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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.
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【Objective】 To explore effective ways to mobilize more blood donors to become voluntary donors of hematopoietic stem cells (HSCs), so as to increase the HSCs supply in China. 【Methods】 Two scales(the information scale and the control scale) with the same items were designed and both included questions concerning the knowledge of HSCs donation and the level of demand. The information scale indicated the correct answer to these questions, while the control scale did not. A total of 3 000 blood donors in Guangzhou were randomly assigned into the intervention group (n=1 500, filled in the information scale) and the control group (n=1 500, filled in the control scale). 【Results】 Blood donors who filled in the informational scale expressed a higher intention to become HSCs volunteers (MInformation =4.32, SD=0.87; MControl=4.02, SD=0.93, t(529)=3.87, P<0.001). Altruism and perceived need (the degree of HSCs demands) were the moderators of grouping and intention, that is, the information scale made blood donors, with stronger altruism and higher perceived need, more willing to become stem cell volunteers. Perceived risk (the negative impact of HSCs donation on health) was a partial mediator of grouping and intention. The information scale reduced blood donors' anxiety about the risk of HSCs donation, and promoted their intention to become HSCs volunteers. 【Conclusion】 This study proved that the informational scale can effectively mobilize blood donors to become HSCs volunteers.
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Objective:To explore the debridement effectiveness of infected bone tissue of chronic hematogenous osteomyelitis in the lower extremities under the guidance of 99mTc-MDP SPECT/CT fused images. Methods:A retrospective case series analysis was conducted on 21 patients with chronic hematogenous osteomyelitis in the lower extremities treated at Southwest Hospital of Army Medical University from May 2017 to June 2020. There were 8 males and 13 females, with the age range of 10-62 years [23(18, 37)years]. The tibial infections were found in 16 patients, and femoral infections in 5 patients. The duration of bone infection was 4-480 months [120(42, 228)months]. According to the Cierny-Mader anatomico-physiological system, 4 patients were classified as type I, 14 as type III, 3 as type IV; 18 patients were classified as type A and 3 as type B. Intraoperative debridement of infected bone tissue was operated at stage I on the region of interest (ROI) where the isocontour(ISO) value was between 30%-40%, using the preoperative 99mTc-MDP SPECT/CT fused images as the reference. The stage II bone defect reconstruction was based on autologous and / or allogeneic bone. To observe the frequency of operations regarding bone infection control in stage I. The preoperative white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), intraoperative bacterial culture and pathological examination were compared at stages I and II. The skin redness and swellings, pain, sinus tract in the infected limbs, and ossification of grafted bones in the original bone defect part were observed at stage II. The accuracy rate between ISO value in the region of interest (ROI) and set ISO figure was checked. The difference of longitudinal length of the bone debridement area in ROI area with the actual bone debridement area was observed under the coronal position. Results:All patients were followed up for 6-36 months [11(9, 29)months] after stage II operation. All of the 21 patients had undergone operations of infection control with an average number of 1.04 times in stage I. 1 patient's intraoperative frozen section indicated that neutrophils were>5/HP. The bone graft at stage II had been completed after another debridement. Comparison of preoperative inflammatory markers at stages I and II: the WBC was decreased from (5.9±1.6)×10 9/L to (5.4±1.5)×10 9/L ( P>0.05), the ESR decreased from 9(5, 26)mm/h to 4(2, 10)mm/h ( P<0.05), and the CRP decreased from 2.8(2.3, 7.7)mg/L to 2.3(1.4, 3.0)mg/L ( P>0.05). The results of bacterial culture of tissue at stage I were positive in 12 patients and negative in 9 patients. The pathological examination indicated neutrophils and lymphocyte infiltration. The results of bacterial culture of tissue at stage II were all negative. A modicum of plasmacyte and lymphocyte infiltration and the neutrophils (<5 per/Hp) had been found in the intraoperative frozen section and pathological examination. No redness, swelling or sinus tract was found in the skin after stage II surgery and ossification of grafted bone was good. The accuracy rate between ISO value in the ROI and set ISO figure was 90.5%. The comparison between longitudinal debridement scope of ROI [(86.8±31.1)mm] and actual bone tissue debridement scope [(86.0±31.3)mm] at stage I showed no significant difference ( P>0.05). Conclusions:99mTc-MDP SPECT/CT fused images can be used as an effective means to define the debridement scope of infected bone tissue preoperatively. The method can not only avoid excessive debridement, but also improve the cure rate of hematogenous osteomyelitis in the lower extremities.
