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Objective To explore the efficacy of early aggressive debridement with implant retention, primary wound clo-sure, closed suction drain without irrigation and antibiotic therapy for the treatment of delayed deep infection after spinal fixation. Methods 4057 patients were underwent dorsal spinal fixation from January 2010 to June 2014. Among them, 42 cases of de-layed deep infection after operation were included in the study. There were 25 males and 17 females, with an average age of 68.6± 8.1 years (ranged from 53 to 83 years). The diagnosis of delayed deep infection was based on the time of onset, clinical symptoms and signs, imaging and laboratory findings. Surgical debridement was performed immediately after diagnosis of infection. In addi-tion, devitalized and necrotic tissue and biofilms which adhered to the surface of the implant were removed meticulously and thor-oughly. Primary wound closure was performed in each patient, and closed suction drains were maintained for about 7-10 d without irrigation. Routine sensitive antimicrobial drugs was applied for 3 months after operation. Results 42 cases were all followed up for 24 to 72 months with an average of 46 months. Among the 42 infected patients, 3 patients were underwent posterior cervical spine surgery and 39 patients were underwent posterior lumbar spine surgery. There were 13 cases of staphylococcus aureus infec-tion, 7 cases of escherichia coli infection, 3 cases of ESBL escherichia coli infection, 3 cases of enterobacter cloacae infection, 2 cases of MRSA, 2 cases of acinetobacter baumannii infection, 2 cases of klebsiella pneumoniae infection, 1 case in enterococcus faecium and pseudomonas aeruginosa and staphylococcus haemolyticus, respectively. There were still 7 patients with negative bacterial culture. 41 cases retained their implant, whereas 1 staphylococcus aureus infection patient had the implants removed be-cause of loosening during debridement. Nevertheless, primary wound healing was found in all patients, and stitches were removed 2 to 3 weeks after debridement. Infections were effectively controlled with no recurrence of infection during the follow-up. The av-erage erythrocyte sedimentation rate was (65.76±20.08) mm/h preoperative, (41.43±14.65) mm/h 1 month postoperative, (10.81±2.72) mm/h 6 months postoperative, and (8.10±5.46) mm/h 12 months postoperative, respectively, the differences were statistically significant. The average C reactive protein was (40.55±16.91) mg/L preoperative, (6.50±2.46) mg/L 1 month postoperative, (4.31± 1.26) mg/L 6 months postoperative, and (3.83±1.50) mg/L 12 months postoperative, respectively, the differences were statistically significant. The average procalcitonin was (0.47±0.28) ng/ml preoperative, (0.08±0.06) ng/ml 1 month postoperative, (0.06±0.03) ng/ml 6 months postoperative, and (0.05±0.00) ng/ml 12 months postoperative, respectively, and the differences were statistically significant. Conclusion A timely diagnosis, aggressive and meticulous debridement, high vacuum closed-suction drain, routine and adequate use of antibacterial agents are keys to successfully resolving infection and maintaining implant retention in the treat-ment of delayed deep infection after spinal fixation.
