Objective To explore an effective prevention and management of nonunion and malunion due to insidious infection after fracture internal fixation. Methods From January 2001 to January 2006,we treated 26 patients with nonunion and malunion due to insidious infection after fracture internal fixation.They were 15 cases of femoral fractures, 2 cases of ulna fractures, 3 cases of radial fracturos, 3 cases of humerus fractures, and 3 cases of tibial fractures. The patients were treated with irrigation after debridement.In 23 fractures, the internal fixation was dislodged and changed into external fixation. In the 3 cases whose internal fixation remained, instillation and drainage were conducted after debridement. Bone grafting was performed for 20 cases after replacement of internal fixation, and for 3 cases after removal of external fixation.Three patients received no bone graft. Results The preoperative X-ray findings confirmed the diagnosis of insidious infection in 21 cases, while the other 5 cases were diagnosed by bacterial culture or pathological examination of the pus and inflammatory granulation tissue found during surgery. The bacterial culture was positive in 17 cases, including 6 cases of Staphylococcus epidermidis, 8 cases of Staphylococcus aureus, and 3 cases of Escherichia coli. All the patients were followed up for 8 to 48 months, with an average of 23.5 months. Of the 26 cases, 22 obtained bony union, 2 partial union and 2 nonunion. Complications included fistula in 2 patients and infection relapse in 3 patients. Conclusions Insidious infection may be related to the bacterial toxicity, anatomical sites and surgical methods. X-ray changes may help the diagnosis of insidious infection. Surgery is necessary for management of nonunion and malunion due to insidious infection after fracture internal fixation.

BACKGROUND: Autologous bone marrow transplantation (ABMT) has been widely used in treatment of the malunion of fracture, but this treatment to cure malunion of fracture induced by infection is still not consistent.OBJECTIVE: To observe the application and clinical outcome of ABUT for the malunion of fracture induced by infection.DESIGN, TIME AND SETTING: A retrospective analysis. The patients were all enrolled at Department of Orthopaedics in the Third Affiliated Hospital of Hebei Medical University from January 2001 to January 2006. PARTICIPANTS: A total of 19 patients with malunion of fracture induced by infection, including 13 males and 6 females aged from 18 to 50 years, with an average of 36. The lesioned site contained fracture of tibia 10, fracture of femur 5, fracture of ulna 2 and fracture of humerus 2. Among them, there were 6 cases with bone defect, 9 cases with bone fracture delayed union and 4 cases with bone fracture disunion.METHODS: Nineteen patients treated with percutaneous ABUT. Among the 19 cases, 12 patients received the transplant 3 weeks after infection was under controlled, and other 8 patients received the transplant following autologous bone transplantation.MAIN OUTCOME MEASURES: After ABMT, all patients were checked using X-ray regularly, the pacing of bone union was traced through observing the growth of callus, and the side reaction was also detected.RESULTS: Totally 19 patients were included in the follow-up visit, and 15 cases of them achieved bony union. Clinical healing time was 7-20 weeks. The patients had no obvious discomforts except local gas pains when injecting and at pristine time after injection. Five patients had a small quantity of exudation. No infection relapse or soft tissue ossification were observed at the injection position. Four patients had not achieved bony union, the reason was that bone defect in 2 patients exceed 2 cm; fracture disunion with pseudoarticulation formatted in one patient, the sclerous broken ends of fractured bone was more than 2 cm; another patient's external fixation displaced, we adjusted it and the bone healed after 12 weeks. Three patients received autoallergic ilium bone transplantation in the second time of operation, the fractured bone got bony union. CONCLUSION: ABMT by percutaneous injection into malunion site can induce ossification, repair bone fracture and bone defects. The clinical application is simple and exhibits small wounds without complications. Especially ABMT is effective for the patient with the malunion of fracture induced by infection.

