大鼠烫伤创面感染模型的研制

Objective To reproduce a reliable rat model of burn with infection for the study of prevention and treatment of infected wound. Methods ( 1 ) Electrical burn producing apparatus equipped with constant temperature (80 ℃ ) and pressure (0.5 kg) was used to reproduce burn injury (with area of 4.5 cm2 ) on both sides of the back in 50 SD rats for different duration (4, 6, 8, 10, 12 s) , with 10 rats for each burn duration. On post burn day (PBD) 1, gross condition of wounds was observed with naked eyes.Wounds on the left side were used to observe healing time. The wounds on the right side were used for histological observation to determine the depth of injury, and they were classified into superficial and deep partialthickness injury. (2) Another 36 SD rats were divided into A (inflicted with superficial partial-thickness burn, n = 18) and B (inflicted with deep partial-thickness burn, n = 18) groups according to the random number table. Rats in both groups were treated in accordance with method of preliminary experiment. Immediately after burn, 0. 1 mL of liquid containing 1 × 109, 1 × 107, 1 × 105 CFU Pseudomonas aeruginosa (PA) ATCC 27853 was respectively inoculated to the wounds on one side (with 6 rats for each amount) ,while the wounds on the other side were treated with the same volume of normal saline as control. Inflammatory reaction of wounds was examined with HE staining on post inoculation day (PID) 1. On PID 1, 2, 3,5, 7, and 14, the number of subeschar bacteria was respectively counted and the bacteria were identified with Gram stain and biochemical reaction. Wound healing time was recorded. Data were processed with t test. Results (1) Burn for 6, 8 s was respectively identified as injury time resulting in superficial or deep partial-thickness injury according to histological observation and wound healing time. (2) Obvious inflammatory cell infiltration was observed in the wounds in B group which were inoculated with 1 × 107 , 1 ×109 CFU PA, and the infiltration was less marked in A group with inoculation of 1 × 109 CFU PA. (3) The bacteria isolated from wounds of A and B groups was identified as PA. The subeschar bacteria count within PID 14 in A group, in which different amount of PA was inoculated, was mostly less than 1 × 105 CFU/g of tissue, while that in B group in which 1 × 109 CFU PA was inoculated was more than 1 × 105 CFU/g of tissue. (4) There was no obvious difference in wound healing time between wounds inoculated with different amount of PA and wounds treated with normal saline in A group ( with t value respectively 1.26, 0. 29, 1.07,P values all above 0.05 ). Wound healing time of wounds in B group, in which 1 × 109 CFU PA was inoculated, was longer as compared with that treated with normal saline [(22.5 + 1.0) d vs. ( 19.4 + 1.6) d, t =2.73, P ＜0. 05]. Conclusions In rat, deep partial-thickness burn wound inoculated with 1 × 109 CFU PA ATCC 27853 is a reliable model with high reproducibility for the study of infection of burn wound.     

