一期及二期翻修在治疗全髋关节置换术后感染中的对比研究

目的 探讨并比较一期及二期翻修在治疗全髋关节置换术后感染中的临床疗效.方法 选择2001年4月至2009年6月因全髋关节置换术后假体周围感染并接受手术治疗的患者共56例.根据修复方式不同分为一期翻修组及二期翻修组,每组28例.患者术后随访,并复查红细胞沉降率(ESR)以及C反应蛋白(CRP),行Harris髋关节功能评分以及X线检查,比较两组患者疗效.结果 两组患者均行术后随访,随访时间为12～ 20( 15.3±4.4)个月.两组患者细菌培养比较差异无统计学意义(P＞0.05).一期翻修组和二期翻修组术后Harris髋关节功能评分[(76.5±8.9)、(94.2±5.6)分]均较术前[(21.3±53)、(20.3±4.8)分]显著提高(P＜0.05),且术后二期翻修组的Harris髋关节功能评分高于一期翻修组,差异有统计学意义(P＜0.05).两组患者术后ESR、CRP均较术前显著降低(P＜0.05)；但两组手术前后组间ESR、CRP比较差异无统计学意义(P＞0.05).结论 与一期翻修比较,二期翻修能够显著提高全髋关节置换术后感染患者的Harris髋关节功能评分,二期翻修疗效优于一期翻修.     

抗生素骨水泥间置器在全髋关节置换感染Ⅱ期翻修中的应用

目的 探讨采用抗生素骨水泥间置器二期翻修治疗人工髋关节感染的疗效.方法 对本院12例初次髋关节置换术后感染患者行Ⅱ期翻修手术,Ⅰ期手术中的假体并放置抗生素骨水泥间置器,Ⅱ期置换手术后于4～6个月进行Harris评分,观察髋关节功能恢复情况(采用Harris评分进行评价).结果 12例患者均获得随访,随访时间8～36个月.所有患者伤口均一期愈合,感染无复发.术后Harris评分较术前明显提高(85.46±8.32 vs 42.52±7.48,P＜0.05).结论 彻底清创、应用抗生素骨水泥间置器能够有效控制感染复发和提高二期置换手术效果.     

全髋关节置换术后感染的治疗

目的 探讨全髋关节置换术后感染的临床治疗特点.方法 回顾性分析医院2006年1月-2011年1月进行全髋关节置换术术后感染的患者病历资料,对其临床治疗方法进行分析.结果 在本组中行保留假体清创术共6例,对失败的4例患者行二期翻修术,行二期翻修术5例,3例行一期翻修术;患者术后随访率100.0％,随访时间2～45个月,平均时间24.6个月,未见感染征象;12例患者均获一期愈合,术前、后髋关节Harris评分分别为50.6±6.42、68.2±12.16,差异有统计学意义;二期翻修术患者间隔时间为2.1～4.6个月,平均间隔时间2.2个月;采取二期翻修术患者随访未见感染征象.结论 全髋关节置换术术后感染临床治疗较复杂,针对术后感染患者应严格掌握适应证进行二期翻修术,临床效果较好.     

人工髋关节翻修重建术28例临床分析

目的 探讨人工髋关节翻修重建术的翻修原因和临床疗效.方法 对2005年6月至2009年6月行人工髋关节翻修重建术28例患者进行随访,用Harris评分法,对人工髋关节翻修重建术的临床疗效进行评估.结果 28例患者术后随访6～48(34.0±8.6)个月.27例患者疼痛消失,关节功能恢复良好,1例患者因翻修术后发生感染,给予清创灌洗及抗生素抗感染治疗后得到控制.术前Harris评分(45.0±14.9)分,术后(89.0±10.2)分,术前与术后Harris评分比较差异有统计学意义(t=4.58,P=0.0042).结论 疼痛性无菌性假体松动是人工髋关节置换术主要的翻修原因,术中应根据患者年龄、骨缺损的类型等选择不同的假体类型,规范手术操作,加强功能锻炼,提高临床疗效.     

二期翻修治疗人工髋关节置换术后感染

目的探讨二期翻修方法治疗人工髋关节置换术后感染的效果。方法对4例人工髋关节置换术后感染病例，采用二期翻修方法治疗：一期手术取出假体、清创，采用抗菌药物骨水泥临时占位，术后关节置管持续冲洗，加强抗感染治疗；二期手术取出占位物，再次清创、翻修关节。结果术后随访6～33个月，无一例感染复发；复查C反应蛋白、血沉，皆恢复正常；关节功能恢复满意。结论采用抗菌药物骨水泥临时占位，感染控制后行二期翻修治疗人工关节置换术后感染效果良好。     

