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Combination of C-reactive protein and fibrinogen is useful for diagnosing periprosthetic joint infection in patients with inflammatory diseases

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Chinese Medical Journal 2022年第16期135卷 1986-1992页

作者： Hong Xu Jinwei Xie Xufeng Wan Li Liu Duan Wang zongke zhou Department of Orthopedic Surgery Orthopedic Research InstituteWest China HospitalSichuan UniversityChengduSichuan 610041China Department of Orthopedic Surgery West China School of NursingWest China HospitalSichuan UniversityChengduSichuan 610041China

Background:The screening of periprosthetic joint infection(PJI)in patients with inflammatory diseases before revision arthroplasty remains uncertain.Serum C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),plasma fbrinogen(FIB),monocyte/lymphocyte ratio,and neutrophil/lymphocyte ratio(NLR)can help screening PJI,but their values in patients with infammatory diseases have not been determined.Methods:Patients with inflammatory diseases who underwent revision hip or knee arthroplasty at West China Hospital,Sichuan University,from January 2008 to September 2020 were divided into infected and non-infected groups based on the 2013 International Consensus Meeting criteria.Sensitivity and specificity of the tested biomarkers for diagnosing infection were determined based on receiver operating characteristic(ROC)curves,and optimal cutoffs were determined based on the Y ouden index.The diagnostic ability of these biomarkers was re-assessed after combining them with each other.Results:A total of 62 patients with inflammatory diseases were studied;of them 30 were infected.The area under the ROC curve was 0.813 for CRP,0.638 for ESR,0.795 for FIB,and 0.656 for NLR.The optimal predictive cutoff of CRP was 14.04 mg/L with a sensitivity of 86.2%and a specificity of 68.7%,while FIB had a sensitivity of 72.4%and a specificity of 81.2%with the optimal predictive cutoff of 4.04 g/L.The combinations of CRP with FIB produced a sensitivity of 86.2%and specificity of 78.1%.Conclusion:CRP with a slightly higher predictive cutoff and FIB are useful for screening PJI in patients with inflammatory diseases,and the combination of CRP and FIB may further improve the diagnostic values.

关键词： Periprosthetic joint infection C-reactive protein Fibrinogen Diagnosis Revision arthroplasty

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A pre-operative high-protein diet can improve the serum albumin levels of patients undergoing total knee arthroplasty

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Chinese Medical Journal 2023年第4期136卷 491-493页

作者： Hong Xu Li Liu Jinwei Xie Duan Wang Zeyu Huang zongke zhou Department of Orthopaedic surgery West China HospitalSichuan UniversityChengduSichuan 610041China Department of Orthopaedic Surgery West China HospitalSichuan University/West China School of NursingSichuan UniversityChengduSichuan 610041China

To the Editor:Malnutrition is associated with an increased risk of complications after total knee arthroplasty(TKA),including persistent wound drainage,delay of wound healing,superficial surgical site and even deep periprosthetic joint infections,and intensive care unit admission.[1]Albumin(ALB)is the most abundant protein in human plasma and is considered a reliable and sensitive biomarker of nutritional status and malnutrition.Like malnutrition,low serum ALB levels are not only associated with various post-operative complications following TKA including pulmonary infection,renal impairment,superficial and deep infections,unplanned intubation,and even mortality;but also associated with increased treatment costs,longer length of stay and higher risk of readmission.[2]

关键词： superficial wound operative

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Long-term results of synovectomy in total knee arthroplasty:a prospective,randomized controlled trial

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Chinese Medical Journal 2023年第1期136卷 73-81页

作者： Weinan Zeng Zeping Yu Simeng Wang Anjing Chen Yiping Zeng Qingjun Yang Yujuan Li Qi Li zongke zhou Department of Orthopedics Orthopedic Research InstituteWest China HospitalSichuan UniversityChengduSichuan 610041China Department of Orthopedics Chongqing General HospitalUniversity of Chinese Academy of SciencesChongqing 400014China Department of Radiology West China HospitalSichuan UniversityChengduSichuan 610041China

