High-Pressure Water Swelling Sealant Injection Injury to the Hand: a Case Report and Review of the Literature

High-pressure injection injuries (HPII) caused by water swelling sealant are rare at present. The patient generally has small-sized skin lesions, and the misleadingly benign presentation may cause delayed treatment at the early stage of management. In addition, radiographic examination may be underestimated. Subsequently, the inadequate surgical intervention may cause tissue necrosis and poor prognosis. Furthermore, the early recognition of water swelling sealant injected into tissue and emergent surgical intervention are the key to successful management for the patient with HPII caused by injecting water swelling sealant to tissue.     

患椎间短椎弓根螺钉在单节段腰骶椎结核稳定性重建中的临床研究

目的证明后路患椎间短椎弓根螺钉固定治疗单节段腰骶椎结核的可行性,并探讨其适应证及疗效。方法 204例诊断明确、脊柱后凸畸形35°,符合纳入标准的单节段腰、骶椎结核患者,随机分为2组,均先进行后路矫形、内固定手术,同期或二期进行前路彻底病灶清除、椎体间自体髂骨支撑植骨融合术。其中短钉组104例,选用长20~35 mm的短椎弓根钉置于患椎椎弓根。如1个患椎剩余骨质1/3,而另1个患椎剩余骨质1/3,则行短钉、常规螺钉固定。长钉组:常规椎弓根螺钉置于患椎相邻的正常椎骨中,固定范围跨越患椎上、下各1个正常间隙。所有患者均采用四联化疗方案。结果 2组患者平均随访62.1个月。术后均无严重并发症发生,末次随访时,所有患者均治愈,无内固定松动及断裂现象。植骨平均愈合时间,短钉组4.3个月,长钉组4.6个月,Cobb角矫正度及丢失率2组分别为13.26°±3.76°,6.22%和16.35°±2.63°,5.24%,2组比较差异无统计学意义(P0.05),组内术前术后比较差异有统计学意义(P0.05)。血沉与C反应蛋白的术前术后差异无统计学意义。2组患者术后2年生活、工作基本恢复正常。短钉组患者术后功能恢复较长钉组好。结论腰、骶椎结核后路患椎间短椎弓根钉固定、前路病灶彻底清除术具有仅融合、固定病变节段,保留相邻正常的脊柱运动单元功能,术后脊柱功能恢复好等优点,具有很高的临床应用价值。     

The Parameters Affecting the Success of Irrigation and Debridement with Component Retention in the Treatment of Acutely Infected Total Knee Arthroplasty

BackgroundThe aims of our study were to evaluate the success rate of irrigation and debridement with component retention (IDCR) for acutely infected total knee arthroplasty (TKA) (< 4 weeks of symptom duration) and to analyze the factors affecting prognosis of IDCR.MethodsWe retrospectively reviewed 28 knees treated by IDCR for acutely infected TKA from 2003 to 2012. We evaluated the success rate of IDCR. All variables were compared between the success and failure groups. Multivariable logistic regression analysis was also used to examine the relative contribution of these parameters to the success of IDCR.ResultsSeventeen knees (60.7%) were successfully treated. Between the success and failure groups, there were significant differences in the time from primary TKA to IDCR (p = 0.021), the preoperative erythrocyte sedimentation rate (ESR; p = 0.021), microorganism (p = 0.006), and polyethylene liner exchange (p = 0.017). Multivariable logistic regression analysis of parameters affecting the success of IDCR demonstrated that preoperative ESR (odds ratio [OR], 1.02; p = 0.041), microorganism (OR, 12.4; p = 0.006), and polyethylene liner exchange (OR, 0.07; p = 0.021) were significant parameters.ConclusionsThe results show that 60.7% of the cases were successfully treated by IDCR for acutely infected TKA. The preoperative ESR, microorganism, and polyethylene liner exchange were factors that affected the success of IDCR in acutely infected TKA.     

