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Zhonghua Wai Ke Za Zhi ; 57(5): 348-352, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31091589


Objective: To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection. Methods: A retrospective analysis of 11 patients(4 hips, 7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years (range:47-77 years). Each patient underwent single-stage revision including aggressive soft-tissue debridement. Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis. Removed the infected components and cement thoroughly, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics. The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that, a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation. Recurrence of infection and clinical outcomes were evaluated. The follow-up period was 5 years (range: 2-12 years). Results: One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79, the difference was statistically significant (t=-11.356, P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25±5.61 to final follow-up 80.50±5.06, and the difference was statistically significant (t=-9.930, P=0.002). Conclusion: Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.

Antifúngicos/administração & dosagem , Artroplastia de Substituição/efeitos adversos , Micoses/tratamento farmacológico , Infecções Relacionadas à Prótese/tratamento farmacológico , Idoso , Antibacterianos/administração & dosagem , Doença Crônica , Terapia Combinada , Feminino , Gentamicinas/administração & dosagem , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Vancomicina/administração & dosagem
Zhonghua Wai Ke Za Zhi ; 56(11): 854-859, 2018 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-30392307


Objective: To observe the outcomes of total hip arthroplasty in patients with stiff hip and moderate or severe leg length discrepancy and to explore the strategy for balance recovery. Methods: A retrospective review was conducted on the clinical data of 30 patients who had stiff hip and moderate or severe leg length discrepancy treated with unilateral primary total hip arthroplasty at Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2017.There were 18 male and 12 female patients aging of (43.5±9.7)years (range, 30-68 years). All patients had different degrees of pelvic tilt and scoliosis. In operation, contractured soft tissues were released, periarticular osteophytes were removed thoroughly and the center of ratation was restablished without femoral shortening osteotomy.Patient satisfaction, Harris hip score, perceived leg length discrepancy (LLD), true LLD and functional LLD were collected.Data were analyzed by paired-samples t-test. Results: The mean follow-up duration was (17.6±7.6)months (range, 12-30 months). The Harris hip score was improved from 37.6±5.7 preoperatively to 84.3±5.2 at last follow-up (t=-57.54, P=0.000). The preoperative and last follow-up data of true LLD((3.19±0.82)cm vs.(0.70±0.71)cm), functional LLD((4.36±1.72)cm vs.(0.46±0.53)cm) and perceived LLD((7.74±2.01)cm vs.(0.98±0.79)cm) was significantly difference(t=26.47, t=15.05, t=26.9, P<0.01). Twenty-seven patients were restored to normal level (LLD≤10 mm ) and there was no sciatic nerve injury observed after surgery. 90.0% (27/30) patients were satisfied by the outcome. Conclusions: Total hip arthroplasty have satisfactory effect in correcting leg-length discrepancy of stiff hip patients. Preoperative assessment, individualized surgical methods and soft tissue releasing are important for balance recovery of affected limbs.

Artroplastia de Quadril , Desigualdade de Membros Inferiores , Adulto , Feminino , Fêmur , Humanos , Artropatias , Desigualdade de Membros Inferiores/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
Zhonghua Wai Ke Za Zhi ; 55(6): 416-422, 2017 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-28592073


