专用锁定解剖钢板技术治疗股骨转子间骨折的临床研究

目的总结应用改进设计的锁定钢板治疗股骨转子间粉碎性骨折技术要点及注意事项,探讨治疗股骨转子间骨折的有效方法。方法将2000年1月至2010年12月应用本研究设计锁定加压钢板系统治疗的60例股骨转子间骨折患者作为治疗组,与采用DHS、GAMMA钉治疗的60例为对照组进行对比研究,全部病例经过6个月以上随访,平均6.8个月。结果治疗组与对照组比较,手术时间、骨折骨性愈合率、有效率无显著性差异（P〉0.05）,但固定失败率、可靠性、住院时间、手术出血量、卧床时间、并发症发生率明显低于对照组,有显著性差异（P〈0.05）。结论专用锁定钢板固定技术治疗股骨转子间骨折具有固定可靠、抗旋转、抗塌陷的优势,是治疗股骨转子间粉碎性骨折的有效方法。     

消毒供应室骨科外来器械植入物质量监控实践探讨

规范骨科外来器械及植入型器械的管理,确保各种器械清洗、消毒、灭菌的质量合格,为患者提供健康和安全的保证。     

微信平台教学在骨外科护理带教中的应用

目的 探讨微信平台教学在骨外科护理带教中的应用效果。方法 选取2017年6月~2018 年5月在我院骨科实习的护理学生48人,随机分成观察组和对照组,每组24人。对照组采用传统带教模式,观察组在对照组的基础上利用微信平台辅助护理教学。对比两组实习不良事件发生率,以及实习4周后出科的理论基础和操作技能成绩。结果 观察组的实习护士不良事件发生率低于对照组（4.17% vs 33.33%）,差异有统计学意义（P＜0.05）。观察组的理论基础成绩高于对照组[（94.33±1.58）分vs（91.71±1.88）分],操作技能成绩高于对照组[（93.75±1.11）分 vs（91.21±1.61）分],差异具有统计学意义（P＜0.05）。结论 用微信平台辅助骨外科护理带教,能够提高骨外科护理教学质量并减少不良事件的发生率。     

Do Antibiotic Intramedullary Dowels Assist in Eradicating Infection in Two-Stage Resection for Septic Total Knee Arthroplasty?

BackgroundEvidence suggests approximately 40% of intramedullary (IM) canals are culture positive at resection for infected knee arthroplasty. While commonly utilized, no clinical data on the efficacy of antibiotic-eluding IM dowels exist. We quantified treatment success with and without the use of antibiotic-eluding IM dowels in two-stage treatment of periprosthetic knee infection using static and articulating antibiotic cement spacers.Methods109 consecutive patients who underwent two-stage treatment for periprosthetic knee infection were reviewed. Treatment failure, defined as repeat resection before reimplantation or recurrent infection within 6 months of reimplantation, was evaluated based on spacer type and use of IM dowels, accounting for infection type and systemic host and local extremity grade.ResultsAfter exclusions for confounds, articulating spacers without IM dowels were used in 49 (57.7%) cases, articulating spacers with IM dowels in 14 cases (16.5%), and static spacers with IM dowels in 22 (25.9%) cases. Treatment success regardless of infection classification was 85.7% for articulating spacers with IM dowels, 89.8% for articulating spacers without IM dowels, and 68.2% for static spacers with IM dowels (P = .074). In chronically infected poor hosts with compromised extremities, treatment success remained highest in patients with articulating spacers with (90.9%) or without (92.9%) IM dowels compared with static spacers with IM dowels (68.4%) (P = .061).ConclusionFindings suggest that the use of IM dowels did not enhance infection eradication above and beyond that observed for articulating spacers alone, including in the worst cases involving chronically infected poor hosts with compromised extremities.     

Asynchronous Bilateral Total Knee Arthroplasty: Predictors of the Functional Outcome and Patient Satisfaction for the Second Knee Replacement

BackgroundThe primary aim of this study is to identify independent preoperative predictors of outcome and patient satisfaction for the second total knee arthroplasty (TKA).MethodsA retrospective cohort of 454 patients undergoing an asynchronous (6 weeks or more apart) bilateral primary TKA were identified from an arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-12 scores were collected preoperatively and 1 year postoperatively. Overall patient satisfaction was assessed at 1 year.ResultsThe 1 year WOMAC pain score (P = .01), and improvement in WOMAC pain (P < .001) and functional (P = .002) scores were significantly lower for the second TKA. Worse preoperative WOMAC pain, function, and stiffness scores were demonstrated to be independent predictors of improvement in the WOMAC pain, function, and stiffness scores, respectively, for both the first and second TKA. The overall rate of satisfaction with the first TKA was 94.0% and 94.7% for the second TKA (P = .67). The rate of satisfaction for the second TKA was 77.8% for patients that were dissatisfied with their first TKA, which was an independent predictor of dissatisfaction (P = .02).ConclusionImprovement in pain and function is less with the second TKA, but the satisfaction rate remains similar. There are common independent predictors for change in the WOMAC score for the first and second TKA; however, the predictors of satisfaction were different with no common factors. Patients that were dissatisfied with their first TKA were more likely to be dissatisfied with their second TKA.Level of Evidence IIPrognostic retrospective cohort study.     