PICU重症坏死性筋膜炎诊治分析

目的分析重症坏死性筋膜炎（necrotizing fasciitis,NF）临床特点及诊断治疗要点。方法回顾性分析安徽省儿童医院PICU2007年1月至2013年9月14例NF患儿临床体征、辅助检查、治疗及预后。结果14例患儿中,男8例,女6例,年龄（15．86±10．48）个月,住院天数（29．07±16．30）d,热程（10．64±5．64）d,清创次数（3．07±1．33）次;均有脓毒性休克,5例有多脏器功能衰竭。发病部位：臀部5例,下肢4例,背部2例,会阴部2例,颈部1例;血培养：6例金黄色葡萄球菌（1例耐甲氧西林金黄色葡萄球菌）,4例铜绿假单胞菌,3例培养未见明显细菌生长,1例咽峡炎群链球菌。CT均见皮肤及皮下组织水肿,筋膜增厚,11例见软组织气体影。组织活检均确诊为NF;病初表现不典型以局部组织红肿为主,随病情进展患处皮肤苍白伴血疱,后颜色逐渐发紫发黑,部分患儿有皮下握雪感,切开后见筋膜大片苍白坏死;均行切开引流（5例行封闭负压引流持续吸引）、彻底清创、有效抗生素治疗、胶体支持治疗;1期愈合7例（50．00％,7／14）,2期植皮4例（28．57％,4／14）,死亡3例（21．43％,3／14）;随访2年,6例患儿有局部肢体活动受限。结论NF病情危重,常见于会阴部、腹部及四肢,易导致脓毒性休克,多脏器功能衰竭,革兰阴性杆菌感染临床症状极危重,病死率高。NF需尽早确诊,强有力抗生素使用,积极广泛、彻底地外科清创,充分引流,加强支持对症处理可降低病死率。     

Is debridement really the best we can do for periprosthetic joint infections following total ankle replacements? A systematic review and meta-analysis

BackgroundAnkle periprosthetic joint infections are rising in number, but an evidence-based gold standard treatment has not been defined yet.MethodsWe made a systematic review about the operative treatment of infections following total ankle arthroplasty. Proportional meta-analysis was used to summarize effects of the surgical techniques included. Primary outcome of this study was infection eradication, followed by complications, re-interventions, amputation rates and functions.ResultsWe included six studies(113 patients) reporting 6 types of surgical interventions, mostly irrigation and debridement (35.4%) and two-stage revisions (24.8%). No differences among all analyzed techniques were found in the infection eradication outcome as well as in the secondary outcomes. Patients receiving a permanent spacer are most likely to end up with amputation.ConclusionsLiterature dealing with infections after total ankle replacement is currently composed by few low-quality articles. The overlapping of confidence intervals related to all analyzed interventions showed no superiority of either technique.Level of evidenceIII.     

A prospective,single-center study following operative treatment for osteochondral lesions of the talus

Background(1) To evaluate patient-reported outcomes and revision surgeries after various operative interventions for osteochondral lesions of the talus (OLT) in a prospective single center series over 10 years, and (2) to identify predicting factors related to subjective ankle status and quality of life pre- and postoperatively.MethodsNinety-nine patients underwent operative treatment due to primary or recurrent OLT, with an average follow up 3.5 (1.8) years. Treatment outcome was followed clinically (FAOS, EQ-5D, Tegner activity scale) and by pursuing any serious adverse events or graft failures.ResultsThere were 80 responding patients (81%) for the study. The mean lesion size was 2.0 (1.1) cm². All FAOS values increased from preoperative to final follow-up values (Symptoms 60–68, Pain 58–69, ADL 71–80, Sport 36–54, QoL 30–45). EQ-5D increased from 0.49 to 0.62, while Tegner activity scale change from 3.2 to 3.4. There were 19 (24%) serious adverse events recorded; 13 (16%) of them were graft-related. Graft survival rates were 100% at 1 year, 94% (males)/93% (females) at 2 years, and 77% (males)/47% (females) at 5 years. Female gender, higher BMI, and higher Kellgren-Lawrence ankle OA score were negative predictors for preoperative patient-reported ankle joint status. The foremost improvement after operative intervention was observed in patients with large osteochondral lesions without postoperative adverse events.ConclusionVarious operative interventions for OLT significantly improved patients’ ankle status and quality of life. High graft survival rates were demonstrated over first two years, but notable decline was confirmed thereafter, especially in female patients.     

关节镜清理联合透明质酸钠治疗膝骨关节炎的短期疗效

目的探究关节镜下清理术联合透明质酸钠腔内注射治疗早中期膝关节骨关节炎的短期临床效果及血清相关指标的变化。 方法回顾性分析广州中医药大学附属佛山市中医院骨科2017年7月至2019年5月收治的膝关节骨关节炎患者。共有108例纳入本研究,采用随机数字表法分为对照组(n＝54)和观察组(n＝54)。两组患者均接受关节镜下膝关节清理术,对照组术后给予安慰剂关节腔内注射,观察组术后给予透明质酸钠关节腔内注射,治疗时间4周,治疗后随访6个月。比较两组治疗前后的疼痛视觉模拟评分(VAS)、日常生活活动量表(ADL)及Lysholm膝关节评分、血清基质金属蛋白酶(MMP-1)、软骨寡聚基质蛋白(COMP)、白介素-1(IL-1)、一氧化氮(NO)和血沉(ESR)的水平,采用t检验比较两组之间的差异。记录两组并发症情况,采用卡方检验评估两组间差异。 结果治疗6个月后,两组ADL及Lysholm评分较治疗前显著升高,治疗后观察组高于对照组(t＝8.390、11.690,P<0.05)。治疗4周后,两组血清MMP-1、COMP、IL-1、NO、ESR水平和VAS评分较治疗前显著降低,治疗后观察组低于对照组(t＝26.284、4.293、5.023、10.508、5.351、8.701, P<0.05)。治疗4周后,观察组并发症发生率为5.56%,与对照组(16.67%)相比,差异无统计学意义(χ²＝2.352,P>0.05)。 结论关节镜下清理术联合透明质酸钠腔内注射治疗早中期膝关节骨关节炎,能在短期内缓解膝关节疼痛、促进关节功能恢复、减轻炎症反应、改善软骨代谢,但远期效果尚需进一步探索和验证。     