Objective: To evaluate the influence of patellofemoral joint degeneration and pre-operative pain location on the outcome of medial Oxford unicompartmental knee arthroplasty (UKA). Methods: A total of 58 patients (58 knees) with medial Oxford UKA had been performed for medial osteoarthritis from March 2013 to July 2014 in Department of Orthopaedic Surgery at First Teaching Hospital of Xinjiang Medical University were retrospective reviewed. There were 24 males and 34 females, the age from 43 to 87 years with the mean age was 68.5 years. The mean body mass index was 25.2 kg/m(2) ranging from 19.7 to 31.5 kg/m(2). Patients were divided into anterior-medial pain group (35 knees), anterior knee pain group (17 knees) and general knee pain group (6 knees) according to pre-operative pain location. Pre-operative radiological statuses of the patellefemoral joint were defined by Ahlback system and divided into patellofemoral joint degeneration group (16 knees) and normal group (42 knees). Patients were also divided into medial patellofemoral degeneration group (20 knees), lateral patellofemoral degeneration group (12 knees) and normal group (26 knees) according to Altman scoring system. Outerbridge system was used intraoperatively and the patients were divided into patellofemoral joint degeneration group (21 knees) and normal group (37 knees). Pre- and post-operative outcomes were evaluated with Oxford Knee Score (OKS), Western Ontario and MacMaster (WOMAC) and patellofemoral score system of Lonner. T test and ANOVA were used to analyze the data. Results: The average duration of follow-up was 33 months (from 26 to 42 months). There were no patients had complications of infection, deep vein thrombosis, dislocation or loosing at the last follow-up. Compared to pre-operation, OKS (18.9±3.5 vs. 38.9±4.7, 19.3±4.2 vs. 39.6±4.6, 18.1±3.2 vs. 38.1±3.7)(t=5.64 to 7.08, all P<0.01) and WOMAC (10.9±2.3 vs.53.2±4.5, 10.4±2.1 vs.54.6±3.4, 11.7±1.8 vs.52.8±3.7)(t=14.50 to 19.16, all P<0.01) decreased, and the Lonner score (88.9±3.4 vs.38.6±2.8, 87.5±4.1 vs.38.2±2.3, 88.2±3.2 vs. 37.6±3.5)(t=-19.78 to -18.16, all P<0.01) increased significantly in anterior-medial pain group, anterior knee pain group and general knee pain group. According to Ahlback scoring system, compared to pre-operation, OKS (18.3±2.4 vs. 38.7±4.4, 19.6±1.8 vs. 38.4±3.1)(t=7.05, 9.08, both P<0.01) and WOMAC (10.6 ±2.6 vs.53.2±4.5, 12.1±1.4 vs.52.4±3.3)(t=14.21, 19.52, both P<0.01) decreased, the Lonner score (88.1±3.1 vs.38.3±3.3, 86.9±2.6 vs.39.1±2.4)(t=-18.90, -23.40, both P<0.01) increased significantly in patellofemoral joint degeneration group and normal group, the outcomes were the same according to Altman and Outerbridge scoring system. There was no significant difference between patellofemoral joint degeneration group and normal group based on Ahlback grading system. According to Altman classification, compared to normal group, there was no statistically differences in OKS, WOMAC and Lonner scoring system between patients with degeneration in the medial patellofemoral joint group, OKS and WOMAC increased (20.2±1.4 vs.18.2±2.7, 12.5±1.7 vs.10.5±2.5) (t=-4.30, P=0.03; t=-4.80, P=0.02), the Lonner score decreased (84.3±2.8 vs.87.4±3.2) (t=-6.20, P=0.01) in lateral patellofemoral degeneration group. According to Outerbridge scoring system, there were no statistically differences in patients in patellofemoral joint degeneration group and normal group. Conclusions: There is a good evidence that neither mild to moderate degree of patellofemoral joint degeneration nor pre-operative pain location will compromise the short-term outcome of medial Oxford UKA, and should not be considered as contraindications. The situation is less clear for lateral patellofemoral degeneration, and more cautious option is advised.