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Objective:To investigate the clinical effect of titanium cable binding plate combined with lengthened proximal femoral nail antirotation (PFNA) for fixation of recurrent fracture after treatment of unstable intertrochanteric fractures.Methods:A retrospective case series study was conducted for analyzing the clinical data of 17 patients with recurrent fracture of unstable intertrochanteric fractures admitted to Southwest Hospital of Army Medical University from January 2010 to January 2018. There were 7 males and 10 females, aged from 65 to 94 years [(75.7±13.2)years]. The patients were treated using titanium cable binding plate combined with PFNA. Anti-osteoporosis therapy was applied as well. X-ray images were performed at postoperative 3 days, 3, 6 and 12 months. The healing and complications of the patients were recorded. The Harris hip score, visual analogue score (VAS), physical health score (PCS), mental health score (MCS) and 36-item short form health survey questionnaire (SF-36) were evaluated before operation and at postoperative 6 and 12 months.Results:All patients were followed up for 12-18 months [(15.3±2.8)months]. Bone healing was achieved in all patients, and the postoperative bone healing time was 3-6 months [(3.6±1.1)months]. One patient developed lumbosacral pressure sores and recovered after dressing change. Two patients developed drooping pneumonia, which was completely relieved after symptomatic treatment including nebulized inhalation of antibiotics and sputum aspiration. At postoperative 6 and 12 months, Harris hip score was (76.5±5.2)points and (85.5±5.7)points, significantly higher than (32.8±5.1)points before operation ( P<0.05); VAS was (3.3±0.5)points and (1.2±0.7)points, significantly lower than (8.5±0.7)points before operation ( P<0.05); PCS was (44.2±4.9)points and (56.9±5.8)points, significantly higher than (29.3±4.7)points before operation ( P<0.05); MCS was (47.9±6.8)points and (58.4±7.9)points, significantly higher than (39.7±5.9) points before operation ( P<0.05); SF-36 was (493.9±85.7)points and (603.4±76.8)points, significantly higher than (415.9±88.2)points before operation ( P<0.05). Conclusions:Titanium cable binding plate combined with lengthening PFNA can provide stability of fracture end, promote fracture healing, reduce complications, relieve pain and improve patients' quality of life for recurrence of unstable intertrochanteric fracture.
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Objective:To investigate the clinical efficacy of membrane induction technique in the treatment of postoperative infection of tibial plateau fractures in adults.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 adult patients with postoperative infection of tibial plateau fractures treated with membrane induction technique from April 2013 to May 2017 in Southwest Hospital of Army Medical University. There were 19 males and two females, aged 19-60 years [(44.1±5.8)years]. There was one patient with type IV fractures, 14 with type V, and 6 with type VI according to the initial fracture typing by Schatzker's classification. There were three patients with infection period of within 3 weeks, 12 of 3-10 weeks, and 6 of over 10 weeks. All patients underwent two-stage operation using membrane induction technique to place cement in the bone defect area. After removal of internal fixation and thorough debridement, antibiotic cement and internal fixation plate were placed at stage I. Bone graft and reconstruction was performed at stage II. The infection indicators were recorded. Infection indices were monitored, including white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Clearance of infection, bony union and complications were evaluated. Range of motion (ROM) and scoring of Hospital for Special Surgery (HSS) were used to evaluate the function of knee joint.Results:All patients were followed up for 12-62 months with an average of 23.5 months. Compared with 3 months after stage II, the indicators of infection at stage I showed that WBC was decreased from (10.6±2.3)×10 9/L to (6.7±3.5)×10 9/L, ESR decreased from (26.0±5.3)mm/h to (12.1±4.3)mm/h, and CRP decreased from (10.0±1.5)mg/L to (5.8±1.0)mg/L ( P<0.05). Infection was cleared in 17 patients after stage I operation, and the other 4 patients had infection recurrence, which were given stage I debridement again to control the infection. Two patients were treated with local flap transfer to cover the wound because of skin soft tissue defect after debridement. Another two patients underwent knee arthrodesis, and none was amputated. X-ray film indicated bony union in 21 patients at 46 months (mean, 4.5 months) after operation, and clinical bone healing was acquired in all 21 patients. One patient showed donor site infection. No nonunion, recurrence of infection after stage II, deep vein thrombosis or pulmonary embolism occured after the second stage. At the latest follow-up, ROM in patients with infection periods within 3 weeks and 3-10 weeks was singnificantly improved from [(95.2±10.4)° and (85.7±11.5)°] to [(120.2±10.5)° and (98.6±12.2)°] ( P<0.01), but not in patients with infection periods of over 10 weeks ( P>0.05). The HSS score in all patients was significantly improved after operation [(65.6±8.2)points vs. (82.0±6.6)points]( P<0.01). Conclusion:For adult patients with tibial plateau fracture, membrane induction technique can effectively control the postoperative infection, achieve clinical bone healing and improve the knee function.