胆道镜经引流窦道清创技术治疗胰周脓肿

目的评价胆道镜经引流窦道清创治疗胰周脓肿的疗效。方法2008年1月～2011年12月,对81例开腹清创引流或超声引导穿刺引流未愈的胰周脓肿,胆道镜经引流窦道进入病灶内部,以活检钳和取石网钳取脓苔及坏死脱落组织,生理盐水灌洗脓腔,反复清创和持续引流,达到治愈。结果治愈76例,治愈率93．8％。4例因CT显示坏死区域靠近肠系膜血管或脾门部位改行开腹手术,1例因并发严重多器官功能衰竭死亡。76例治愈者接受胆道镜清创2—9次,平均5．1次,第一次镜下清创至治愈拔管时间25～132d,平均37d。胆道镜清创并发出血2例,肠漏1例,保守治愈。76例治愈患者随访3～38个月,其中〉12个月39例,无病灶残余。结论胆道镜完成对胰周脓肿病灶的清创,方法简单,临床效果可靠。     

前路病灶清除植骨内固定结合局部灌洗化疗治疗下颈椎结核伴巨大脓肿

目的:评价前路病灶清除植骨内固定结合术后异烟肼生理盐水持续灌洗局部化疗治疗下颈椎结核伴巨大脓肿的临床疗效.方法:2001年6月～2010年6月收治下颈椎结核伴巨大脓肿患者13例,男8例,女5例;年龄28～62岁,平均44岁.病变累及部位:C3～C4 2例,C4～C5 3例,C5～C6 4例,C5 2例,C6 2例;脓肿累及节段:C3～C6 5例,C3～C7 3例,C4～C7 4例,C4～T1 1例.患者均存在颈部疼痛和不同程度的吞咽及呼吸困难,术前颈部疼痛VAS评分7～10分(8.1±1.3分).10例出现神经功能障碍,JOA评分5～12分(8.3±1.7分).术前血沉78±12mm/h,C反应蛋白65±17mg/L.均在全身抗结核药物治疗下采用颈前路结核病灶清除、钛网填充自体髂骨植骨内固定,术后异烟肼生理盐水持续局部灌洗化疗,并继续全身抗结核治疗12～18个月.随访观察患者临床症状改善、脓肿清除和植骨融合情况.结果:手术均顺利完成,所有患者无术中及术后并发症,术后异烟肼生理盐水持续灌洗14～26d,平均18d.未出现窦道、瘘管和脑脊膜感染.随访24～72个月,平均42个月,血沉和C反应蛋白在术后3个月内均恢复正常,手术节段在3～7个月(平均5.8个月)均得到骨性融合.颈部疼痛VAS评分末次随访时为0～3分(1.5±0.7分),与术前比较有显著性差异(P＜0.05).末次随访时JOA评分为12～17分(14.6±1.5分),与术前比较有显著性差异(P＜0.05).末次随访复查MRI均未见结核复发.结论:在全身规范抗结核药物治疗的前提下,采用前路病灶清除植骨内固定结合术后持续局部灌洗化疗治疗下颈椎结核伴巨大脓肿安全有效,临床效果满意.     

急性坏死性筋膜炎诊治体会

目的 总结坏死性筋膜炎(necrotizing fasciitis,NF)的临床诊断和治疗经验. 方法 回顾性分析中国医科大学附属第一医院2006-2012年24例坏死性筋膜炎的临床资料,并总结诊治体会.结果 本组24例坏死性筋膜炎患者,其中男19例,女5例;年龄25 ～ 72岁,平均年龄(54±12)岁.发病部位:会阴部、臀部16例,左下肢3例,背部2例,右下肢2例,右下肢及左背部l例.治疗方法:24例均采取广泛切开引流、彻底清创及有效的抗生素治疗,其中输白蛋白13例,输血9例,应用肠外营养19例,接受高压氧治疗15例.24例中一期治愈17例(70.83％),二期植皮4例(16.67％),复发2例(8.33％),死亡1例(4.17％).结论 坏死性筋膜炎起病较急,进展迅速,必须尽早确诊,给予有效抗生素治疗的同时强调早期切开引流、彻底清创,并要加强临床护理及相关营养等支持疗法.