Objective:To evaluate Masquelet technique plus flap transfer in repair of tibial infected defects complicated with extensive soft tissue defects in the lower leg.Methods:A retrospective analysis was performed in the 23 patients who had been treated by Masquelet technique plus flap transfer at Institute of Orthopedics and Trauma, 920 Hospital for tibial infected defects complicated with extensive soft tissue defects in the lower leg from March 2016 to June 2019. They were 15 males and 8 females, aged from 18 to 59 years (average, 38.4 years). The duration of disease ranged from 6 to 312 months (average, 23.6 months). All patients underwent surgery by 2 stages:1) debridement, locking compression plate fixation, formation of induced membrane by antibiotic-loaded bone cement, and repair of soft tissue defects with lower leg flaps; 2) removal of bone cement and fixation 6 to 8 weeks after infection control, fixation of broken ends after rinse, followed by grafting of cancellous bone particles in the induced membrane. The area of wound soft tissue defects after debridement ranged from 4.0 cm × 3.5 cm to 18.0 cm × 6.0 cm, and the length of bone defects from 6 to 12 cm (average, 8.4 cm). Locally grafted were pedicled fasciocutaneous flap in 4 cases, sural nerve nutrition skin flap in 9 cases (including 4 anterograde and 5 retrograde ones), saphenous nerve nutrition vascular flap in 7 cases (including 2 anterograde and 5 retrograde ones), retrograde superficial peroneal nerve nutrient vessel flap in one and free flap in 2 cases. The curative efficacy was evaluated according to the Paley fracture healing scores.Results:All the 23 patients were followed up for 9 to 46 months (average, 15.6 months). Flaps healed by the first stage in 18 cases and after skin grafting in 3 cases; skin flap transfer was conducted again in 2 cases. Infection was controlled in 21 cases but recurred in 2 cases at 9 and 14 months respectively after secondary surgery. The time for bone reunion ranged from 4 to 11 months (average, 6.2 months). According to the Paley criteria for fracture healing, 21 cases were excellent, one was good and one poor.Conclusion:In the treatment of tibial infected defects complicated with extensive soft tissue defects, Masquelet technique plus transfer of a variety of lower leg flaps can result in reliable outcomes because it controls infection, promotes formation of complete induced membrane and accelerates the process of bone reconstruction along with repair of soft tissue defects.

Objective To investigate the curative effect of imipenem cilastatin sodium in the treatment of patients with severe infection complicated with multiple organ dysfunction ,and its effect on blood lactic acid.Methods From January 2012 to January 2017,a total of 124 patients with severe organ failure and multiple organ dysfunction in the Second Hospital of Shanxi Medical University were selected ,and they were randomly divided into study group and control group according to the digital meter method ,with 62 cases in each group.The study group received a broad -spectrum antibiotic imipenem cilastatin sodium treatment , the control group received levofloxacin treatment.The curative effect,bacterial clearance rate,infection control time and the change of BLA level in the two groups were recorded and compared.Results The total effective rate was 82.26%in the study group and 79.03%in the control group,there was no statistically significant difference between the two groups (χ2＝1.187,P＞0.05).The bacterial clearance rate in the study group was 80.00%,which was significantly higher than 52.94%in the control group(χ2＝5.176,P＜0.05).The infection control time in the study group was earlier than that in the control group [(3.17 ± 1.14)d vs.(5.21 ±1.18) d),t ＝11.579,P ＜0.05].Before treatment,there was no statistically significant difference in BLA level between the two groups (t＝1.879,P＞0.05).After treatment,the BLA level in the study group was significantly higher than that in the control group (t＝12.179,P＜0.05),the level of BLA in the study group gradually decreased after one week of withdrawal ,which had no statistically significant difference compared with the control group(t＝1.483,P＞0.05).There was no statistically significant difference in BLA level between the two groups after one week of discontinuation (t＝1.237,P＞0.05).Conclusion Imipenem and cilastatin sodium has good curative effect and bacterial clearance rate in the treatment of patients with severe infection complicated with multiple organ dysfunction.It can control the infection more promptly and has a significant effect on the prognosis of patients.It is worthy of widely clinical promotion and application.