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The chemical constituents of Viburnum taitoense Hayata were investigated using column chromatography silica gel and Sephadex LH-20, etc. Seven pentacyclic triterpenoids were isolated and their structures were elucidated by spectral data and physicochemical properties as 3β,6β-dihydroxy olean-11,13(18)-dien-28-acid (1), 3β-hydroxy olean-11,13(18)-diene-28-acid (2), 12-ene-olean-28-acid-3β-palmitate (3), 3β-acetylcocodiol (4), corosolic acid (5), uvaol (6) and ursolic acid (7). Among them, compound 1 is a new oleanane type triterpenoid and its absolute configuration was confirmed by single-crystal X-ray diffraction data. Compounds 2-5 were isolated from this genus for the first time. All the compounds were evaluated for their anti-inflammatory activities in vitro, and compound 5 showed significant inhibitory activity against nitric oxide (NO) production in lipopolysaccharide (LPS)-induced RAW264.7 macrophage cells with an IC50 of 25.52 ± 0.56 μmol·L-1 when compared to the positive control, quercetin (IC50 of 25.46 ± 0.62 μmol·L-1).
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Objective To investigate the clinical efficacy of optimizing perioperative nursing process and applying enhanced recovery after surgery (ERAS) model in the treatment of post-traumatic bone infection of lower limb using the membrane induction technique.Methods A retrospective case control study was conducted to analyze the clinical data of 225 patients with post-traumatic bone infection of lower limb admitted to the First Affiliated Hospital of Army Medical University from January 2015 to December 2016.There were 184 males and 41 females,aged 19-63 years,with an average age of 41.8 years.There were 123 patients with tibia infection,80 with femur infection and 22 with fibula infection.A total of 125 patients received process optimization plus ERAS (test group),and 100 patients received traditional treatment (control group).Visual analogue scale (VAS) before operation and 1,3 and 7 days after operation,incidence of deep venous thrombosis (DVT),bedridden time,sleep time,ambulation distance,length of stay in hospital and patient satisfaction were compared between the two groups.Results The VAS scores in the test group were (4.5 ± 0.7) points,(3.7 ± 0.6) points,and (2.7 ± 0.5) points at 1,3 and 7days after operation,which were lower than those in the control group (5.7 ± 0.8) points,(5.5 ± 0.8) points,(3.6 ± 0.5) points (P ＜ 0.05 or 0.01).There was no significant difference in VAS 10 days after operation between the two groups (P ＞ 0.05).The incidence of DVT in test group was 16.0％,which was significantly lower than that in the control group 39.0％ (P ＜ 0.01).The bedridden time of the test group was (3.5 ± 0.1) days,and that of the control group was (7.0 ± 0.4) days (P ＜0.05).The sleep time at 1,2,and 3 days after operation as well as the ambulation distance at 3,4,and 5 days after operation in the test group were significantly longer than those in the control group (P ＜0.05).The hospitalization time was (13.4 ± 1.2) days in the test group and (17.6 ± 1.9) days in the control group (P ＜ 0.05).The satisfaction rate was 99.2％ in the test group and 87.0％ in the control group (P ＜ 0.05).Conclusion During treatment of post-traumatic bone infection of lower limb using the membrane induction technique,nursing process optimization plus ERAS intervention program can effectively alleviate postoperative pain,improve daily activity abilities,shorten hospitalization time,improve patient satisfaction and better promote patient rehabilitation.