The role of ADAMTS genes in the end stage of hip osteoarthritis

PurposeThe aim of this study is to investigate which ADAMTS genes play a major role in the development of primary hip osteoarthritis, by comparing the tissue and blood samples in patients with hip osteoarthritis and a control group.Material and methodsHuman articular cartilage was obtained from femoral heads of 15 patients with end stage osteoarthritis undergoing total hip replacement. As the control group, the cartilages was obtained from femoral heads of 15 patients, who did not have osteoarthritis or degenerative changes in hip joint, undergoing hip replacement following the fracture of the femoral neck. After the cartilage samples were taken from the resection materials, the DNA polymorphisms in the patients' cartilage samples were tested by Polymerase Chain Reaction (PCR), the serum levels of aggrecanase genes were analyzed with Enzyme-Linked ImmunoSorbent Assay (ELISA).ResultsThe level of ADAMTS5 and ADAMTS9 genes were found significantly lower as a result of ELISA analysis degenerative arthritis group than the control group (p < 0,05). ADAMTS 1, 4, 8, 15 were similar between the two groups in ELISA analysis (p > 0,05). As a result of quantitative real time RT-PCR analysis, the level of ADAMTS8 mRNA increased 3.5 fold in hip degenerative arthritis group when compared with femoral neck fractures group. ADAMTS1, ADAMTS4 and ADAMTS5 expression levels in hip degenerative arthritis group were decreased 2.5, 2 and 2.5 fold, respectively. ADAMTS9, 15 were found to be similar between two groups.ConclusonAs a result of this study on hip osteoarthritis, the ADAMTS8 levels was found to be significantly higher in the end stage of hip osteoarthritis. Unlike similar studies on knee osteoarthritis, ADAMTS1,4,5 levels were found to be lower.     

利奈唑胺治疗骨科术后革兰阳性球菌感染者的临床分析

目的分析利奈唑胺治疗骨科术后革兰阳性球菌感染者的临床疗效及安全性。 方法回顾性分析两家医院于2010年1月至2014年6月使用利奈唑胺治疗的骨科术后革兰阳性球菌感染的23例患者的临床资料。 结果23例患者均检出革兰阳性球菌,其中腰椎手术后感染11例,7例为四肢管状骨骨折内固定术后感染,5例为髋关节术后假体周围感染,使用利奈唑胺后总有效率为95.7%,起效时间为3～10 d,其中14例直接使用利奈唑胺治疗,用药后有效13例（92.9%）,9例为万古霉素无效或不能耐受后改用利奈唑胺治疗,用药后有效7例（77.8%）,共5例出现不良反应,2例腹泻,2例皮疹,1例白细胞及血小板减少,全部患者均能够耐受,停药后症状消失。 结论利奈唑胺治疗骨科术后革兰阳性球菌感染安全有效,可应用于骨科术后抗革兰阳性球菌感染治疗或万古霉素治疗无效者。     

持续质量改进对骨科住院患者医院感染的防控效果

目的探究持续质量改进对骨科住院患者医院感染的防控效果。 方法选取骨科2014年5月至11月收治的150例手术治疗患者作为对照组,采用常规护理方法;选取骨科2014年12月至2015年5月收治的150例手术治疗患者作为试验组,在对照组基础上采用持续质量改进护理模式,住院1个月后比较两组患者的感染率、患者满意度、环境卫生学监测合格率。对医院感染各检查项目进行评价,比较两组患者的医院感染评价总得分。 结果对照组患者感染率为5.33%,试验组患者感染率为2.00%,差异具有统计学意义（χ²= 6.208、P = 0.024）;患者满意度调查发现,对照组有19例不满意,33例满意,98例非常满意,满意度为87.33%,而试验组中6例不满意,27例满意,117例非常满意,满意度为96.00%,试验组患者满意度显著优于对照组,差异具有统计学意义（χ²= 6.454、P = 0.011）;对照组患者病房环境卫生学监测合格率为80.67%,试验组患者病房环境卫生学监测合格率为99.33%,差异具有统计学意义（χ²= 6.215、P = 0.021）;试验组医院感染评价总得分显著高于对照组,差异具有统计学意义（χ²= 6.194、P = 0.027）。 结论持续质量改进是控制骨科患者医院感染率的有效管理方法。