BACKGROUND: Systemic administrations are widely used in preventing or curing bone infections, however, it accompanied by great adverse reactions and limited local blood drug levels. Therefore, local administration becomes a research focus, which aimed to explore a carrier possess good biocompatibility and slow-release antibiotics. OBJECTIVE: To explore the effect of calcium alginate gel compound vancomycin on prevention of bone infection, simultaneously, single drug was injected or implanted into models to compare the results.METHODS: A total of 60 healthy adult New Zealand white rabbits were prepared for osteomyelitis models by injecting Staphylococcus auraus to right tibiae medullaris, and randomly divided into systemic treatment, tricalcium phosphate and calcium alginate gel groups. After model preparation, rabbits in the systemic treatment group were intramuscular injected vancomycin (0.03 g, twice per day, for 4 successive days); in the triceicium phosphate group, 1 g tricalcium phosphate combined with 0.1 g vancomycin.was filled in the defects, sealed with bone wax. In the calcium alginate gel group, calcium alginate gel combined with vancomycin was implanted. Gross observation, radiological image and histological analysis were performed at weeks 4 and 8 after operation.RESULTS AND CONCLUSION: Local swelling and partial sinus were found in the systemic treatment and tricalcium phosphate groups after operation. The pathological slice showed that there were a large number of lymphocytes and some sequestrum in the systemic treatment and tricelcium phosphate groups. However, there was no manifestation of osteomyelitis in the calcium alginate gel group. The results suggested that calcium alginate gel compound vancomycin exhibit superior therapeutic effect on prevention of bone infection to local administration of calcium alginate gel combined with vancomycin or systemic application of vancomycin.

[Objective]To study diagnosis and treatment of insidious infection after the internal fixation of long bone fracture.[Method]Thirteen patients with insidious infection after internal fixation of long bone fracture were treated with irrigation after debridment. Among the 13 cases 8 fractures were dislodged internal fixation and then were fixed with the external fixation. 5 fractures were remained the internal fixation and were instilled after debridment. All of the patients were given with antibiotics for 2～3 weeks after operation.[Result]All the 13 patients were followed up. The follow-ranged from 8 to 48 months with an average of 23.5 months. Among the thirteen patients 11 fractured-bone had bony union, one nonunion and one case had fistula, Infection relapsed in two patients.[Conclusion]Bone defects, fracture nonunion often occur on patients who have insidious infection after internal fixation of long bone fracture. These patients need to be operated. In slight infections fracture can be remained after debridement. Fractures with seriously infectious have to dislodge internal fixation and to be fixed with made according to its radiographic changes.

Objective To evaluate the short-term results of ARCH plate in cerical expansive open-door laminoplasty(ELAP)for OPLL.Methods From June 2010 to September 2011,a total of 12 cases with OPLL underwent open-door ELAP by ARCH plate fixation and were followed up in our hospital.8 cases were males and 4 cases were female.The average age was 60.5 years.The neurological effect was evaluated by use Japanese Orthopedic Association(JOA)scoring criteria for cervical myelopathy.The ana-tomical effect was analyzed by compare roentgenogram and CT before and after surgery.Results The JOA scores were improved for 39% after the operation,while the saggital diameters of the cervical spinal canaldural after operation was enlarged for 82%(P<0.05).X-ray films and CT scan after operation that there was no occurrence of re-close of door,there was no occurrence of anchor loosing.Conclusion For OPLL,ELAP using ARCH plate fixation bring less occurrence of re-close of door,slight postoperative neck AS,and satisfactory clinical outcomes.

Objective To review the status of diagnosis and treatment for invasive fungal pulmonary infections(IFPI)in Lishui Central Hospital.Methods The clinical data of 79 patients with IFPI were retrospectively analyzed.Results The diagnostic status could be classified ills follows:6 eases had confirmed diagnosis,30 had clinical diagnosis,35 had suspected diagnosis and 8 misdiagnosed.The treatments were all effeetive in 6 COnfirmed cases;in 30 clinically diagnosed cases,6 were eriective.21 were inefiective and 3 died;in 35 suspected cases.3 were effective.25 were iHefieetive and 7 cflses did not receive antifungal treatment.Aspergillus and Cryptococcus pulmonary infections were predominant in confirmed cases.and the antifungal treatment lasted for 3 to 6 months.Conclusion Diagnosis and treatment for IFPI need to be improved.

