ABSTRACT
Objective:To analyze the clinical efficacy of debridement, antibiotics irrigation and implant retention (DAIR) in the treatment of acute periprosthetic infection (PJI) and to explore the risk factors leading to the failure of DAIR.Methods:From January 2010 to January 2021, 122 patients underwent DAIR for acute PJI at Department of Orthopedics, General Hospital of Eastern Theater of PLA. They were 55 males and 67 females, aged from 50 to 86 years (mean, 68.0 years). Their C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), body temperature, white blood cell count and visual analogue scale (VAS) were compared at admission and discharge to analyze the clinical efficacy of DAIR. The 122 patients were assigned into a cured group (81 cases) and an uncured group (41 cases). Risk factors were screened by univariate analysis out of their gender, age, body mass index, site of infection, type of infection (early postoperative infection or acute hematogenous infection), type of surgery (primary or revision), comorbidities, CRP, ESR, albumin and hemoglobin at admission, duration of symptoms, Staphylococcus aureus infection, multiple bacterial mixed infection, and preoperative sinus tract. For the factors of P<0.05, multivariate binary logistic regression analysis was used to determine the risk factors for failure of DAIR. Survival curves were plotted for the patients using DAIR failure as the endpoint event. Results:The CRP, ESR, VAS score, body temperature and white blood cell count at discharge in the 122 patients were significantly lower than the corresponding values at admission ( P<0.05). The success rate of DAIR was 66.39%(81/122). The multivariate binary logistic regression analysis suggested that duration of symptoms over 3 weeks( OR=1.230, 95% CI: 1.092~1.576, P=0.020), Staphylococcus aureus infection( OR=4.607, 95% CI: 2.057~10.318, P<0.001), preoperative sinus tract( OR=6.115, 95% CI: 2.630~14.220, P<0.001) and multiple bacterial mixed infection( OR=2.600, 95% CI: 1.131~5.977, P=0.020) were risk factors for DAIR failure; Kaplan-Meier survival curve also confirmed that the patients with Staphylococcus infection, multiple bacterial mixed infection, duration of symptoms over 3 weeks, or preoperative sinus tract had a significantly lower rate of survival than their controls ( P<0.05). Conclusions:For acute PJI, DAIR can be used to retain the prosthesis and control infection. However, DAIR is not recommended for the patients with Staphylococcus aureus infection, multiple bacterial mixed infection, symptoms lasting more than 3 weeks, or preoperative sinus formation.
ABSTRACT
Objective Uncemented prothesis has become the preference of first hip arthroplasty, but there is a little study on its application in cemented acetabular revision arthroplasty.This paper aimed to evaluate the clinical effects of uncemented acetabular cup in cemented acetabular prosthesis revision arthroplasty. Methods A retrospective analysis was made on the clinical data of 31 patients(31 hips) who underwent revision arthroplasty using uncemented acetabular prosthesis from January 2012 to March 2015.Har-ris hip score( HSS) was applied to measure the hip function and visual analogue score( VAS) was preformed to assess the pain degree of knee joint preoperatively and postoperatively(3 months, 6 months and 1 year).All the patients were followed up for a mean of 22 months ranging from 3 to 42 months. Result The mean HSS increased from preoperative points (53.19 ±9.12) to postoperative points([77.71 ±5.75]at 3 months,[80.61 ±5.74] at 6 months,[82.94 ±5.80] at 1 year ).The mean VAS score decreased from preoperativepoints (6.23 ±1.23) to postoperative points(0.26 ±0.27).No lossening, infection or deep vein thrombosis were found in the patients′prostheses. Conclusion For patients with PaproskyI-Ⅱ acetabular defects, uncemented acetabular prosthesis has satisfactory short-term clinical results in revision arthroplasty with cemented acetabular prosthesis, however, long-term clinical results remain to be further observed.
ABSTRACT
The idea of using tissue engineering scaffolds in the treatment of spinal cord injury(SCI) is drawing more and more clinical attention,and the introduction of some new materials has promoted its development.Tissue engineering scaffolds used in the treatment of SCI mainly include nature biomaterial and synthesize macromolecule biomaterial,each with its advantages and disadvantages.This review focuses on some tissue engineering scaffolds commonly used in SCI.