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OBJECTIVE@#To summarize and discuss the clinical efficacy and application value of intravenous drip of linezolid combined with local targeted sustained-release of vancomycin in the treatment of traumatic osteomyelitis of extremities infected with MRSA.@*METHODS@#Thirty patients with traumatic osteomyelitis of extremities infected by MRSA from March 2015 to March 2017 were analyzed retrospectively, including 21 males and 9 females; aged 25 to 64 years old, with an average age of(47.94± 6.23) years old;the course of disease ranged from 9 to 23 months, with an average of (15.68±6.23) months. The lesions were located in tibia in 18 cases and calcaneus in 12 cases. The causes of injury were fall injury in 12 cases, trafficaccident injury in 9 cases and fall injury in 9 cases. There were 22 patients with closed fractures and 8 patients with open fractures. There were 13 cases of internal fixation. Twenty-two patients had sinustract, 8 patients had soft tissue defect with bone and internal fixation exposure, soft tissue defect area ranged from 2.0 cm × 3.0 cm to 8.2 cm × 12.3 cm;10 patients had bone defect, defect area ranged from 0.5 to 3.4 cm;bacterial culture of sinus tract or wound secretion in all patients was MRSA. On the basis of thorough debridement, calcium sulfate artificial bone loaded with vancomycin was implanted in the lesion, and linezolid and glucose injection was given intravenously during the perioperative period. The patients were followed up regularly according to the time of antibiotic use, blood routine, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, liver and kidney function and other related laboratory indexes, X-ray, CT and other imaging examinations, bone healing, flap survival, joint function and McKee's osteomyelitis cure criteria.@*RESULTS@#All the patients were followed up, and the duration ranged from 3 to 6 years, with a mean of (4.23±0.76) years. No recurrence of osteomyelitis occurred. Fracture healing, infection control, wound healing and functional recovery were achieved.@*CONCLUSION@#Intravenous drip of linezolid combined with local targeted sustained-release of vancomycin for the treatment of MRSA infected traumatic osteomyelitis in limbs have significant effects and low recurrence rates.
Subject(s)
Adult , Female , Humans , Infant , Male , Middle Aged , Extremities , Methicillin-Resistant Staphylococcus aureus , Osteomyelitis , Retrospective Studies , Surgical Flaps , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To explore the methods and results of modified one-stage revision procedure for treating proximal femoral infected nonunion after intramedullary nail fixation.</p><p><b>METHODS</b>From June 2010 to June 2015, 10 patients of proximal femoral infected nonunion after intramedullary nail fixation were treated with modified one-stage revision procedure, including 9 males and 1 female, ranging in age from 35 to 77 years old. There were 3 cases of intertrochanteric fractures, 2 cases of intertrochanteric fractures accompanied with proximal femoral fractures and 5 cases of subtrochaneric fracures. The fractures ware fixed by LISS plate after radically debridement. The bone defects were repaired by free vascularized fibular graft and autogenous cancellous bone graft mixed artificial bone containing antibiotics. Postoperatively, ambulation without weight bearing was encouraged as early as possible.</p><p><b>RESULTS</b>Ten patients were followed up from 9 to 30 months and all nonunions healed smoothly without wound infection recurrence or internal fixation failure at the final follow-up. The time for full weight bearing was from 12 to 28 weeks. The hip joint function was evaluated by Sanders Traumatic Hip Rating Scale, the result was excellent in 7 cases, good in 2, and fair in 1 at the final follow-up.</p><p><b>CONCLUSIONS</b>Modified one-stage revision procedure is an effective treatment with a good functional result for proximal femoral infected nonunion after intramedullary nail fixation. On the basis of radical debridement, the combination of infection control and bone healing therapeutic techniques is key for success.</p>
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<p><b>OBJECTIVE</b>To evaluate the middle-long-term clinical effects of unilateral and bilateral percutaneous kyphoplasty(PKP) for vertebral fragility fracture in the elderly.</p><p><b>METHODS</b>The clinical data in elderly patients with vertebral fragility fracture treated by unilateral and bilateral PKP between January 2008 and January 2010 was retrospective analyzed. According to a unified criteria to divided into two groups for 104 patients(44 males and 60 females), of them, 50 cases were divided in unilateral group using unilateral pedicle surgical approach for PKP and 54 cases were in bilateral group using bilateral pedicle approach. VAS score, Cobb angle, and the height of anterior and posterior vertebral body were respectively analyzed peroperatively and at 3 d, 3 months, 1 year, 3 years postoperatively and final follow-up. Clinical effects and safety were assessed in two groups.</p><p><b>RESULTS</b>All the operations were successful. Operative time and bone cement injection volume in unilateral group were less than those of bilateral group(<0.05). Postoperative VAS scores, Cobb angle, and the height of anterior and posterior vertebral body were obviously improved in two groups(<0.05), and there was no significant difference between two groups(>0.05). Bone cement leakage occurred in 12 cases(11.5%), recurrent fracture of vertebral body occurred in 5 cases(4.8%), cerebrospinal leak occurred in 2 cases(1.9%), and nerve root irritation occurred in 3 cases(2.9%). The above complications were transient and released after symptomatic treament.</p><p><b>CONCLUSIONS</b>Middle-long-term clinical effects of unilateral and bilateral percutaneous kyphoplasty for vertebral fragility fracture are safe and satisfactory, and may be extended as a minimally invasive method. Unilateral approach for PKP has advantages of short operation time, relative less trauma, thus is a more ideal method.</p>