Objective To find out current distribution of Oncomelania snails and Schistosoma infection in snails in Zhejiang Province, so as to improve the project of schistosomiasis control. Methods Investigation spots were selected by stratified cluster sampling method, 100 villages of 34 counties were selected from 7 106 villages of 55 counties as survey spots. Synchronously systematic and environmental samplings were used for the survey. Snails were dissected to determine the infection status and spots with sham snails were set to assess the quality of the survey. Results The result showed that snails were found in 223 strips, 1 572 frames and 73 300 m 2 area in 32 villages of 21 counties. Snails were found in an area covering 72 640 m 2 in 29 villages of 18 counties in hilly region, which accounted for 99.1% of total snail habitats. The significantly larger area with snails was revealed in hilly region than that in water network region (t=3.04, P

Objective:To evaluate the effect of hydrogen on lung injury induced by extremity ischemia-reperfusion (I/R) in elderly patients.Methods:Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-75 yr, with height 155-180 cm, weighing 50-75 kg, undergoing lower limb surgery under spinal anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: hydrogen inhalation group (H group) and control group (C group). In H group, 67% hydrogen-33% oxygen was inhaled through the nasal catheter until the end of surgery starting from the completion of anesthesia.In group C, 33% oxygen was inhaled through the nasal catheter until the end of surgery after the completion of anesthesia.Blood samples from the radial artery were collected before anesthesia and at 60 min after tourniquet deflation.Blood gas analysis was performed to determine and record arterial oxygen partial pressure (PaO 2) and arterial carbon dioxide partial pressure (PaCO 2), and alveolar-arterial partial pressure of oxygen difference (A-aDO 2), oxygenation index (OI) and respiratory index (RI) were calculated.Pulmonary surfactant protein D (SP-D) and interleukin-6 (IL-6) concentrations in serum were measured by enzyme-linked immuno sorbent assay.ICU stay time and incidence of pulmonary complications within 7 days after operation were recorded. Results:Compared with group C, PaO 2 and OI were significantly increased, RI and A-aDO 2 were decreased, SP-D and IL-6 concentrations in serum were decreased at 60 min after tourniquet deflation, and ICU stay time was shortened ( P<0.05), and no significant change was found in the incidence of pulmonary complications within 7 days after surgery in group H ( P>0.05). Conclusion:Hydrogen can reduce the lung injury induced by extremity I/R, and the mechanism may be related to the reduction of inflammatory response in elderly patients.

Objective:To investigate the application value of digital X-ray radiotherapy and single photon emission computed tomography(SPECT)radionuclide bone imaging in the diagnosis of intertrochanteric fracture of femur.Methods:A total of 70 patients who were diagnosed as intertrochanteric fracture of femur in Shijiazhuang People's hospital from January 2017 to December 2020 were selected,and they were divided into study group and control group according to random number method,with 35 cases in each group.Digital X-ray radiography combined with SPECT radionuclide bone imaging was used in the study group,and digital X-ray radiography was used in the control group.And then,the accuracy of the diagnostic results between the two groups were compared.Results:The radiographic examination indicated that 31 cases(88.6%)of 35 cases in the study group were confirmed,and 24 cases(68.6%)of 35 cases in the control group were confirmed.The diagnostic accuracy rate of the study group was significantly higher than that of the control group,and the difference was statistically significant(x2=4.158,P<0.05).The preoperative imaging diagnosis indicated that diagnosed number of fracture blocks in the study group was(3.57±0.50),which was significantly higher than that(2.67±0.40)in the control group,and the difference of that between two groups was statistically significant(t=8.315,P<0.05).In the actual intraoperative examining for bone continuity,5 cases were continuity and 30 cases were non-continuity.In the bone stability,13 cases were stability and 22 cases were non-stability.The study group was closer to intraoperative bone continuity and bone stability,and the differences of them between two groups were statistically significant(x2=12.857,4.644,P<0.05),respectively.Conclusion:The combination of digital X-ray radiography and SPECT radionuclide bone imaging has higher diagnostic value for intertrochanteric fracture of femur,which can provide important reference for clinical diagnosis.