Surgical Treatment of Chronic Periprosthetic Joint Infection: Fate of Spacer Exchanges

BackgroundPatients with periprosthetic joint infection (PJI) undergoing 2-stage exchange arthroplasty may undergo an interim spacer exchange for a variety of reasons including mechanical failure of spacer or persistence of infection. The objective of this study is to understand the risk factors and outcomes of patients who undergo spacer exchange during the course of a planned 2-stage exchange arthroplasty.MethodsOur institutional database was used to identify 533 patients who underwent a 2-stage exchange arthroplasty for PJI, including 90 patients with a spacer exchange, from 2000 to 2017. A retrospective review was performed to extract relevant clinical information. Treatment outcomes included (1) progression to reimplantation and (2) treatment success as defined by a Delphi-based criterion. Both univariate and multivariate Cox regression models were performed to investigate whether spacer exchange was associated with failure. Additionally, a propensity score analysis was performed based on a 1:2 match.ResultsA spacer exchange was required in 16.9%. Patients who underwent spacer exchanges had a higher body mass index (P < .001), rheumatoid arthritis (P = .018), and were more likely to have PJI caused by resistant (0.048) and polymicrobial organisms (P = .007). Patients undergoing a spacer exchange demonstrated lower survivorship and an increased risk of failure in the multivariate and propensity score matched analysis compared to patients who did not require a spacer exchange.DiscussionDespite an additional load of local antibiotics and repeat debridement, patients who underwent a spacer exchange demonstrated poor outcomes, including failure to undergo reimplantation and twice the failure rate. The findings of this study may need to be borne in mind when managing patients who require spacer exchange.     

经皮辅助关节囊入路微创人工全髋关节置换术

目的分析经皮辅助关节囊(SuperPATH)入路微创人工全髋关节置换术的短期随访结果和可行性。 方法纳入自2014年12月至2015年7月在上海市第六人民医院骨科关节外科,诊断为髋关节骨关节炎、无菌性股骨头坏死或轻度先天性髋关节发育不良的采用SuperPATH微创技术行初次人工全髋关节置换术病例,排除有髋关节感染史,创伤性髋关节炎史和结核性髋关节炎的病例,共纳入14例(14髋),男6例,女8例,年龄62～81岁,平均(74±6)岁。记录本组病例手术时间、术中出血量、切口长度、住院天数、术后并发症、影像学评价,并采用单因素重复测量方差分析比较患髋疼痛改善、功能康复情况。 结果14例病例均获得随访,平均随访时间(16±3)个月,手术时间、术中出血量、切口长度、住院天数分别为(101±25)min,(450±230)ml,(8.9±1.4)cm,(7.2±0.8)d。术后首次直腿抬高时间为(31±7)h;术后1、3月患侧单腿站立试验阴性率42.8%(6/14)、100%(14/14);疼痛视觉模拟评分(VAS)评分术前、术后第1、3、5天、1月、3月分别平均为(8.0±1.3)、(4.3±1.1)、(2.5±0.9)、(2.0±0.8)、(1.6±0.8)、(1.1±0.6)(F＝62.8,P<0.01);术前、术后1月、术后3月、末次随访髋关节Harris评分分别平均为(43.4±5)、(80.3±8.9)、(91.6±6.7)、(93.3±5.3)(F＝432.4,P<0.01);术前、术后第3、5天、1月3月和末次随访Berg评分分别平均为(29.7±6.7)、(13.8±3.7)、(18.2±6.0)、(39.6±4.3)、(49.0±6.1)、(54.5±2.7)(F＝152.6,P<0.01);术前、术后第3、5天、1月3月和末次随访Barthel指数分别平均为(57.9±8.4)、(32.1±8.5)、(48.9±10.6)、(81.5±5.9)、(94.2±6.5)、(97.5±5.2)(F＝217,P<0.01)。术后影像学检查,双下肢长度差值、双侧股骨偏心距差值、髋臼外展角和前倾角分别平均为(4.6±3.1)mm、(3.2±2.2)mm、(36.0±4.9)°、(17.4±7.5)°,术后未发生假体周围骨折,感染、深静脉血栓、肺栓塞及血管神经损伤并发症。 结论Super-PATH全髋关节置换术切口小,创伤小,不切断髋关节周围肌肉,且不影响假体植入,改善术后疼痛及加快功能康复,是一个安全可行的微创全髋关节置换手术技术。     

人工关节置换术后假体周围感染的临床分类

假体周围感染(PJI)是关节外科领域临床处理上最为棘手的问题之一。PJI的发生可以出现在关节置换术后任何时期,并且有着复杂多样的临床表现。同时PJI的病情迁延难愈,严重时可以导致截肢甚至危及生命。在针对PJI的治疗中,合理的临床分类能够帮助医生迅速判断病情,搭建对病情综合性评估的框架,进而做出合理化治疗方案选择。目前国际上关于PJI的临床分类还没有足够清晰的划分。毫无疑问,明确的临床分期和分型会对PJI的治疗有重大的意义。本综述旨在总结文献中PJI的不同临床分类角度,常见的临床分类,探讨其合理性,并进一步归纳其与治疗的关系,为PJI的临床分类及治疗策略选择提供参考。     

Function recovery after chemobleaching (FRAC): evidence for activity silent membrane receptors on cell surface

Membrane proteins represent approximately 30% of the proteome of both prokaryotes and eukaryotes. Unique to cell surface receptors is their biogenesis pathway, which involves vesicular trafficking from the endoplasmic reticulum through the Golgi apparatus and to the cell surface. Increasing evidence suggests specific regulation of biogenesis for different membrane receptors, hence affecting their surface expression. We report the development of a pulse-chase assay to monitor function recovery after chemobleaching (FRAC) to probe the transit time of the Kir2.1 K+ channel to reach the cell surface. Our results reveal that the channel activity is contributed by a small fraction of channel protein, providing evidence of activity-silent "sleeping" molecules on the cell surface. This method distinguishes molecular density from functional density, and the assay strategy is generally applicable to other membrane receptors. The ability of the reported method to access the biogenesis pathways in a high-throughput manner facilitates the identification and evaluation of molecules affecting receptor trafficking.     