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Objective To investigate the clinical efficacy of vancomycin cement spacer in the treatment of bone infection after calcaneal fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 31 patients with bone infection after calcaneal fracture admitted to First Affiliated Hospital of Army Medical University from February 2012 to August 2016.There were 24 males and seven females,aged 20-59 years,with an average of 43 years.There were 11 patients with infection at the left foot,17 patients at the right foot,and three patients at both feet.Two patients were accompanied with skin and soft tissue defects.The duration of bone infection was 0.25-40 years,with an average of 6.5 years.After thorough debridement,the vancomycin cement spacer was used to fill the bone defect.Limb reconstruction with autogenous bone graft was performed after 6-8 weeks.After the operation,white blood cell count (WBC),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) and interleukin-6 (IL-6) were recorded.The clinical manifestations of the affected limb (redness,swelling,heat,pain and sinus formation) and X-ray films (lateral position and axial position) were observed.The American Foot and Ankle Surgery Association's hind foot (AOFAS-AH) score was used to assess the postoperative limb function.Wound healing and complications were recorded.Results The patients were followed up for 14-42 months,with an average of 20.5 months.At postoperative 1 month,WBC was decreased from preoperative (10.9 ± 5.2) × 109/L to (8.4 ± 2.7) × 109/L,and ESR decreased from preoperative (27.5 ±25.5)mm/h to (6.21 ±3.20)mm/h,CRP decreased from preoperative (11.4 ± 9.3) mg/L to (3.3 ± 1.8) mg/L,and IL-6 decreased from preoperative (7.3 ± 5.2) ng/L to (4.3 ± 2.2) ng/L (all P ＜ 0.05).Three patients who had sinus after operation received vancomycin cement spacer treatment for a second time and were not seen relapse of sinus afterwards.The cure rate of bone infection was 91％ (28/31).X-ray films were regularly reviewed at 1,3,6,and 12 months after surgery and showed good bone cement position.Sinus tract appeared in the affected limbs of three patients after operation,and no recurrence was found after the vancomycin cement spacer treatment again.The cure rate of bone infection was 91％ (28/31).The AOFAS-AH score improved from preoperative (38.4 ± 3.7) points to (50.2 ± 7.4) points at postoperative 1 month and to (65.5 ± 2.9) points at postoperative 6 months (P ＜ 0.05).Four patients with postoperative foot pain received autologous bone grafting and the pain was relieved.All patients were seen with wound healing at postoperative 0.5-3 months (mean,1.5 months) and returned to work.Conclusions The vancomycin cement spacer is a simple and effective method for bone infection after calcaneal fracture.Autologous bone grafting can be performed after the operation,which can promote wound healing and preserve limb function.
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OBJECTIVE@#To explore the correlation between special A/O genotype and the O phenotype.@*METHODS@#Group O samples with partially reduced or lack of isoagglutinins were collected to determinate the ABO genotype with a PCR-sequence specific primer (PCR-SSP) assay. Seven samples with A/O genotype were selected for further study. Serological tests including forward and reverse typing, H antigen determination and adsorption/elution were carried out with a tube method. Genomic DNA was genotyped by amplifying and sequencing of the coding regions of exons 1 to 7 of the ABO gene.@*RESULTS@#Seven samples were serotyped as group O by the forward typing test. However, reduced anti-A activity was found in 5 samples by the reverse typing test, reduced anti-A and anti-B activities were found in 1 sample, and no anti-A isoagglutinin activity was found with 1 sample. H antigen was determined in all samples by routine serologic method. Neither anti-A nor anti-B was eluted from red cells derived from all samples. Three samples were genotyped as Ael02/O02, whilst the remainders were Ael02/O13, Ael02/O65, Am04/O75, Ael06/O02, respectively.@*CONCLUSION@#Special A/O genotype may not express the A antigen, leading to the generation of group O red cells. Reduced or missed anti-A activity is the typical serological feature of this special group of O phenotype, for which ABO*Ael02 and ABO*O02 are the major alleles. Group O individuals with isoagglutinin detection problem should be grouped by serological tests and genomic DNA analysis.
