预后的报道,但对其长期功能及预后的报道尚少。目的:探讨行国产型股骨远端肿瘤型旋转铰链式膝关节假体置换后患者的假体长期预后情况及肢体功能。方法:回顾性分析2000年1月至2008年6月安徽医科大学第一附属医院骨科收治的股骨远端恶性骨肿瘤患者34例,均采用旋转铰链式人工假体置换。结果与结论:34例患者平均随访时间62.4个月(11-126个月),末次随访23例患者生存,11例患者死亡;23例生存患者中7例发生与假体相关并发症:4例行翻修,3例行截肢。肿瘤型膝关节假体的患者5年生存率为67.6%;29例患者在置换后2年时行膝关节Enneking评分,总体平均分为19.3分(7-27分):优6例,良16例,中5例,差2例,患者假体功能总的优良率为75.9%。结果提示,旋转铰链式人工假体置换在治疗股骨远端恶性骨肿瘤中能获得满意的肢体功能和患者长期生存率。 展开更多
关键词 植入物 人工假体 膝关节 恶性骨肿瘤 肿瘤型人工关节 置换 生存率
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72例儿童骨与关节化脓性感染的临床分析 被引量:10
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作者 应灏 焦勤 《中华医院感染学杂志》 CAS CSCD 2004年第9期1013-1015,共3页
目的 评估儿童骨与关节化脓性感染的主要病原菌、耐药性演变情况 ,为临床抗生素治疗提供依据。方法回顾性分析 1995年 4月~ 2 0 0 3年 10月 ,上海市儿童医院骨科收治的 72例骨与关节化脓性感染病例的血、脓液、胸水培养和药敏及临床... 目的 评估儿童骨与关节化脓性感染的主要病原菌、耐药性演变情况 ,为临床抗生素治疗提供依据。方法回顾性分析 1995年 4月~ 2 0 0 3年 10月 ,上海市儿童医院骨科收治的 72例骨与关节化脓性感染病例的血、脓液、胸水培养和药敏及临床治疗结果。结果 金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌和铜绿假单胞菌检出率最高 ,金黄色葡萄球菌对多种抗生素呈耐药趋势。结论 耐药的金黄色葡萄球菌是儿童骨与关节化脓性感染的主要致病菌 ;近年发现大肠埃希菌和铜绿假单胞菌也占不少比例 ;儿童骨与关节化脓性感染的病程中常伴有菌血症或败血症 ;抗生素使用前应常规进行血培养 ,选用敏感的抗生素并根据药敏试验结果调整用药 ;对于金黄色葡萄球菌感染的病例 ,联合应用抗生素 ,可以提高疗效 ,避免诱导细菌产生耐药性 ,降低药物不良反应 ;疾病早期规范的抗生素治疗和及时对病灶进行手术引流 ,对减少抗生素耐药性有很大帮助并能加快疾病的愈合 。 展开更多
关键词 儿童 骨与关节 感染 耐药性 抗生素
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D-二聚体诊断髋关节置换后慢性假体周围感染的敏感性和特异性 被引量:16
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作者 刘永裕 徐景利 +6 位作者 林天烨 吴峰 沈楚龙 熊冰朗 邹启昭 赖启忠 张庆文 《中国组织工程研究》 CAS 北大核心 2021年第12期1853-1857,共5页
背景:目前慢性髋关节假体周围关节感染的诊断尚缺乏有效特异性的指标,研究发现D-二聚体水平在炎症疾病中会升高,因此D-二聚体可能成为诊断慢性髋关节假体周围关节感染有价值的生物标志物。目的:观察D-二聚体检测慢性髋关节假体周围关节... 背景:目前慢性髋关节假体周围关节感染的诊断尚缺乏有效特异性的指标,研究发现D-二聚体水平在炎症疾病中会升高,因此D-二聚体可能成为诊断慢性髋关节假体周围关节感染有价值的生物标志物。目的:观察D-二聚体检测慢性髋关节假体周围关节感染的敏感性和特异性,以提高慢性髋关节假体周围关节感染诊断的准确性。