关节滑液检测在关节假体周围感染诊断中的研究进展

关节假体周围感染(periprosthetic joint infection,PJI)是人工关节置换术后可能发生的一种严重并发症,其导致的严重后果,无论对于医生还是患者来说,都很难接受。目前,由于多种不确定因素的存在,PJI诊断的准确性较低。传统的血清学检查、影像学检查有一定的价值,但是易受全身情况的影响,导致特异性不高。为了正确诊断关节假体周围感染,不同学科的研究人员采用各种不同的方法进行了大量的诊断研究,并取得了丰富的成果。近年来,关节滑液炎性标志物检测、分子生物学方法等被研究证实具有较高的敏感性和特异性。因此,关节滑液CRP、-防御素、白细胞酯酶、PCR技术等被广泛研究,期望能从中找到诊断关节假体周围感染的特异性指标,提高临床诊断的准确性。     

Management of Chronically Infected Total Knee Arthroplasty With Severe Bone Loss Using Static Spacers With Intramedullary Rods

BackgroundTwo-stage revision with static antibiotic spacers is the preferred treatment for chronically infected total knee arthroplasty (TKA) associated with severe bone loss. Intramedullary rods to reinforce static spacers have been described. On those, however, bacterial colonization may occur and hamper infection control. This study reports the microbiological findings on the spacer rods and the treatment outcome among these patients.MethodsWe reviewed 97 infected TKA with extensive bone loss treated with antibiotic-loaded cement spacers reinforced with intramedullary rods. Mean interim period with the spacer in situ was 9 weeks (range: 6-24 weeks). Intraoperative cultures and sonicated spacer rods were analyzed. Mean follow-up after TKA reimplantation was 41 months (range: 27-56 months). Treatment success was defined using the modified Delphi consensus criteria.ResultsTwenty-two patients (23%) had treatment failure, including 3 reinfections caused by the same organism, 9 reinfections caused by a different organism, 9 patients required interim spacer exchange, and 1 patient died in the early postoperative course. Sonication cultures of the spacer rods were positive in 2 cases (2%), and none of them failed. Host and limb status was significantly worse in patients who sustained reinfection. At the latest follow-up, all patients had a TKA in place, and 2 patients received chronic antibiotic suppression.ConclusionTwo-stage revision with the use of intramedullary rods is a safe and efficient treatment for chronically infected TKA with severe bone loss. Most reinfections grew different organisms compared with initial infection. Compromised hosts and extremities may be subjected to chronic antibiotic suppression.     

8种寄生虫病例分析

本文报道并分析8例寄生虫病例,其中包括脑裂头蚴病、眼部裂头蚴病、肺吸虫幼虫移行症、肺吸虫病、钩虫病、肝吸虫病、包虫病和广州管圆线虫病各1例。8例寄生虫病均有不同程度的误诊,其中6例在寄生虫抗体筛查检测阳性后得以确诊。因此,寄生虫病应引起临床医生的重视,抗体筛查有助于发现寄生虫病例。     

支气管镜灌注术联合抗生素治疗肺癌术后感染的疗效观察

目的探讨支气管镜灌注术(BP)联合抗生素治疗肺癌术后感染的效果及对血清肿瘤坏死因子α(TNF-α)、白细胞介素-8(IL-8)、超敏C反应蛋白(hs-CRP)和降钙素原(PCT)水平的影响。方法选取2017年5月至2018年9月间西安市北方医院收治的80例肺癌术后感染患者,采用随机数表法分为观察组和对照组,每组40例。对照组患者采用常规抗感染治疗,观察组患者在常规治疗基础上应用BP联合局部灌注抗生素治疗,比较两组患者临床疗效、呼吸力学指标、血清TNF-α、IL-8、hs-CRP、PCT及不良反应情况。结果观察组患者临床治疗总有效率为92.5%,高于对照组患者的75.0%,差异有统计学意义(P<0.05)。治疗前,两组患者的气道峰压(PIP)、动态顺应性(Cdyn)、呼吸做功(WOB)和气道阻力(Raw)指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者的PIP、WOB和Raw指标均下降,且观察组均低于对照组,两组患者Cdyn指标均上升,且观察组高于对照组,差异均有统计学意义(均P<0.05)。治疗前,两组患者TNF-α、IL-8、hs-CRP和PCT指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者TNF-α、IL-8、hs-CRP和PCT指标均下降,且观察组上述指标均低于对照组,差异均有统计学意义(均P<0.05)。治疗期间,对照组患者出现呛咳1例,低氧血症1例,发绀1例;观察组患者出现低氧血症1例,对症治疗后,两组患者症状均消失。两组患者不良反应情况比较,差异无统计学意义(P>0.05)。结论采用BP联合抗生素治疗肺癌术后感染患者疗效确切,可有效减轻炎症反应,提升呼吸功能。