Objective:To investigate the clinical effect of induced membrane technique combined with staged internal fixation for treatment of infected femoral nonunion.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with infected femoral nonunion treated from January 2016 to December 2018 in 920th Hospital of Joint Logistics Support Force of PLA. There were 13 males and 8 females, with the age of 18-57 years [(38.9±6.7)years]. The duration of nonunion was 7-78 months [(27.1±11.4)months]. All patients were treated by induced membrane technique in two stages. At stage I, the original internal fixation was removed and debrided thoroughly, then the antibiotic-loaded bone cement and locking compression plate (LCP) were placed. The length of bone defect following debridement was 5-15 cm[(7.4±1.9)cm]. At stage II, the bone defect was reconstructed with bone grafts and fixed with the intramedullary nail and/or LCP. The wound condition, white blood cell count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded after stage I surgery and at the last follow-up to measure infection control. The complications and bone healing time were recorded. The bone healing was evaluated by the Paley criteria and the functional recovery of the affected limb was evaluated by the range of motion of the knee at the last follow-up.Results:All patients were followed up for 23-43 months [(31.9±6.7)months]. The infection recurred in 4 patients after stage I surgery, and the wound healed after repeated debridement. There was no infection recurrence after stage II surgery. The white blood cell count, CRP and ESR were (6.1±1.8)×10 9/L, (10.1±3.1)mg/L, (10.2±3.4)mm/h at the last follow-up, significantly decreased from preoperative (15.0±4.8)×10 9/L, (69.8±14.8)mg/L, (66.2±13.2)mm/h ( P<0.05). The incidence of complications was 43%. Besides infection recurrence in 4 patients after stage I surgery, the donor site at the posterior superior iliac spine in 3 patients showed delayed healing, and the limb shortening occurred in 2 patients with the discrepancy of 3 cm and 4 cm. Bony union was observed in all patients within 6-16 months [(8.8±2.7)months]. The results were excellent in 19 patients and good in 2 patients according to the Paley criteria at the last follow-up. The knee range of motion was significantly improved from preoperative 30.0°(15.0°, 110.0°) to 90.0°(61.5°, 120.0°) at the last follow-up ( P<0.05). Conclusion:For infected femoral nonunion, the induced membrane technique combined with staged internal fixation can effectively control infection, achieve bony union, and promote functional recovery.

Objective:To investigate the clinical efficacy of induced membrane technique in the staged treatment of adult chronic hematogenous osteomyelitis (CHOM) of long bone.Methods:The clinical data were retrospectively analyzed of the 22 adult patients with CHOM of long bone who had been admitted to the 920th Hospital, Joint Logistics Support Force of PLA from January 2016 to December 2019. There were 18 males and 4 females, aged from 16 to 56 years (average, 31.81 years). Their disease duration ranged from 0.6 to 42.0 years, averaging 18.4 years. By the Cierny-Mader anatomical classification, 4 cases were type Ⅰ, 6 cases Type Ⅲ, and 12 cases type Ⅳ. In the first stage, the bone defects were filled with antibiotic bone cement after thorough debridement. In the second stage when the infection had been controlled, the bone defects were repaired with bone grafts after removal of the bone cement. Bone healing time and complications were followed up. The treatment effects were evaluated by comparisons of the infection control indexes [including clinical manifestations like local redness, swelling, pus, and pain, and blood white blood cell count, C-Reactive protein (CRP), and erythrocyte sedimentation rate (ESR) as well] before the primary surgery, before the secondary surgery and at the last follow-up.Results:The volumes of the bone defects after stage-one debridement ranged from 54 cm 3 to 176 cm 3 (mean, 90.9 cm 3). All patients were followed up for 20 to 51 months (mean, 30.1 months) after surgery. All bone defects healed after 4 to 11 months (mean, 6.6 months). Postoperatively, infection developed at the bone extraction site of the posterior superior iliac spine in 3 cases and pain was observed at the donor site in one case, but the conditions were relieved after symptomatic treatment. Fracture and plate breakage occurred at the bone defect site in one case who had fallen down 7 months after operation, but responded to reoperation. The last follow-up revealed such symptoms as redness, swelling and pus discharge in none of the patients. The white blood cell count [(5.70 ± 1.57) × 10 9/L and (5.65 ± 1.58) × 10 9/L], CRP [(7.56 ± 2.57) mg/L and (7.25 ± 3.83) mg/L] and ESR [(9.64 ± 2.90) mm/h and (10.55 ± 5.23) mm/h] before the secondary surgery and at the last follow-up were significantly lower than those before the primary surgery [(8.24 ± 2.18) × 10 9/L, (49.54 ± 19.56) mg/L, and (42.68 ± 13.77) mm/h] (all P < 0.05). However, there were no significant differences between the indexes before the secondary surgery and at the last follow-up ( P > 0.05). Conclusion:In the staged treatment of adult CHOM of long bone, the induced membrane technique can effectively control infection, achieve repair of bone defects, and reduce complications.