Background:Synovectomy has been introduced into total knee arthroplasty(TKA)with the aim of relieving pain and inflammation of the synovium.However,there are no long-term,comparative data to evaluate the effect of synovectomy in TKA.This study was aimed at assessing pain,function,and complications in patients undergoing synovectomy during TKA for osteoarthritis(OA)at long-term follow-up.Methods:This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA.Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA.The overall efficacy of both strategies was evaluated by determination of blood loss,the Knee Society score(KSS),and knee inflammation conditions during a 3-month postoperative period.The postoperative pain,range of motion(ROM),and complications were sequentially evaluated to compare the two groups until 10 years after surgery.Results:At the 10-year follow-up,both groups had a similarly significantly improved ROM(114.88±9.84°vs.114.02±9.43°,t=0.221,P=0.815)and pain relief with no differences between the two groups(1.0[1.0]vs.1.0[1.5],U=789.500,P=0.613).Similar changes in total blood loss,KSS,and knee inflammation were found in both groups during 3 months postoperatively(P>0.05).Additionally,there was no significant difference regarding complications and satisfaction between the two groups(P>0.05).Conclusions:Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain,ROM,and satisfaction during a 10-year follow-up.In addition,it may not result in more blood loss and increased incidence of long-term complications.Based on our long-term findings,it should not be performed routinely.Trial registration:Chinese Clinical Trial Registry,ChiCTR-INR-16008245;https://***/showproj.aspx?proj=13334.

关键词： Randomized controlled trial Synovectomy Clinical outcomes Total knee arthroplasty

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Effects of tranexamic acid on vascular occlusive events and perioperative resuscitation in patients with atrial fibrillation undergoing total joint arthroplasty

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Chinese Medical Journal 2022年第19期135卷 2354-2356页

作者： Shangkun Tang zongke zhou Jing Yang Pengde Kang Bin Shen Fuxing Pei Xiaojun Shi Department of Orthopedics Orthopedic Research InstituteWest China HospitalSichuan UniversityChengduSichuan 610041China.

To the Editor:Tranexamic acid(TXA)has recently become popular for use in orthopedic surgeries owing to its efficacy in reducing blood loss,transfusion rates,and mortality without increasing the risk of deep venous thrombosis.ll Although the ideal dosage and route for TXA administration remain unclear,it has become one of the most important parts of the perioperative blood conservation strategy.However,it remains controversial to prescribe TXA to patients with cardiovascular diseases,because of prothrombotic and proconvulsant effects,which potentially increases cardiovascular risk.

关键词： patients dosage cardiovascular

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初次全膝关节置换中应用股四头肌V-Y成形术暴露强直或僵硬膝关节

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中华骨科杂志 2024年第9期44卷 587-593页

作者：刘霄阳陈绪明赵恩泽周宗科四川大学华西医院骨科成都610041

目的分析初次全膝关节置换(total knee arthroplasty,TKA)中应用股四头肌V-Y成形术暴露强直或僵硬膝关节的中长期疗效。方法回顾性分析2010年5月至2019年2月于四川大学华西医院因膝关节强直或僵直采用股四头肌V-Y成形术显露的TKA患者12... 详细信息