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<p><b>OBJECTIVE</b>To discuss the treatment of life-threatening refractory pressure ulcers around hips in patients with spinal cord injuries(SCI)and evaluate its clinical outcomes.</p><p><b>METHODS</b>From March 2012 to June 2015, eight paraplegic patients with life-threatening refractory pressure ulcers around hips were treated with total thigh musculocutaneous flaps following amputation of proximal femurs or hips, including 7 males and 1 female with an average age of (52.0±2.6) years old ranging from 35 to 68. The coures of disease was from 10 months to 7 years with a mean of(2.9±0.2) years. All the 8 patients had compound ulcers of more than two parts, 7 cases had hip infection on the same side. The area of superficial wounds ranged from 3.0 cm×3.0 cm to 12.0 cm×15.0 cm. The clinical effects were evaluated according to infection controlling, wound healing, improving of nutrition and life quality of patients.</p><p><b>RESULTS</b>All patient were followed up for 3 months to 2 years with an average of 1.3 years. All flaps survived, 5 cases obtained wound healing at one-stage, 2 cases had wound dehiscence and the wounds were closed after a second operation, 1 case had partial flap necrosis which was healed by dressing change, 1 case had urethral injury that was repaired in operation. All wounds were cured successfully without infection and ulcer recurrence during the follow-up period. The nutrition and quality of life of all cases improved observably after operation.</p><p><b>CONCLUSIONS</b>The total thigh musculocutaneous flap is effective to reconstruct the refractory pressure ulcers around hip of patient with SCI. It can rescue life at the cost of losing one lower limb. It is an operation of last resort for the patients.</p>
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<p><b>OBJECTIVE</b>To retrospectively investigate the clinical effect of the rivet-assisted hollow screw in the treatment of posterior cruciate ligament avulsion fracture.</p><p><b>METHODS</b>Total 49 patients with knee cruciate ligament avulsion fracture in the ending point of the ligament from January 2010 to December 2014 were divided into the treatment group and the control group. Thirty-one patients in treatment group were treated with rivet-assisted double cannulate nail, including 13 males and 18 females, ranging in age from 38 to 51 years old, with a mean of (40.6±5.1) years old; according to Meyers classification, 23 cases of type 2, 8 cases of type 3; 5 patients were caused by the low energy injury and 26 patients were caused by the high energy injury. Eighteen patients in control group were treated with double gold hollow screw fixation, including 5 males and 13 females, ranging in age from 36 to 52 years old, with an average age of (4.16±4.7) years old; according to Meyers classification, 14 cases of type 2 and 4 cases of type 3;2 patients were caused by the low energy injury and 16 patients were caused by the high energy injury. The operation time, postoperative complications, fracture healing time and the last AKS scoring system were compared between the two groups.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 24 months, with an average of 14.2 months. The patients in treatment group had no displacement of fracture fragments and internal fixation failure. The results of AKS score:pain was 48.1±1.5, activity was 21.3±2.7, stability was 20.9±2.5, walking ability was 47.3±1.9, under the stairs ability was 43.4±2.1, the total score was 190.7±2.9. There were 2 cases in control group had fracture fragment displacement and 1 patient had nail withdraw. The results of AKS score:pain was 40.1±2.2, activity was 20.1±0.2, stability was 18.1±3.2, walking ability was 46.3±1.7, under the stairs ability was 40.2 ±1.3, the total score was 180.2±1.4. Therefore, the comparison of the above indicators, the results of the treatment group were better than those of the control group.</p><p><b>CONCLUSIONS</b>Rivet-assisted hollow screw fixation in the treatment of cruciate ligament avulsion fracture in the ending, has some advantages such as follows:accurate reduction, less postoperative complications and better postoperative knee function recovery, therefore it is an effective way to treat posterior cruciate ligament avulsion fracture.</p>