大鼠烫伤创面感染模型的研制

Objective To reproduce a reliable rat model of burn with infection for the study of prevention and treatment of infected wound. Methods ( 1 ) Electrical burn producing apparatus equipped with constant temperature (80 ℃ ) and pressure (0.5 kg) was used to reproduce burn injury (with area of 4.5 cm2 ) on both sides of the back in 50 SD rats for different duration (4, 6, 8, 10, 12 s) , with 10 rats for each burn duration. On post burn day (PBD) 1, gross condition of wounds was observed with naked eyes.Wounds on the left side were used to observe healing time. The wounds on the right side were used for histological observation to determine the depth of injury, and they were classified into superficial and deep partialthickness injury. (2) Another 36 SD rats were divided into A (inflicted with superficial partial-thickness burn, n = 18) and B (inflicted with deep partial-thickness burn, n = 18) groups according to the random number table. Rats in both groups were treated in accordance with method of preliminary experiment. Immediately after burn, 0. 1 mL of liquid containing 1 × 109, 1 × 107, 1 × 105 CFU Pseudomonas aeruginosa (PA) ATCC 27853 was respectively inoculated to the wounds on one side (with 6 rats for each amount) ,while the wounds on the other side were treated with the same volume of normal saline as control. Inflammatory reaction of wounds was examined with HE staining on post inoculation day (PID) 1. On PID 1, 2, 3,5, 7, and 14, the number of subeschar bacteria was respectively counted and the bacteria were identified with Gram stain and biochemical reaction. Wound healing time was recorded. Data were processed with t test. Results (1) Burn for 6, 8 s was respectively identified as injury time resulting in superficial or deep partial-thickness injury according to histological observation and wound healing time. (2) Obvious inflammatory cell infiltration was observed in the wounds in B group which were inoculated with 1 × 107 , 1 ×109 CFU PA, and the infiltration was less marked in A group with inoculation of 1 × 109 CFU PA. (3) The bacteria isolated from wounds of A and B groups was identified as PA. The subeschar bacteria count within PID 14 in A group, in which different amount of PA was inoculated, was mostly less than 1 × 105 CFU/g of tissue, while that in B group in which 1 × 109 CFU PA was inoculated was more than 1 × 105 CFU/g of tissue. (4) There was no obvious difference in wound healing time between wounds inoculated with different amount of PA and wounds treated with normal saline in A group ( with t value respectively 1.26, 0. 29, 1.07,P values all above 0.05 ). Wound healing time of wounds in B group, in which 1 × 109 CFU PA was inoculated, was longer as compared with that treated with normal saline [(22.5 + 1.0) d vs. ( 19.4 + 1.6) d, t =2.73, P ＜0. 05]. Conclusions In rat, deep partial-thickness burn wound inoculated with 1 × 109 CFU PA ATCC 27853 is a reliable model with high reproducibility for the study of infection of burn wound.     

全髋及全膝置换术后感染的治疗概论

To discuss the management of infections around total knee and hip arthroplasties.Methods and Results:We present the results of our management of 521 patients with infection around total hip arthroplasty and 262 with infected total knee arthroplasty between 1970 and 2001.131 of the hips and 94 of the knees were managed conservatively.Nine total knees and 11 total hips with infection were managed by soft tissue debridement and irrigation without removing the arthroplasty.Two of the knees and 3 of the hips were well cured of their infection while 5 from each group had a fair result.Seventeen patients had their knee arthroplasties exchanged in one stage.Nine were confirmed infected,4 were well cured.Fifty were revised in two stages of whom 37 were well cleared.Fort three had hip revision in one stage for infection,of whom 31 were well healed and 198 were revised in two stages with 128 well cured.Seventy-seven of the total knees were managed by arthrodesis.One hundred and froty-two patients were managed with an excision arthrophasty of the hip.Seventy one were cured at first attempt and another 18 after two attempts.Eight patients required limb ablation.Five of these above the knee and three through the hip .four patients died in this series(3 hip and 1 knee arthroplasty),Three had serious vascular complications(2 hip and 1 knee arthroplasty).Conclusion:Low grade musculo skeletal infection presents little or no threat to health,let alone life in the majority of cases,A single operation has some obvious advantages,The costs are halved and the period of hospitalisation or recumbency is halved for knees and reduced to one third for hips.The less ovious advantages of one stage exchanges of knees are the greatly reduced incidence of wound morbidity and in both hips and knees there is a lower incidence of thrombo-embolic disease-a potentially fatal complication.Naturally post-operative rehabilitation will be expedited.The most important advantage of a two stage programme is better chance of curing infection.It may take longer to rehabilitate after a two stage programme but at the end of the day there is little difference in the final level of pain and function between one and two stage exchanges of hips and knees.Among the advantages of a two stage propramme is the fact that one has not burnt one‘s bridges because if the operation fails to bring the infection under control one can either repeat the debridement or switch to arthrodesis in the case of a failed knee arthroplasty or leave the hip as an excision arthroplasty.     

A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis

Objective : To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees. Methods: A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996. Resnits: One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3 %, 93.6 % and 78.2 % two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure ). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications ( 12 /161 ), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees ) missed follow-up, among them 10 patients (11 knees) died. Conclusions: HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.