方法:回顾性分析广州中医药大学第一附属医院2010至2018年收治的髋关节翻修病例,根据诊断标准分为无菌性松动组(n=83)和慢性假体周围感染组(n=61)。术前3 d测定D-二聚体、降钙素原、C-反应蛋白、红细胞沉降率(血沉)和白细胞总数,对比两组之间的差异,并通过受试者工作特征曲线和曲线下面积分析诊断的准确性。结果与结论:(1)慢性假体周围感染组的D-二聚体、降钙素原、C-反应蛋白、血沉和白细胞总数均高于无菌性松动组,差异有显著性意义(P<0.001);(2)D-二聚体曲线下面积为0.898,比降钙素原(0.816)、红细胞沉降率(0.773)、C-反应蛋白(0.708)和白细胞总数(0.669)都要更准确,差异有显著性意义(P<0.001);(3)D-二聚体的最佳截断值为1470.5μg/L,诊断慢性髋关节假体周围关节感染的敏感性为83.6%,特异性为89.2%;(4)提示D-二聚体在慢性髋关节假体周围感染中的诊断价值优于其他炎性指标(降钙素原、C-反应蛋白、血沉和白细胞总数),D-二聚体与其他炎性指标联用有利于早期诊断慢性髋关节假体周围感染及评估病情。 展开更多
关键词 髋关节置换 关节翻修 假体 感染 D-二聚体 白细胞
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^(99)Tc^m-MDP、^(99)Tc^m(V)-DMSA和^(99)Tc4~m-Citrate显像对骨组织良恶性疾病鉴别诊断的对比研究 被引量:4
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作者 武兆忠 吴波以 +6 位作者 林伟 魏学立 邬恒夫 范子文 欧阳智 吴长伟 袁戈文 《核技术》 CAS CSCD 北大核心 2003年第8期633-637,共5页
为评价99Tcm(V)二巯基丁二酸钠(DMSA)显像和99Tcm枸缘酸(Citrate)显像在骨转移癌和骨及骨关节炎症诊断中的意义,对骨转移癌患者和骨及骨关节炎症患者各18例分别进行99Tcm亚甲基二膦酸(MDP)、99Tcm(V)DMSA和99TcmCitrate全身显像,并比较... 为评价99Tcm(V)二巯基丁二酸钠(DMSA)显像和99Tcm枸缘酸(Citrate)显像在骨转移癌和骨及骨关节炎症诊断中的意义,对骨转移癌患者和骨及骨关节炎症患者各18例分别进行99Tcm亚甲基二膦酸(MDP)、99Tcm(V)DMSA和99TcmCitrate全身显像,并比较了它们的显像结果。18例经病理学、CT或MRI证实有骨转移癌的患者,99TcmMDP显像共检出64个病灶,99Tcm(V)DMSA显像显示在与99TcmMDP显像相同部位同检出49个病灶,而99TcmCitrate显像仅检出1个病灶。18例经细菌学、CT或MRI证实的骨及骨关节炎症患者,99TcmMDP显像共检出22个病灶,99Tcm(V)DMSA显像显示在与99Tcm MDP显像相同部位同检出17个病灶,99TcmCitrate显像检出16个病灶。本组病例99Tcm(V)DMSA显像诊断骨转移癌的灵敏度为76.56%,特异性为22.73%; 99TcmCitrate显像诊断骨转移癌的灵敏度仅为1.56%,特异性为27.27%。99Tcm(V)DMSA显像诊断骨及骨关节炎症的灵敏度为77.27%,特异性为23.44%;99TcmCitrate显像诊断骨及骨关节炎症的灵敏度为72.73%,特异性为98.44%。以上结果表明,99Tcm(V)DMSA显像在诊断骨转移癌和骨组织炎症时应该慎重,因为它不能区分骨组织的良恶性病变性质,其对骨组织的良恶性病变性质的鉴别诊断应排除外骨组织炎症、骨折等骨组织良性病变的干扰。 展开更多
关键词 骨恶性肿瘤 骨及骨关节炎症 ^99Tc^m核素骨显像 亚申基二膦酸 二巯基丁二酸钠 枸缘酸
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