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<p><b>OBJECTIVE</b>To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis.</p><p><b>METHODS</b>From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed.</p><p><b>RESULTS</b>Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15.62+/-11.23 )% in hormone injection group.</p><p><b>CONCLUSION</b>Using needle-knife to cut off the medial branch of the lumbar posterior ramus could get longer efficacy than hormone injection in the treatment of lumbar facet osteoarthritis.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Case-Control Studies , Low Back Pain , General Surgery , Lumbar Vertebrae , General Surgery , Osteoarthritis, Spine , General Surgery , Spinal Nerves , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the clinical results of arthroscopy-assisted open reduction and internal fixation for the treatment of acute Lauge-Hansen stage IV ankle fractures.</p><p><b>METHODS</b>A prospective cohort of study was done in 42 patients of acute ankle fractures treated with arthroscopy-assisted open reduction and internal fixation from January 2008 to December 2009. According to Lauge-Hansen classification, there were 26 supination-eversion stage IV fractures, including 11 females and 15 males; with an average age of (36.8 +/- 11.7) years; and there were 16 pronation-eversion stage IV fractures, including 6 females and 10 males, with an average age of (37.6 +/- 11.2) years. All the patients were treated with arthroscopy-assisted open reduction and internal fixation,and intra-articular disorders were observed. Syndesmotic diastasis was treated with three-cortices syndesmotic screw, and osteochondral injuries were disposed by Cheng-Ferkel staging system. The clinical effects were evaluated according to AOFAS scores.</p><p><b>RESULTS</b>All the patients were followed up for 1 year. At the final review,the mean AOFAS score was (92.00 +/- 9.32). Twenty-eight patients got an excellent result, 11 good, 3 fair. Lesions of the cartilage were found in 31 cases. The AOFAS scores of patients with osteochondral lesions were higher than those of patients without osteochondral lesions. The AOFAS scores of patients with osteochondral lesions below C grade were higher than those of patients with osteochondral lesions above C grade. The AOFAS scores of patients with osteochondral lesions were higher than those of patients with osteochondral lesions above C grade. The AOFAS scores of patients with syndesmosis fixation were lower than those of patients without syndesmosis fixation.</p><p><b>CONCLUSION</b>Intra-articular disorders are common in Lauge-Hansen stage IV ankle fractures, and osteochondral lesion and sydesmosis diastasis are the most important prognostic factor that leads to unsatisfactory ankle functions. Arthroscopy-assisted open reduction and internal fixation for the treatment of acute ankle fractures is not only helpful to anatomical reduction of the articular surface, but also can improve the clinical results with effective diagnosis and treatment of combined intra-articular disorders.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Ankle Joint , General Surgery , Arthroscopy , Methods , Fracture Fixation, Internal , Methods , Fractures, Bone , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate therapeutic effects of minimally invasive arthroscopic internal fixation with plates and screws in treating tibial plateau fractures.</p><p><b>METHODS</b>A retrospective study from December 2006 to June 2010 was done on 69 patients with tibial plateau fractures. According to Schatzker classification, 5 patients were type I, 5 patients were type II, 25 patients were type III, 20 patients were type IV, 9 patients were type V and 5 patients were type VI. Thirty-six patients were treated with arthroscopy-assisted reduction and internal fixation, including 21 males and 15 females, ranging in age from 17 to 59 years (averaged, 34.2 years); another 33 patients were treated with small incision and fixed with plates and screws,including 19 males and 14 females, ranging in age from 18 to 62 years (averaged, 35.4 years). The operation time, blood loss during operation,drainage volume of blood, healing time, weight-bearing time and function of effected knee were compared between the two groups.</p><p><b>RESULTS</b>All the patients were followed up,and the duration ranged from 6 to 12 months (averaged, 10.3 months). All the patients had no complications such as infection, articular collapse, re-fracture and joint stiffness. There were no significant differences in weight-bearing time, complications and Rasmussen scores between two groups (P>0.05); but there were significant differences in the operative time, blood loss, drainage volume of blood, hospital stay time, the healing time between two groups (P<0.05). The results showed that arthroscopy-assisted technique was better than minimally invasive internal fixation in operation duration, blood loss during operation and the healing time.</p><p><b>CONCLUSION</b>Different types of fracture of tibial plateau should be treated with different surgical treatments. Arthroscopic technique for reduction of fractures, which has less influence on bony union and minimally invasive, and can provide a good clinical outcome.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Arthroscopy , Methods , Case-Control Studies , Fracture Fixation, Internal , Methods , Minimally Invasive Surgical Procedures , Methods , Tibial Fractures , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To treat heel pain with small needle-knife according to its classification,so as to improve the therapeutic effects.