ABSTRACT
Objective To explore the efficacy of early aggressive debridement with implant retention, primary wound clo-sure, closed suction drain without irrigation and antibiotic therapy for the treatment of delayed deep infection after spinal fixation. Methods 4057 patients were underwent dorsal spinal fixation from January 2010 to June 2014. Among them, 42 cases of de-layed deep infection after operation were included in the study. There were 25 males and 17 females, with an average age of 68.6± 8.1 years (ranged from 53 to 83 years). The diagnosis of delayed deep infection was based on the time of onset, clinical symptoms and signs, imaging and laboratory findings. Surgical debridement was performed immediately after diagnosis of infection. In addi-tion, devitalized and necrotic tissue and biofilms which adhered to the surface of the implant were removed meticulously and thor-oughly. Primary wound closure was performed in each patient, and closed suction drains were maintained for about 7-10 d without irrigation. Routine sensitive antimicrobial drugs was applied for 3 months after operation. Results 42 cases were all followed up for 24 to 72 months with an average of 46 months. Among the 42 infected patients, 3 patients were underwent posterior cervical spine surgery and 39 patients were underwent posterior lumbar spine surgery. There were 13 cases of staphylococcus aureus infec-tion, 7 cases of escherichia coli infection, 3 cases of ESBL escherichia coli infection, 3 cases of enterobacter cloacae infection, 2 cases of MRSA, 2 cases of acinetobacter baumannii infection, 2 cases of klebsiella pneumoniae infection, 1 case in enterococcus faecium and pseudomonas aeruginosa and staphylococcus haemolyticus, respectively. There were still 7 patients with negative bacterial culture. 41 cases retained their implant, whereas 1 staphylococcus aureus infection patient had the implants removed be-cause of loosening during debridement. Nevertheless, primary wound healing was found in all patients, and stitches were removed 2 to 3 weeks after debridement. Infections were effectively controlled with no recurrence of infection during the follow-up. The av-erage erythrocyte sedimentation rate was (65.76±20.08) mm/h preoperative, (41.43±14.65) mm/h 1 month postoperative, (10.81±2.72) mm/h 6 months postoperative, and (8.10±5.46) mm/h 12 months postoperative, respectively, the differences were statistically significant. The average C reactive protein was (40.55±16.91) mg/L preoperative, (6.50±2.46) mg/L 1 month postoperative, (4.31± 1.26) mg/L 6 months postoperative, and (3.83±1.50) mg/L 12 months postoperative, respectively, the differences were statistically significant. The average procalcitonin was (0.47±0.28) ng/ml preoperative, (0.08±0.06) ng/ml 1 month postoperative, (0.06±0.03) ng/ml 6 months postoperative, and (0.05±0.00) ng/ml 12 months postoperative, respectively, and the differences were statistically significant. Conclusion A timely diagnosis, aggressive and meticulous debridement, high vacuum closed-suction drain, routine and adequate use of antibacterial agents are keys to successfully resolving infection and maintaining implant retention in the treat-ment of delayed deep infection after spinal fixation.
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Objective To study the diagnostic significance of whole blood sample index in the severity of hand, foot and mouth disease, and to analyze its pathogenesis. Methods 194 cases of severe cases of hand, foot and mouth disease were selected as the case group,and 193 cases of mild hand, foot and mouth disease were selected as the control group. Blood samples were collected after admission to study the whole blood samples, including white blood cells, erythrocytes, platelets, medium cell ratio, lymphocyte ratio, mononuclear cell ratio, C-reactive protein test; The patient's immune system, the nervous system were also tested. Results Compared with patients with mild group, the white blood cell level of the patients in the severe group was higher and the albumin level was higher, the difference was statistically significant (P<0.05), the monocyte ratio, the T cell ratio was lower, the difference was statistically significant (P<0.05). Conclusion The white blood cell level and monocyte ratio of patients with severe hand, foot and mouth disease have changed. The whole blood sample has a certain sensitivity to the diagnosis of severe hand, foot and mouth disease.
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BACKGROUND:Closed reduction using proximal femoral nail antirotation gradual y becomes the golden standard in the treatment of intertrochanteric fractures. OBJECTIVE:To evaluate the advantages of proximal femoral nail antirotation in the treatment of intertrochanteric fractures by a new way that accurate positioning is used to modify the skin incision. METHODS:Ninety-nine patients with intertrochanteric fractures undergoing proximal femoral nail antirotation were included in the study, including 41 cases in the modified incision group and 58 cases in the standard operation group. Length of skin incision, mean bleeding volume, mean operation time, mean hospitalization time and the Harris scores were compared between two groups postoperatively. RESULTS AND CONCLUSION:Compared with the standard incision group, the mean bleeding volume and length of skin incision were decreased by 50.9%and 44%respectively in the modified incision group, as wel as the mean operation time was also shorter in the modified incision group (P<0.05). However, there was no difference in mean hospitalization time and Harris scores at the end of fol ow-up. The modified incision is more suitable for proximal femoral nail antirotation treatment of intertrochanteric fractures, with smal er incision, less trauma, shorter operation time and less blood loss.
