Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty–should we use antibiotic-loaded bone cement?

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.

Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

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.

Nuclear medicine and the failed joint replacement: Past, present, and future

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.

Viral infections in orthopedics: A systematic review and classification proposal

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.

Polymethylmethacrylate bone cements and additives: A review of the literature

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.

Total hip revision with custom-made spacer and prosthesis:A case report

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.

Comprehensive meta-analysis of antibiotic-impregnated bone cement versus plain bone cement in primary total knee arthroplasty for preventing periprosthetic joint infection

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.

Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements:A state-of-the-art review

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.

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

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。

抗生素骨水泥增强胫骨横向骨搬运治疗感染创面的能力

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。

不同年龄骨关节感染患者的病原学特点及耐药性分析

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。

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

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。

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

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。

^(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

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。

庆大霉素PMMA珠链在骨和关节感染中的临床应用

目的 观察庆大霉素PMMA珠链治疗骨和关节感染的临床疗效。方法 对从 1995年以来应用德国生产的庆大霉素PMMA珠链治疗的 11例骨和关节感染的病例 ,定期门诊随访 ,观察疗效。结果 11例患者经病灶彻底清除 ,置入不同数量的庆大霉素PMMA珠链 ,全部治愈。结论 庆大霉素珠链是治疗及预防骨和关节感染的重要方法。

人工关节置换术后感染的预防、诊断和治疗研究进展

人工关节感染是人工关节置换术后最严重的并发症,一旦发生感染,会给患者带来巨大的身体负担和经济压力,除此之外,人工关节感染的诊断治疗难度较大,且大量抗菌药物的使用会使细菌耐药性增加,因此,必须了解人工关节置换术中导致感染的危险因素,及时采取预防措施,清楚实验室检查诊断的内容,还要严格按照细菌培养、药敏试验的结果合理选择抗菌药物,避免细菌耐药率的增加。另外,抗生素骨水泥的应用也作为重点研究的内容,本文针对这些问题进行扼要综述。

72例儿童骨与关节化脓性感染的临床分析

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 。

全膝关节置换中的改良截骨

背景:近年来全膝关节置换在临床应用普遍,置换技术及假体设计理念均获得极大改善和提高,但尚无截骨顺序方面的研究。目的:探讨改良截骨方法在全膝关节置换过程中应用的临床效果。方法:对60例患者的60膝行全膝关节置换,原发疾病包括骨关节炎52例,类风湿性关节炎6例,创伤性关节炎2例,均为后稳定型膝关节,应用强生PFC-Sigma PS型假体或LINK Gemini PS型假体。在极度屈膝下,先行股骨截骨,包括股骨远端前方后方斜面截骨(某些类型还包括股骨髁间截骨)。髌骨不常规置换,再行胫骨平台截骨。记录手术时间,置换后引流量,置换前及置换后6,12周膝关节活动度及美国特种外科医院膝关节评分,并进行统计学分析。结果与结论:60例患者均获得随访,随访时间3-14个月。手术时间平均(51.3±12.5)min,置换后引流量平均(302±39)mL。置换后6,12周患者膝关节活动度及美国特种外科医院膝关节评分均较置换前明显改善(P<0.01)。2例患者置换后1个月出现低度感染,经抗感染治疗后好转,未出现假体排异反应。提示全膝关节置换过程中先行股骨截骨可以为胫骨的操作获得更大的空间,方便切除半月板,并可安全地进一步松解周围软组织。操作简便,可以缩短手术时间,减少术中失血,具有良好的修复效果。

弹性髓内钉固定与钢板固定治疗锁骨中段骨折的Meta分析

背景:对于弹性髓内钉固定和钢板固定,选择何种方法治疗锁骨中段骨折疗效满意,目前尚未达成共识,且当前的研究仅限于小样本研究,很难做到大样本多中心治疗观察分析。目的:用Meta分析的方法评价弹性髓内钉固定与钢板固定治疗锁骨中段骨折的疗效及安全性。方法:计算机检索PubMed、EMbase、Cochrane Library(2012年第1期),CBM、CNKI、VIP和万方数据库,并手工检索相关领域杂志,时间从建库至2012年3月。搜集关于弹性髓内钉固定与钢板固定治疗锁骨中段骨折的对照研究,由两名评价员独立选择试验、提取资料,并进行质量评价。结果与结论:最终纳入1项随机对照试验,4项回顾性队列研究试验,共388例患者。Meta分析结果显示,弹性髓内钉固定组术后功能恢复Constant评分高于钢板固定组(P<0.01)。在骨折平均愈合时间、手术时间、切口长度、术中出血量及住院时间等方面弹性髓内钉固定组少于或小于钢板固定组(P<0.01)。在并发症发生率方面,骨不连、内置物固定失败、切口感染和骨折畸形愈合等方面两组差异无显著性意义。现有证据表明,弹性髓内钉固定治疗锁骨中段骨折疗效优于钢板固定,在并发症发生率方面两种方法差异无显著性意义,但上述结果尚需高质量的随机对照试验进一步验证。

碘伏灌注冲洗治疗骨关节化脓性感染

2000年1月至2006年3月,收治骨关节化脓性感染31例,病灶采用碘伏（iodophors）溶液灌注冲洗治疗,疗效满意,报告如下。