Artroplastia do Joelho , Articulação Patelofemoral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Luxações Articulares , Joelho , Articulação do Joelho , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
Int J Tuberc Lung Dis ; 17(12): 1638-44, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24200282


SETTING: Risk of pneumonia in chronic obstructive pulmonary disease (COPD) patients due to comorbid pulmonary disease is not well understood. OBJECTIVE: To compare factors associated with risk of community-acquired pneumonia (CAP) in COPD patients for those with and without lung cancer, bronchiectasis and/or history of active tuberculosis. DESIGN: Retrospective chart review of patients diagnosed with COPD (forced expiratory volume in 1 second/forced vital capacity < 0.70) between 2006 and 2010, including patient characteristics, occurrence of CAP and type of inhalation treatment. Pneumonia-free survivals were assessed using Kaplan-Meier curves. Factors associated with CAP were assessed using Cox's proportional hazard regression and expressed as adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). RESULTS: Of 2630 patients, 402 (15.3%) developed CAP during follow-up. The likelihood of CAP increased with increased age (aHR 1.03, 95%CI 1.02-1.04), lower body mass index (BMI; aHR 0.97, 95%CI 0.95-1.00), lung cancer (aHR 3.81, 95%CI 2.88-5.05), bronchiectasis (aHR 2.46, 95%CI 1.70-3.55) and inhaled corticosteroid (ICS) containing treatment (aHR 1.60, 95%CI 1.30-1.96). ICS-containing treatment was associated with increased risk of CAP only for patients without comorbid pulmonary disease (aHR 1.68, 95%CI 1.30-2.17). CONCLUSION: For COPD patients: 1) increased age, low BMI, lung cancer and bronchiectasis may increase the risk of CAP, and 2) without respiratory comorbid disease, ICS use increases the risk of CAP.

Bronquiectasia/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Neoplasias Pulmonares/epidemiologia , Pneumonia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Tuberculose Pulmonar/epidemiologia , Fatores Etários , Idoso , Índice de Massa Corporal , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatologia , Distribuição de Qui-Quadrado , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/fisiopatologia , Comorbidade , Intervalo Livre de Doença , Feminino , Volume Expiratório Forçado , Humanos , Estimativa de Kaplan-Meier , Pulmão/fisiopatologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pneumonia/diagnóstico , Pneumonia/fisiopatologia , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/fisiopatologia , Capacidade Vital
Lin Chuang Er Bi Yan Hou Ke Za Zhi ; 14(7): 322-3, 2000 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-12563887


OBJECTIVE: Research on examination and significance of the auditory brain stem response (ABR) in non-hearing loss tinnitus patients. METHOD: Recording from forehead-mastoid comparing ABR of non-hearing loss tinnitus patients with normal hearing youths. RESULT: In the tinnitus patients, the prolongate latency percentage of wave I was 51.6%; the wave III was 20.9%; wave V was 17.9%. CONCLUSION: Although hearing-loss was not founded in the patients, but the cochlea of some patients had been damaged.

Potenciais Evocados Auditivos do Tronco Encefálico , Zumbido/diagnóstico , Adolescente , Adulto , Doenças Cocleares/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Zhonghua Zhong Liu Za Zhi ; 9(6): 451-3, 1987 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-2454786


187 patients with subclinical hepatic cancer (SHC), collected by mass screening or follow-up of the hepatic diseases in our hospital from Dec. 1972 to Dec. 1984, are reported. The age ranged from 18 to 76 years with a median of 47. The sex ratio of male and female was 1.97:1. 143 (76.5%) patients had a positive pathology. The exploration rate was 60.4% and resection rate was 77.9%. Of them, there were 72 (81.8%) small liver cancers with lesions equal to or less than 5 cm in diameter. For patients with resection, the 1, 3 and 5 year survival rates were 77.3%, 39.3% and 34.6%, markedly higher than those treated by other means. B-ultrasonography gave a significantly higher positive rate (96.4%) in the localization of SHC, compared with nuclide imaging (17.6%). Basing on analysis of 187 patients with SHC, close follow-up of the subjects with low level persistent positive alpha-fetoprotein without active liver disease plays an important role in the early detection of SHC.

Carcinoma Hepatocelular/mortalidade , Neoplasias Hepáticas/mortalidade , Adolescente , Adulto , Idoso , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Ultrassonografia , alfa-Fetoproteínas/análise