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Objective To explore the differences of the life styles and their influencing factors among students who came from city,countryside or migrant families.Methods The stratified cluster random sampling method was conducted to recruit 1980 college students from 4 colleges of Huainan,Anhui.Results The study showed that under the ternary social structure college students from city preferred to the higher degree of T1,T2 or T3 dietary patterns,of which the OR (95％ CI) were 0.432 (0.255-0.730),0.140 (0.073-0.267) and 0.402 (0.236-0.683),respectively.They chose to exercise in middle-intensity physical activity for 30 minutes,of which OR (95％CI) was 0.524(0.352-0.779).Also there were much more drinkers in this group,of which the OR (95％ CI) was 0.564(0.325-0.981).Secondly,college students from migrant families in city preferred to T2 and T4 dietary pattern in low degree,of which OR (95％ CI) were 1.714(1.165-2.519) and 1.592(1.100-2.305),respectively.And they exercise 5 times or less per week in middle-intensity physical activity and the OR (95％ CI) was 0.699(0.535-0.912).Thirdly,college students from countryside preferred to T1,T2 and T3 dietary pattern in low degree and the OR (95％ CI) were 1.548 (1.083-2.213),1.498 (1.048-2.141) and 1.740(1.216-2.491),respectively.However,they preferred T4 dietary pattern in high degree rather than in low degree,in which the OR (95％ CI) was 0.624(0.436-0.893).They exercise more than 5 times and more than 30 minutes per time in middle-intensity physical activity,of which OR (95 ％ CI) were 1.314 (1.022-1.688) and 1.472 (1.071-2.022).Conclusion College students from three groups lived in different life styles and much more attention should be paid to them.
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@#Objective To observe the effect of rehabilitation gymnastics with music on non-incisional pain of gynecological patients after laparoscopic operation.Methods 192 gynecological patients undergone laparoscopic operation were divided into the music group (66 cases, adopted rehabilitation gymnastics matching music after operation), non-music group (64 cases, adopted rehabilitation gymnastics) and routine group (62 cases, adopted routine nursing without rehabilitation gymnastics or music).Results The patients of the music group got pain eased more obviously than those of the non-music group and rule group ( P<0.05).Conclusion The rehabilitation gymnastics with music can relieve non-incisional pain after gynecological laparoscopic operation, and improve anus exhausting.
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Objective To explore the value of electronic colonoscope,MSCT and MRI in the etiological diagnosis of intestinal obstruction.Methods The clinical data of 140 ileus patients were retrospectively studied.Results 140 cases of ileus included 60 cases of colon ileus,70 cases of small intestines ileus and 7 indefinite cases.67 cases were checked with colonoscopy,among them,41 cases with colon tumors,6 cases with colon polypi,6 cases with colon set folds,2 cases with sigmoid colon turned round,2 cases with ileum tumor and 10 cases with unknown reason.80 cases were checked by MSCT checks,among them,26 cases with small intestines tumor 24 cases with small intestines muck piece,23 cases with unknown reasons,2 cases with muck stone 2,4 cases with bowel chamber outside lymphoid lump,1 case with bowel fastens film blood to bolt.30 cases were kept to cure.2 cases were turn round to reset under the eolonoscopy,3 cases were set folds air to infuse bowel to reset,6 cases with inside the mirror descend colon polyp were resected with hish frequency electricity resection.99 cases were cured by surgical operation.5 cases were dead and 135 cases were recovered from illness.Conclusion Electronic colonoscopy,MSCT and MRI checking are accurate methods to diagnose why and where of ileus,and which establish importance basts for clinical treatment.