人工髋关节置换术后感染二期翻修治疗的临床研究

目的探讨二期翻修治疗人工全髋关节置换术后感染的临床效果,以期提高临床治疗水平。方法回顾性分析2010年3月-2013年2月55例人工全髋关节置换术后感染患者,均采用一期手术彻底清创,取出感染假体,置入抗生素骨水泥间隔器,二期手术植入骨水泥型或非骨水泥型假体,分别对实验室检查、影像学检查和髋关节功能等方面进行比较分析。结果人工全髋关节置换术后感染患者二期翻修治疗后,Harris髋关节功能评分术前为(29.52±3.73)分、术后为(83.74±5.83)分,平均提高了(54.22±2.1)分,Harris评分优良率为92.73%;实验室检查中术前血沉为(38.53±8.93)mm/h、CRP为(65.94±34.95)mg/L,术后分别为(21.52±4.36)mm/h、(5.36±1.74)mg/L,而术前培养出病原菌55株,术后未检出,差异有统计学意义(P<0.05);在影像学上,术前假体下沉、松动、骨溶解、骨膜反应、内固定不稳等表现分布率,分别为61.82%、43.64%、23.64%、45.45%、16.36%,而术后均无假体下沉、松动、骨溶解、内固定不稳表现,差异有统计学意义(P<0.05)。结论二期翻修治疗人工全髋关节置换术后感染临床效果显著。     

二期翻修治疗髋关节置换术后感染临床分析

目的探讨二期翻修治疗髋关节置换术后感染的临床疗效。方法回顾性分析研究髋关节置换术后感染患者24例,一期行清创后抗菌素骨水泥旷置术,控制感染后二期翻修术治疗。术后定期随访,根据X线片及Harris评分结果进行评价。结果 1例患者随访1年后失访,1例患者感染复发后拒绝进一步治疗,2例分别于术后等3、4个月再次感染,行旷置术及再次翻修,其余20例患者均获随访,随访时间为12~36个月,平均20.5个月,X线片未见影响假体稳定的骨吸收,Harris评分从术前的平均(28.3±4.1)分提高到术后随访结束时的平均(80.1±7.6)分。结论明确诊断的髋关节置换术后感染,有效的抗生素应用,结合骨水泥占位器,二期翻修治疗可以取得良好临床疗效。     

小切口人工髋关节置换术治疗高龄股骨颈骨折疗效分析

目的 探讨小切口人工髋关节置换术治疗高龄股骨颈骨折的临床疗效.方法 回顾分析2003～2007年应用小切口髋关节置换术治疗高龄股骨颈骨折患者99例,全髋关节置换术73例,半髋关节置换术26例.对患者术后功能进行Harris评分.结果 随访3～50(24±5.4)个月,随访97例,疗效优69例,良20例,可7例,差1例,围手术期死亡2例.Harris关节功能65～95(86±3.8)分.术后深静脉血栓形成1例;皮下感染1例,固手术期死亡2例;周围异位骨化4例.结论 小切口人工髋关节置换术治疗高龄股骨颈骨折具有手术时间短、术后髋关节功能佳、并发症少等优点,是治疗高龄股骨颈骨折的可靠办法.     

人工髋关节置换术后感染的治疗

目的 探讨人工髋关节置换术后感染的治疗方法.方法 回顾性分析2006～2009年我科所收治8例人工关节置换术后感染患者的临床资料.收集患者分泌物或关节穿刺液进行细菌培养、药敏试验.治疗包括:保留假体清创,VSD(vacuum sealing drainage)闭合冲洗3例;二期翻修5例.结果 3例保留假体清创闭合冲洗者,1例术后感染复发,后改为取出假体旷置,二期翻修.5例二期翻修者,术后均未见感染复发.所有患者均荻随访12～36个月,平均25个月,末次随访时,8例患者均未见感染复发.结论　人工髋关节置换术后感染的治疗方法以二期翻修较为理想.保留假体清创治疗应严格掌握适应证.     

一期双侧全髋关节置换术疗效分析

目的 探讨一期双侧全髋关节置换术临床疗效的影响因素.方法 回顾性分析1998年2月至2008年3月行一期双侧全髋关节置换术36例患者的临床资料.均采用Smith-Peterson切口.结果 本组平均手术时间(3.2±1.2)h,术中平均输血(620±120)ml.术后36例患者均获随访,平均随访时间(22.0±6.0)个月.其中1例下肢深静脉栓塞,1例肢体不等长达1.5 cm,其余患者术后均无感染、肺栓塞、假体脱位、松动、下沉等并发症.术后髋关节Harris评分(88.0±3.6)分,较术前髋关节Harris评分的(28.0±4.2)分明显提高,差异有统计学意义(P<0.05).结论 一期双侧全髋关节置换术疗效满意.严格病例选择、充分术前准备、重视手术操作、防治术后并发症及积极的术后康复是取得良好疗效的关键.     

Investigation and Control of Anthrax Outbreak at the Human–Animal Interface,Bhutan, 2010

In 2010, we investigated anthrax outbreak in Bhutan. A total of 43 domestic animals died, and cutaneous anthrax developed in 9 persons, and 1 died. All affected persons had contact with the carcasses of infected animals. Comprehensive preparedness and response guidelines are needed to increase public awareness of anthrax in Bhutan.     