目的分析初次全膝关节置换(total knee arthroplasty,TKA)中应用股四头肌V-Y成形术暴露强直或僵硬膝关节的中长期疗效。方法回顾性分析2010年5月至2019年2月于四川大学华西医院因膝关节强直或僵直采用股四头肌V-Y成形术显露的TKA患者12例,男7例、女5例,年龄(53.9±14.9)岁(范围24~72岁),左侧6例、右侧6例。术前诊断:骨关节炎7例、类风湿关节炎2例、创伤性关节炎1例、血友病性关节炎2例。记录患者手术前后膝关节疼痛视觉模拟评分(visual analogue scale,VAS)、关节活动度、股四头肌肌力、美国膝关节协会评分(Knee Society score,KSS)及术后并发症。结果所有患者均顺利完成手术并获得随访,随访时间为(102.2±31.1)个月(范围51~141个月)。手术时间为(87.0±15.7)min(范围73~123 min),术中出血量为(823.6±237.7)ml(范围555~1471 ml),住院时间为(13.3±6.3)d(范围6~28 d)。所有患者术后VAS评分均降低,手术前后比较差异有统计学意义(F=132.000,P<0.001)。术后3个月和末次随访的VAS评分分别为(2.2±0.7)分和(1.2±0.4)分,小于术前的(5.2±0.7)分,差异有统计学意义(P<0.05)。所有患者术后KSS膝评分均升高,手术前后比较差异有统计学意义(F=40.960,P<0.001)。术后3个月和末次随访的KSS膝评分分别为(56.0±14.1)分和(74.3±16.1)分,大于术前的(26.1±7.8)分,差异有统计学意义(P<0.05)。所有患者术后KSS功能评分均升高,手术前后比较差异有统计学意义(F=24.332,P<0.001)。术后3个月和末次随访的KSS功能评分分别为(52.9±19.4)分和(79.2±19.6)分,大于术前的(27.1±15.6)分,差异有统计学意义(P<0.05)。所有患者术后膝关节活动度均升高,手术前后比较差异有统计学意义(F=24.145,P<0.001)。术后3个月和末次随访的膝关节活动度分别为57.5°±22.2°和70.0°±25.9°,大于术前的12.5°±14.1°,差异有统计学意义(P<0.05)。术前股四头肌肌力3级2例,4级10例;末次随访时4级1例,5级11例,肌力较术前改善,差异有统计学意义(Z=11.000,P<0.001)。末次随访时无一例出现伤口渗液、延迟愈合、浅表或深部软组织感染、假体周围感染及松动、下肢深静脉血栓形成及肺栓塞等并发症。结论对接受TKA的膝僵直或强直患者,采用股四头肌V-Y成形术可增加显露,从而可改善膝关节活动度和股四头肌肌力。

关键词：关节成形术,置换,膝四头肌活动范围,关节

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金属填充物重建全膝关节翻修术中严重骨缺损的研究进展

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中华骨科杂志 2024年第4期44卷 270-278页

作者：黄超王浩洋曾伟南周宗科四川大学华西医院骨科成都610041

随着全膝关节置换术(total knee arthroplasty,TKA)的广泛开展,因各种原因需行膝关节翻修术的患者数量也逐渐增加。严重骨缺损的重建是膝关节翻修术的一大挑战。近年来,骨缺损的重建方法不断发展,基于骨缺损的大小和部位出现了多种翻修... 详细信息

随着全膝关节置换术(total knee arthroplasty,TKA)的广泛开展,因各种原因需行膝关节翻修术的患者数量也逐渐增加。严重骨缺损的重建是膝关节翻修术的一大挑战。近年来,骨缺损的重建方法不断发展,基于骨缺损的大小和部位出现了多种翻修策略。严重骨缺损的重建需要诸如自体骨移植、同种异体骨移植或金属填充物等进行重建。然而,骨移植面临来源受限、吸收塌陷或疾病传播等风险,临床应用受限;而金属填充物因其来源广、可定制、安全性高等优点在实际应用中受到广泛关注,可避免骨移植的各种弊端。金属垫块的优势在于可提供即时支撑、无需加固、不会发生骨坏死和吸收塌陷,然而金属与骨之间的弹性模量差异可能会导致应力遮挡,增加潜在的骨质丢失风险。Cone和Sleeve均可实现干骺端骨的生物固定,但出现假体周围感染时,由于假体骨长入和骨整合,很难轻易取出。本文对金属填充物在全膝关节翻修严重骨缺损重建中的应用进行综述,将有助于评估各种重建方案,提高为患者制定高性能翻修策略的能力。

关键词：膝关节再手术内固定器骨缺损

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单纯内固定或假体翻修治疗全膝关节置换术后假体周围骨折

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中华骨科杂志 2024年第4期44卷 203-209页

作者：刘净峰石小军杨静康鹏德周宗科沈彬裴福兴四川大学华西医院骨科成都610041

目的分析单纯内固定和假体翻修治疗全膝关节置换术后假体周围骨折的临床疗效。方法回顾性分析2008年1月至2022年1月就诊于四川大学华西医院骨科的全膝关节置换术后发生假体周围骨折患者35例(35膝),男13例、女22例,年龄(71.4±4.1)岁(范... 详细信息