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Humans , ABO Blood-Group System , Alleles , Exons , Genotype , PhenotypeABSTRACT
Hyperhomocysteinemia (Hhcy) is an independent risk factor for Alzheimer's disease (AD), and insulin-resistance is commonly seen in patients with Hhcy. Liraglutide (Lir), a glucagon-like peptide that increases the secretion and sensitivity of insulin, has a neurotrophic or neuroprotective effect. However, it is not known whether Lir ameliorates the AD-like pathology and memory deficit induced by Hhcy. By vena caudalis injection of homocysteine to produce the Hhcy model in rats, we found here that simultaneous administration of Lir for 2 weeks ameliorated the Hhcy-induced memory deficit, along with increased density of dendritic spines and up-regulation of synaptic proteins. Lir also attenuated the Hhcy-induced tau hyperphosphorylation and Aβ overproduction, and the molecular mechanisms involved the restoration of protein phosphatase-2A activity and inhibition of β- and γ-secretases. Phosphorylated insulin receptor substrate-1 also decreased after treatment with Lir. Our data reveal that Lir improves the Hhcy-induced AD-like spatial memory deficit and the mechanisms involve the modulation of insulin-resistance and the pathways generating abnormal tau and Aβ.
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The biomass multi-elements self-doped TiO2was synthesized simultaneously by ultrasonic irradiation assisted sol-gel method, and characterized by field emission scanning electron microscopy (FESEM), X-ray diffraction(XRD), X-ray photoelectron spectroscopy (XPS), UV-Vis diffuse reflectance spectroscopy (UV-Vis-DRS), Fourier transform infrared (FT-IR) spectroscopy, and photoluminescence (PL). The characterization results showed that,multiple elements, C, N, P, Cl and K, were doped in the composite TiO2. Compared with pure TiO2,the band gap of the composite catalyst was narrowed by 0.21 eV, and possessed more surface hydroxyl radical and active sites, lower recombination rate of photo-generated carriers, higher crystallinity and higher specific surface area. The photocatalytic ability of the composite catalyst was studied,using methylene blue (MB) as target pollutant. The experimental results showed that, under visible light irradiation,the degradation efficiency of methylene blue was up to 98% after photocatalytic reaction for two hours by the composite catalyst.
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Objective To observe the clinical efficacy of induced membrane technique combined with locking compression plate as an external fixator for the treatment of tibia infected defects.Methods Data of 107 patients with tibia infected defects who were treated by induced membrane technique combined with locking compression plate (LCP) as an external fixator in our department from June 2013 to May 2015 were retrospectively analyzed.Among them,62 cases' LCP were replaced with intramedullary nail during second stage (internal fixation group),while 45 cases kept their LCP (external fixation group).There were 52 males and 10 females in internal fixation group,aged from 18-61 (average,39.6),and their bone defects ranged from 3-17 cm (average,6.93 cm).15 cases were type Ⅲ and 47 cases were type Ⅳ according to Cierny-Mader classification.9 cases were suffered from hematogenous osteomyelitis and 53 cases suffered from trauma.15 cases located in proximal tibia,28 cases in middle tibia and 19 cases in distal tibia.There were 45 cases in external fixation group,aged from 18-65 (average,41.3),and their bone defects ranged from 5-12 cm (average,7.12 cm).13 cases were type Ⅲ and 32 cases were type Ⅳ according to Cierny-Mader classification.6 cases were suffered from hematogenous osteomyelitis and 39 cases suffered from trauma.12 cases located in proximal tibia,19 cases in middle tibia and 14 cases in distal tibia.Results All 107 patients have been successfully followed up for 18-40 months (23.5 in average).There were 20 patients (18.7％) encountered with a second debridement before grafting because of infection recurrence and culture positive was verified in 10 cases.101 cases acquired bone union,including 58 cases in internal fixation group and 43 cases in external fixation group.Average radiographic bone union time was 6.2 and 6.9 months in internal fixation group and external fixation group respectively.Nonuinon was observed in 6 cases (internal fixation group 4 cases,external fixation group 2 cases),with nonuion rate of 6.5％ (4/62) and 4.4％ (2/45).Infection reccurrence was found 3 cases in internal fixation group and 2 cases in external fixation group,with infection reccurence rate of 4.8％ (3/62) and 4.4％ (2/45) respectively.There were 5 cases observed pin track infection and 6 cases with pin track loosening in external fixation group.Conclusion Locking compression plate combined with induced membrane technique in the treatment of tibia infected defects can achieve a good clinical efficacy despite the complication of pin-track loosening and infection,unfavorable to the reconstruction of grafting bone.In internal fixation group,both radiographic bone union and clinical bone union were shorter comparing with external fixation group.So,intramedullary nail is a better choice of induced membrane technique during the second stage.