普通感冒不同证候医师报告结局的指标构成及权重的研究

目的：探索研究普通感冒中医医师报告结局的指标构成及权重。方法：在德尔菲法专家调查的第二轮问卷调查中结合层次分析法,筛选普通感冒不同证候的疗效观察指标并计算其权重。结果：初步总结出普通感冒风寒证、风热证、外寒内热证和暑湿证常见证候的疗效评价指标及其权重。结论：本研究应用层次分析法对普通感冒疗效评价指标及其权重的确定做了有益的探索,将专家的经验判断给予量化,为普通感冒证候医师报告结局量表的制定奠定了基础。     

Combinatorial augmentation of voltage-gated KCNQ potassium channels by chemical openers

Noninactivating potassium current formed by KCNQ2 (Kv7.2) and KCNQ3 (Kv7.3) subunits resembles neuronal M-currents which are activated by voltage and play a critical role in controlling membrane excitability. Activation of voltage-gated potassium channels by a chemical opener is uncommon. Therefore, the mechanisms of action are worthy further investigation. Retigabine and zinc pyrithione are two activators for KCNQ channels but their molecular interactions with KCNQ channel remain largely elusive. Here we report that retigabine and zinc pyrithione recognize two different sites of KCNQ2 channels. Their agonistic actions are noncompetitive and allow for simultaneous binding of two different activators on the same channel complex, hence giving rise to combinatorial potentiation with characteristic properties of both openers. Examining their effects on mutant channels, we showed zinc pyrithione is capable of opening nonconductive channels and coapplication of zinc pyrithione and retigabine could restore a disease mutant channel similar to wild type. Our results indicate two independent activator binding sites present in KCNQ channels. The resultant combinatorial potentiation by multiple synthetic chemical openers indicates that KCNQ channels are accessible to various types and combinations of pharmacological regulation.     

我院骨科围手术期抗生素的预防应用分析

目的：探讨我院骨科围手术期抗生素的预防应用情况。方法：回顾性分析2007年1月至2009年1月间在我院骨科住院治疗的1024例患者的抗生素预防性应用情况。结果：头孢菌素类应用例次最多,占抗生素应用例次的70.84%;其次为喹诺酮类,占15.69%;依次为β-内酰胺类、林可霉素类、大环内酯类、青霉素类、氨基甙类、糖肽类。术前0.5-2h用药者占74.71%,术前2-24h用药者占21.88%,术前〉24h用药者占3.42%。持续时间术后〈3d者占5.66%,术后〈7d者占63.48%,术后〉7d者占30.85%。Ⅰ类切口用药最多,占71.48%,Ⅲ类切口用药最少,占10.55%。一联用药者占75.49%,二联用药者占15.23%,三联用药者占9.28%。结论：我院骨科抗生素的预防应用情况基本合理,针对部分不合理问题医院应强化监管,使抗生素的预防使用进一步规范化。     

创伤后多脏器功能衰竭患者细胞粘附分子和补体激活成分水平的变化及意义

目的：探讨创伤后多器官功能衰竭（ＭＯＦ）患者血浆粘附分子和补体活化成分水平的变化及意义。方法：采用酶联免疫吸附法（ＥＬＩＳＡ）检测３６例创伤后ＭＯＦ患者及３１例创伤患者和３５例健康人外周血白细胞ＣＤ１８的变化、血浆可溶性细胞间粘附分子－１（ｓＩＣＡＭ－１）,可溶性血管细胞间粘附分子－１（ｓＶＣＡＭ－１）和血浆补体活化片段（ｓＣ５ｂ－９）浓度的变化。结果：ＭＯＦ患者白细胞ＣＤ１８的表达、ｓＩＣＡＭ－     

中药免煎配方颗粒对儿童服药率影响的研究

目的：观察中药免煎配方颗粒对儿童服药率的影响。方法：选择儿科常见病患儿104 例为研究对 象，按随机数字表法分为汤剂组与配方颗粒组各52 例。汤剂组给予传统中药汤剂治疗，配方颗粒组给予中药 免煎配方颗粒治疗。观察2 组患儿服药率及药物销售金额。结果：配方颗粒组服药率为63.46%，优于汤剂组 40.38%，2 组比较，差异有统计学意义（P＜0.05）。配方颗粒组各个时间段的药物销售金额均高于汤剂 组（P＜0.05），且随时间推移呈上升趋势（P＜0.05）；汤剂组各时间段药物销售金额比较，差异无统计学意 义（P＞0.05）。结论：采用中药免煎配方颗粒有利于提高儿科患者服药率，并能提高药物销售金额，且销售金 额呈上升趋势状态。