目的分析单纯内固定和假体翻修治疗全膝关节置换术后假体周围骨折的临床疗效。方法回顾性分析2008年1月至2022年1月就诊于四川大学华西医院骨科的全膝关节置换术后发生假体周围骨折患者35例(35膝),男13例、女22例,年龄(71.4±4.1)岁(范围62~81岁)。左膝19例,右膝16例。RorabeckⅡ型20例、RorabeckⅢ型15例。初次置换均使用固定平台后稳定型膝关节假体,以骨水泥固定。RorabeckⅡ型患者接受单纯内固定治疗(内固定组),RorabeckⅢ型患者接受更换假体翻修术(翻修组)。比较两组患者术后美国特种外科医院(Hospital for Special Surgery,HSS)评分、膝关节活动度范围(range of motion,ROM)、下肢力线矫正情况及术后并发症的发生率。结果所有患者均顺利完成手术并获得随访,随访时间为(5.2±3.6)年(范围1~12年)。术中失血量为(680±102)ml(范围420~1100ml)。内固定组手术时间为(105±17)min,小于翻修组的(140±21)min,差异有统计学意义(t=-5.450,P3°),翻修组下肢力线均满意,两组下肢力线满意率的差异无统计学意义(P=0.057)。内固定组骨折愈合时间、末次随访时膝关节ROM及HSS评分分别为(5.1±1.3)个月、86°±5°、(84±5)分,翻修组为(4.8±1.5)个月、83°±6°、(82±4)分,差异均无统计学意义(P>0.05)。翻修组1例术后确诊为假体周围感染,病原菌培养提示为白色念珠菌,反复出现膝前窦道和髌骨外露,进而发展为骨髓炎,于翻修后1年行大腿中段截肢术。结论假体稳定性是决定全膝关节置换术后假体周围骨折治疗方案的重要参考,对假体未松动患者行坚强的内固定术、对假体松动的患者采取更换假体的翻修术,均可获得良好的膝关节功能。

关键词：膝关节假体周围骨折骨折固定术,内再手术

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三水铝石和勃姆石吸附行为的研究进展

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硅酸盐通报 2024年第3期43卷 878-890页

作者：周宗可覃宗华万泉聂信于文彬杨淑勤中国科学院地球化学研究所矿床地球化学国家重点实验室贵阳550081

三水铝石和勃姆石不仅是在土壤和水环境中分布广泛的铝氢氧化物矿物,也是重要的工业原料与产品。它们与环境中无机非金属离子、无机金属离子及有机物的吸附作用极大地影响着地表环境中物质的迁移富集和环境污染物的吸附去除,并且由于结... 详细信息

三水铝石和勃姆石不仅是在土壤和水环境中分布广泛的铝氢氧化物矿物,也是重要的工业原料与产品。它们与环境中无机非金属离子、无机金属离子及有机物的吸附作用极大地影响着地表环境中物质的迁移富集和环境污染物的吸附去除,并且由于结构特性和表面性质,三水铝石和勃姆石在研究高效经济的吸附剂方面也具有较为重要的应用。本文在概述三水铝石和勃姆石结构和表面物理化学性质的基础上,对三水铝石和勃姆石表面多种非金属离子、金属离子和有机物的吸附行为进行综述,期望加深对铝氢氧化物矿物在地表环境物质循环中所起作用的理解,以及拓展其工业应用。

关键词：三水铝石勃姆石铝氢氧化物吸附非金属离子金属离子

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Comparative Study on the Trans-Province Transfer of the Multiple Trauma Patients after Sichuan Earthquake

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Open Journal of Earthquake Research 2016年第1期5卷 7-19页

作者： Guodong Liu Shan Ou Jun Qiu Danfeng Yuan Zhihuan Yang zongke zhou Yuan Yao Suxing Wang Xiuzhu Zhang Wuchao Wang Dawei Liu Zhengguo Wang Jihong zhou Department 8 Research Institute of Surgery Daping Hospital Third Military Medical University Chongqing China Department of Anesthesiology Chengdu First People’s Hospital Chengdu China State Key Laboratory of Trauma Burns and Combined Injury Research Institute for Traffic Medicine Research Institute of Surgery Daping Hospital Third Military Medical University Chongqing China Department of Orthopedics West China Hospital of Sichuan University Chengdu China Department of Emergency Center for Traffic Injury No. 117th Hospital of PLA Hangzhou China