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Objective To investigate the clinical outcome of post-traumatic tibial osteomyelitis treated by induced membrane technique combined with the antibiotic cement-coated locking plate.Methods A restrospective case series analysis was made on 71 cases of post-traumatic tibial osteomyelitis treated by induced membrane technique from September 2014 to September 2014.There were 55 males and 16 females, aged 18-60 years(mean, 37.4 years).Mean length of bone defect following debridement was 4.5 cm(range, 4-11 cm).Antibiotic cement-coated locking plates were used to provide the stability of the bone defects after one-stage debridement.Bone grafting and exchanging the plates with ntramedullary nails were done during the second-stage surgery.Parameters were monitored dynamically after operation to evaluate infection recurrence and bone healing, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), clinical features(sinus formation, redness and swelling, warmth and pain) and X-ray films of the involved limbs.Results All patients were followed up for 13-25 months (mean, 19.5 months).There was no sign of recurring infection and CRP and ESR were normal in all cases after the first stage surgery.However, four cases (6%) had recurrent infection with sinus exudates and their CRP and ESR were abnormal after the second stage surgery, and further treatments were carried out on these patients.Follow-up showed bony union in all patients within mean 5.5 months (range, 4-6 months).Conclusion Induced membrane technique with antibiotic cement-coated locking plates for treatment of post-traumatic tibial osteomyelitis can shorten bone healing time and decrease infection recurrent rate without obvious impact on osteogenic activity.
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Long bone osteomyelitis often results from serious open fractures or some closed fractures.Its treatment is a clinical difficultly in orthopaedics.Masquelet is a new strategy for bone reconstruction,validated by surgeons in their treatment of acute bone loss,bone tumor and bone infection.It is carried out in 2 stages.At the first stage,infection was eliminated by radical debridement and placement of antibiotic bone cement into the defect,which induces a pseudomembrane to facilitate the growth of bone graft.At the second stage,reconstruction of the bone defect is performed by bone grafting in the membrance after removal of the bone cement.The unique characteristics of this technique arouse more and more attention recently.Therefore,we would like to present a review about this Masquelet technique dealing with post-traumatic osteomyelitis of long bones.
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Objective To investigate the results of Cierny-Mader type Ⅳ posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique.Methods A retrospective case series analysis was made on 36 patients with posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique from January 2013 to January 2015.There were 30 male and 6 female patients between 21 and 68 years (mean,41 years).Infection control,bone union,function activity and complications were detected after operation.Results After debridement in the first stage,a segmental bone defect of 5.5 cm in length (range,2-10.9 cm) was seen in all patients.Seven patients needed a local flap transfer to cover the wound and five patients had a second debridement.Mean duration of systemic antibiotic use was 2 weeks (range,1-6 weeks) and mean time interval of second-stage bone grafting was 12 weeks after debridement (range,6-36 weeks).Mean follow-up was 29.5 months (range,24-45 months).One patient had recurrence and was cured with radical debridement and a permanent acrylic spacers insertion,with the cure rate of bone infection of 97％ (35/36).All patients achieved bone union with a mean duration of 5.9 months (range,4-8 months),and were able to walk independently.Thirty patients returned to work or pre-operative physical labor.No pain and re-fracture occurred.Six patients had adjacent joint stiffness.Conclusion En bloc resection combined with induced membrane technique is associated with radical debridement,decreased recurrence rate and limb salvage,indicating a simple and effective method for Cierny-Mader type Ⅳ posttraumatic long bone infection.
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Objective To establish a management system to promote early rehabilitation for work injured patients. Methods The 2015 hospitalized patients were set as control group (n=16,635), and the 2016 hospitalized patients were set as observation group (n=15,372). The control group was hospitalized for injury data collection surveys and was not implemented systematic rehabilitation propaganda, rehabilita-tion assessment and rehabilitation guidance. However, the observation group hospitalized after establishment of the Work Injuries Rehabilita-tion Investigation System and accepted work injuries rehabilitation intervention, such as rehabilitation propaganda, rehabilitation assessment and rehabilitation guidance. The changes of hand trauma rehabilitation indicators were compared between two groups. Results The rate of work injuries rehabilitation intervention was 80.6%in the observation group. In the observation group, the proportion of the patients who re-ceived early rehabilitation treatment in the designated hospital (56.8%) was significantly higher than that of the control group (17.0%) (χ2=2603.683, P<0.001);the proportion of injured patients who were admitted to the designated work injuries rehabilitation institutions (9.4%) was higher than that of the control group (4.3%) (χ2=285.906, P<0.001). The proportion of patients evaluated as disability in the observation group (17.4%) was significantly less than that of the control group (26.3%) (χ2=235.327, P<0.001). The disability score was significantly lower in the observation group (6.23±1.29) than in the control group (8.26±1.16) (t=68.371, P<0.001). Conclusion The Work Injuries Reha-bilitation Investigation System can promote the early rehabilitation for the hand trauma patients in the designated hospital for work injuries, improve the proportion of hand trauma patients to enter the designated work injuries rehabilitation institutions to receive rehabilitation treat-ment, reduce the proportion of disabled persons, and reduce the degree of disability, effectively promote the overall recovery of patients with hand trauma.