</p><p><b>METHODS</b>From August 2005 to December 2008, 200 patients with 266 heel pain were treated according to the author's classification standards. There were 83 males and 117 females, ranging in age from 26 to 72 years, with a mean age of 46 years; the course of the disease ranged from 3 to 36 months, averaged 6.8 months. According to the classification:67 heels with plantar fasciitis type, 61 heels with calcaneal bursitis type, 36 heels with plantar fat pad inflammation-based type, 6 heels with calcaneus high pressure-type, 21 heels with nerve compression type, 75 heels with mixed type. All the patients were treated with small needle-knife by using different methods according to its classification.</p><p><b>RESULTS</b>After 1 month treatment, among the patients with plantar fasciitis-type, 31 heels got an excellent result,36 good;among the patients with calcaneal bursitis type, 32 heels got an excellent result, 29 good; among the patients with plantar fat pad inflammation-based type, 9 heels got an excellent result, 20 good, 4 poor and 3 bad; among the patients with calcaneus high pressure-type, 1 patient got an excellent result, 3 good and 2 poor; among the patients with nerve compression type, 11 heels got an excellent result, 8 good, 1 poor and 1 bad; among the patients with mixed type, 16 heels got an excellent result, 46 good, 5 poor and 8 bad. At the 6th month after treatment, among the patients with plantar fasciitis-type, 21 heels got an excellent result, 40 good,5 poor and 1 bad; among the patients with calcaneal bursitis type, 30 heels got an excellent result, 28 good and 3 poor; among the patients with plantar fat pad inflammation-based type, 15 heels got an excellent result, 18 good, 2 poor and 1 bad; among the patients with calcaneus high pressure-type, 0 patient got an excellent result, 3 good and 3 poor;among the patients with nerve compression type,7 heels got an excellent result, 11 good, 1 poor and 2 bad; among the patients with mixed type, 10 heels got an excellent result, 45 good, 11 poor and 9 bad.</p><p><b>CONCLUSION</b>The causes of heel pain can't be explained by using single pathogenesy,and also can't be treated with one method. The patients with calcaneal pain should be treated with different methods according to classification of heel pain, and thus the therapeutic effects can be improved.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bursitis , General Surgery , Fasciitis, Plantar , General Surgery , Foot Diseases , Classification , General Surgery , Heel , Medicine, Chinese Traditional , Pain , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the operative method for the treatment of syndesmosis injury in ankle fractures.</p><p><b>METHODS</b>A retrospective study was done on 21 ankles of 20 patients included male 11 and female 9;the range of age were from 27 to 52 years with an average of 36 years) with syndesmosis injury in closed ankle fractures from September 2005 to December 2007. All patients with ankle fractures and syndesmosis injury were diagnosed by the history, physical examination and radiology, then treated with open reduction, internal fixation, and syndesmotic stabilization with a three-cortices syndesmotic screw according to the Lauge-Hansen classification system. Radiological evaluation comprised tibiofibular overlap, total clear space and medial clear space. The clinical effects were evaluated according to modified Baird-Jackson standard.</p><p><b>RESULTS</b>All patients were followed up from 1.0 to 2.2 years with an average of 1.3 years. Radiographic measurements were detailed as follows: tibiofibular overlap averaged (0.46 +/- 3.56) mm in preoperative and (7.14 +/- 0.62) mm in postoperative; mean total clear space (5.69 +/-0.88) mm in preoperative and (3.28 +/- 0.39) mm in postoperative; medial clear space averaged (5.67 +/- 1.23) mm in preoperative and (3.12 +/- 0.33) mm in postoperative; tibiofibular overlap in mortise view averaged (-0.87 +/- 0.96) mm in preoperative and (2.91 +/- 0.30) mm in postoperative. There was significant difference above data between preoperative and postoperative (P < 0.01). Four cases were confirmed minor tibiofibular diastasis through CT scans during postoperative. The modified Baird-Jackson scoring was from 62 to 98 scores with an average of (86.24 +/- 13.26) score at the final review. Of them, 13 ankles had not pain; 16 ankles reported no instability complaints; 11 ankles gained normal walking ability; 8 ankles could run normally; 11 ankles could return work without any restrictions. Activity of ankle in dorsiflexion, plantar flexion, inversion and eversion were respectively (21.05 +/- 5.00) degrees, (33.57 +/- 5.76) degrees, (19.48 +/- 4.57) degrees and (24.05 +/- 4.86) degrees. Three cases had radiological and clinical manifestations of osteoarthritis, but no breakage of syndesmotic screw in all cases. There were excellent results in 12 cases, good in 2, fair in 4, poor in 3.</p><p><b>CONCLUSION</b>The treatment for the syndesmosis diastasis with a three-cortices screw fixation in ankle fractures is effective. Good functional outcome can be obtained with anatomical restoration of the tibiofibular syndesmosis. The repair of deltoid ligament is important for stability of the lower tibiofibular syndesmosis. Removal of the screw before weight loading should be performed to avoid possible screw breakage.</p>