Background: Trans-province transfer of the patients has been successfully carried out and has greatly relieved the burden of the hospitals in Sichuan Province after Sichuan earthquake. The aim of the study was to retrospectively analyze the efficacy and feasibility of the trans-province transfer of the multiple trauma patients after Sichuan earthquake. Methods: A retrospective and descriptive analysis was conducted based on the medical records of the multiple trauma patients (ISS ≥ 16) transferred to the Grade 3A hospitals outside Sichuan province. The patients were divided into two groups based on the distance to Sichuan province, i.e., Group A (the seismic patients transferred to Chongqing) and Group B (the seismic patients transferred to the other provinces/ municipalities). A comparison was done in aspects of distance of transfer, time from injury to transfer, vital signs, the infection rates (at transfer and on discharge), injury severity and prognostic indices (cure rate, disability rate and mortality). Results: The distance between Chengdu and the other places was at a wide range of 313 - 1653 km, whereas the time from injury to transfer showed no statistical difference between groups (P > 0.05). There were no significant differences between both groups with respects to patient demographics, injury mechanism, time from injury to transfer, vital signs, infection rate and injury severity. The prognostic indices showed no significant difference, except for FIM scores (P < 0.05). Conclusions: The results of the study indicate that the different distance of the transfer of the multiple trauma patients does not aggravate the severity or deteriorate the prognosis, which proves that the medical supportive transfer system is acceptable, effective and worthy of further implementation in China, which may be ascribed to the advanced transportation system and high level of therapeutic capacity of the hospitals. In the meantime, attention should be paid to psychological intervention and functional rehabilitation during

关键词： Earthquake Hospital Transfer Vital Signs Injury Severity Score Prognosis

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X-ray image characteristics and related measurements in the ankles of 118 adult patients with Kashin-Beck disease

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Chinese Medical Journal 2014年第13期127卷 2479-2483页

作者： Zeng Yi zhou zongke Shen Bin Yang Jing Kang Pengde zhou Xuan Zou Ling Pei Fuxing Department of Orthopedic Surgery Department of Radiology West China Hospital West China Medical School SichuanUniversity Chengdu Sichuan 610041 China

Background Kashin-Beck disease （KBD） is a chronic,degenerative osteoarthropathy that causes severe skeletal deformation.Although many researchers have proven that almost all KBD patients who showed an increaseing proximo-distal gradient had radiographic abnormalities of the ankle,few detailed description of radiographic changes in the ankles of patients with KBD has been reported,especially for variable measurements of ankle changes.The purpose of this study was to demonstrate the radiographic characteristics of the ankles of adult KBD patients.Methods One hundred and eighteen adult KBD patients from september to October 2010 in Rongtang county in China were examined with lateral radiographs of the right ankle.The morphological abnormalities in the talus,calcaneus,navicular bone,distal tibia,and joint space were analyzed,and the calcaneus length,height,length-height ratio,tuber angle,front angle,plantar angle,and distal tibia anteroposterior （AP） length were measured using Riepert＇s method.Results Eighty-one patients （68.6％） had abnormal ankle radiographs; 72 （88.9％） patients had talus changes,69 （85.2％） patients had calcaneus changes,28 （34.6％） patients had navicular bone changes,and 48 （59.2％） patients had distal tibia changes.For 118 KBD patients,the average calcaneus length was 7.4 cm,height was 4.3 cm,and the length-height ratio was 1.7.The calcaneus tuber angle was 28.2°,front angle was 38.0° and the plantar angle was 74.2°.The distal tibia anteroposterior length was 4.05 cm.Compared with 50 normal adults （control group）,significant differences were found for the calcaneus length,the calcaneus length-height ratio,and the distal tibia AP length.Conclusions Patients with KBD have characteristic abnormalities on ankle radiographs; talus depression and deformity,calcaneus shortening deformity,and distal tibia deformity with AP length widening were the most typical changes.

关键词： kashin-beck disease ankle X-ray film

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