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Objective To establish a management system to promote early rehabilitation for work injured patients. Methods The 2015 hospitalized patients were set as control group (n=16,635), and the 2016 hospitalized patients were set as observation group (n=15,372). The control group was hospitalized for injury data collection surveys and was not implemented systematic rehabilitation propaganda, rehabilita-tion assessment and rehabilitation guidance. However, the observation group hospitalized after establishment of the Work Injuries Rehabilita-tion Investigation System and accepted work injuries rehabilitation intervention, such as rehabilitation propaganda, rehabilitation assessment and rehabilitation guidance. The changes of hand trauma rehabilitation indicators were compared between two groups. Results The rate of work injuries rehabilitation intervention was 80.6%in the observation group. In the observation group, the proportion of the patients who re-ceived early rehabilitation treatment in the designated hospital (56.8%) was significantly higher than that of the control group (17.0%) (χ2=2603.683, P<0.001);the proportion of injured patients who were admitted to the designated work injuries rehabilitation institutions (9.4%) was higher than that of the control group (4.3%) (χ2=285.906, P<0.001). The proportion of patients evaluated as disability in the observation group (17.4%) was significantly less than that of the control group (26.3%) (χ2=235.327, P<0.001). The disability score was significantly lower in the observation group (6.23±1.29) than in the control group (8.26±1.16) (t=68.371, P<0.001). Conclusion The Work Injuries Reha-bilitation Investigation System can promote the early rehabilitation for the hand trauma patients in the designated hospital for work injuries, improve the proportion of hand trauma patients to enter the designated work injuries rehabilitation institutions to receive rehabilitation treat-ment, reduce the proportion of disabled persons, and reduce the degree of disability, effectively promote the overall recovery of patients with hand trauma.
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Two new flavonoid glycosides were isolated from the aerial parts of Nervilia fordii by various chromatographies such as D101 macroporous resin, ODS and preparative HPLC chromatographic techniques. Their structures were elucidated as rhamnocitrin-3-O-β-glucopyranosyl-4'-O-β-galactosyl-(1→3)-glucopyranoside (1) and 7, 3'-di-O-methylquercetin-4'-O-[β-galactosyl-(1→3)-β-glucopyranosyl]-3-O-β-glucopyranoside (2) on the basis of extensive spectroscopic analyses, including 1D-, 2D-NMR, HR-ESI-MS and analytical hydrolysis.
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Purpose To investigate the clinical outcome of induced membrane technique for treatment of post-traumatic tibial osteomyelitis.Methods A retrospective analysis was made on 17 cases of post-traumatic tibial osteomyelitis admitted from August 2011 to October 2012.There were 13 males and 4 females aged 19-67 years (mean,40.9 years).Mean length of bone defect was 6.7 cm (range,2.0-18.5 cm).Surgical treatments were performed including phase Ⅰ surgical debridement and antibiotics-loaded bone cement impregnation to induce a membrane and phase Ⅱ bone defect reconstruction by intramembranous bone grafting.Clinical effect of the treatment was evaluated.Results Bone healing was detected at the 27-month follow-up (range,24-32 months).Radiographic healing was obtained 4-6 months after operation.Two cases of recurrent infection were noted after phase Ⅰ surgery and had another debridement.External fixator proximal pin track infection occurred in one case and infection was controlled by hardware removal and dressing change.There was one case of metal rejection,two function disorders,one clubfoot,and one ankle stiffness.Conclusion Induced membrane technique is effective in the treatment of post-traumatic tibial osteomyelitis,especially in lone bone defect reconstruction,but limb functional complications are worth consideration during treatment.