Dengue Virus Transmission by Blood Stem Cell Donor after Travel to Sri Lanka; Germany, 2013

Three days after donation of peripheral blood stem cells to a recipient with acute myeloblastic leukemia, dengue virus was detected in the donor, who had recently traveled to Sri Lanka. Transmission to the recipient, who died 9 days after transplant, was confirmed.     

Risk for Travel-associated Legionnaires’ Disease,Europe, 2009

Legionnaires’ disease is underreported in Europe; notification rates differ substantially among countries. Approximately 20% of reported cases are travel-associated. To assess the risk for travel-associated Legionnaires’ disease (TALD) associated with travel patterns in European countries, we retrieved TALD surveillance data for 2009 from the European Surveillance System, and tourism denominator data from the Statistical Office of the European Union. Risk (number cases reported/number nights spent) was calculated by travel country. In 2009, the network reported 607 cases among European travelers, possibly associated with 825 accommodation sites in European Union countries. The overall risk associated with travel abroad was 0.3 cases/million nights. We observed an increasing trend in risk from northwestern to southeastern Europe; Greece had the highest risk (1.7). Our findings underscore the need for countries with high TALD risks to improve prevention and control of legionellosis; and for countries with high TALD risks, but low notification rates of Legionnaires’ disease to improve diagnostics and reporting.     

Travel-associated Diseases,Indian Ocean Islands, 1997–2010

Data collected by the GeoSentinel Surveillance Network for 1,415 ill travelers returning from Indian Ocean islands during 1997–2010 were analyzed. Malaria (from Comoros and Madagascar), acute nonparasitic diarrhea, and parasitoses were the most frequently diagnosed infectious diseases. An increase in arboviral diseases reflected the 2005 outbreak of chikungunya fever.     

Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance,Epidemiology, and End Results Database

BackgroundActual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported.ObjectiveThis study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC.MethodsWe performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan–Meier analysis, and multivariate Cox proportional hazards model for the analyses.ResultsWe included 8050 patients in this study, including 6929 (86.1%), 743 (9.2%), 237 (2.9%), and 141 (1.8%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3%), followed by other cancers (8.1%), other causes of death (7.3%), cardiac-related death (3.2%), and nonmalignant pulmonary disease (3.2%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer–specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors.ConclusionsOvarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize the surveillance program for long-term ovarian cancer survivors.     

Dihydropteroate synthase gene mutations in Pneumocystis and sulfa resistance

Pneumocystis pneumonia (PCP) remains a major cause of illness and death in HIV-infected persons. Sulfa drugs, trimethoprim-sulfamethoxazole (TMP-SMX) and dapsone are mainstays of PCP treatment and prophylaxis. While prophylaxis has reduced the incidence of PCP, its use has raised concerns about development of resistant organisms. The inability to culture human Pneumocystis, Pneumocystis jirovecii, in a standardized culture system prevents routine susceptibility testing and detection of drug resistance. In other microorganisms, sulfa drug resistance has resulted from specific point mutations in the dihydropteroate synthase (DHPS) gene. Similar mutations have been observed in P. jirovecii. Studies have consistently demonstrated a significant association between the use of sulfa drugs for PCP prophylaxis and DHPS gene mutations. Whether these mutations confer resistance to TMP-SMX or dapsone plus trimethoprim for PCP treatment remains unclear. We review studies of DHPS mutations in P. jirovecii and summarize the evidence for resistance to sulfamethoxazole and dapsone.     

PCR versus hybridization for detecting virulence genes of enterohemorrhagic Escherichia coli

We compared PCR amplification of 9 enterohemorrhagic Escherichia coli virulence factors among 40 isolates (21 O/H antigenicity classes) with DNA hybridization. Both methods showed 100% of the chromosomal and phage genes: eae, stx, and stx2. PCR did not detect 4%-20% of hybridizable plasmid genes: hlyA, katP, espP, toxB, open reading frame (ORF) 1, and ORF2.     

Raccoons and skunks as sentinels for enzootic tularemia

We analyzed sera from diverse mammals of Martha's Vineyard, Massachusetts, for evidence of Francisella tularensis exposure. Skunks and raccoons were frequently seroreactive, whereas white-footed mice, cottontail rabbits, deer, rats, and dogs were not. Tularemia surveillance may be facilitated by focusing on skunks and raccoons.     

Outbreak of Panton-Valentine Leukocidin–Associated Methicillin-Susceptible Staphylococcus aureus Infection in a Rugby Team,France, 2010–2011

Staphylococcus aureus strains that produce Panton-Valentine leukocidin are known to cause community infections. We describe an outbreak of skin abscesses caused by Panton-Valentine leukocidin–producing methicillin-susceptible S. aureus (clonal complex 121) in a professional rugby team in France during July 2010–February 2011. Eight team members were carriers; 7 had skin abscesses.