Objective: To investigate the effect of mechanical ventilation in prone position combined with lung recruitment on severe acute respiratory distress syndrome (ARDS). Methods: From February 2015 to February 2017, 82 patients with ARDS admitted to ICU of the Second Hospital of Shanxi Medical University were divided into two groups according to random number table, with 41 cases in each group.The study group was treated with mechanical ventilation in prone position combined with lung recruitment therapy, and the control group was treated with mechanical ventilation in supine position combined with lung recruitment therapy.The differences of heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), partial pressure of oxygen (PaO₂), oxygenation index (PaO₂/FiO₂), plateau pressure (Pplat), and static pulmonary compliance (Cst) were compared between the two groups before treatment (T0), and 1h (T1), 2h (T2), 6h (T3) after treatment. Results: The PaO₂ and PaO₂/FiO₂ levels of the two groups increased significantly after lung recruitment.In the study group at different time after treatment, PaO₂[(69.17±7.51)mmHg, (74.64±6.78)mmHg, (82.52±10.37)mmHg], PaO₂/FiO₂ [(116.91±15.57)mmHg, (123.06±16.34)mmHg, (135.23±18.41)mmHg]were higher than those in the control group[PaO₂: (64.23±7.72)mmHg, (68.51±8.05)mmHg, (73.43±9.12)mmHg; PaO₂/FiO₂: (106.50±12.97)mmHg, (115.42±13.19)mmHg, (123.42±14.95)mmHg], the differences were statistically significant (t=3.225, 3.254, 4.245, 3.954, 3.886, 4.135, all P<0.05). HR and CVP increased at T2-T3, T3 decreased, MAP decreased at T2-T3, and T3 increased in both two groups.HR at T1-T3 in the study group were (123.17±13.41)times/min, (114.64±10.08)times/min, (102.52±6.57)times/min, which were lower than those in the control group[(129.23±12.75)times/min, (117.51±10.35)times/min, (108.43±9.77)times/min], the differences between the two groups were statistically significant (t=3.884, 4.215, 4.667, all P<0.05). Conclusion Prone position mechanical ventilation combined with lung recruitment can effectively improve the oxygenation status of severe ARDS, and has less effect on hemodynamics, and the effect is better than supine position mechanical ventilation combined with lung recruitment.

Objective To evaluate surgical treatment of chronic tibial osteomyelitis of Cierny-Mader type Ⅳ with Ilizarov technique and lesion osteotomy. Methods From January 2010 to May 2016, 39 patients with chronic tibial osteomyelitis of Cierny-Mader type Ⅳ were treated at our center. They were 33 males and 6 females, 8 to 54 years of age (average, 33.8 years). After debridement and lesion osteotomy, the tibia was fixated with Ilizarov external fixator. Bone was transported to the bone defect after corticotomy was performed on the proximal and/or distal tibial metaphyses simultaneously. Bifocal corticotomy was per-formed in 11 cases, proximal corticotomy in 21 cases, and distal corticotomy in 7 cases. The transport began 3 to 5 days after operation at a speed of 0.5 to 1.0 mm/d initially. The speed was lowered according to the bone healing and pain. Radiographic examination was done every 2 weeks to observe transporting deviation and osteogenesis in the transporting area. The transporting was adjusted whenever any abnormality was observed. The bone transporting lasted for 50 to 130 days (average, 62.4 days). Results The patients were fol-lowed up for 11 to 49 months (average, 21 months). All the soft tissue wounds healed uneventfully and there was no relapse of osteomyelitis. The bone defects in the 32 cases were reconstructed primarily. Nonunion of fracture ends happened in 5 cases and nonunion of the bone lengthening zone in 2 cases. The 7 cases of nonunion were healed after secondary bone grafting. Malalignment happened in 5 cases, 4 of which responded to timely adjustment of the external fixation and one of which had to receive secondary bone grafting after failure in adjustment of the external fixation. Ankle joint dysfunction occurred in 7 cases, 5 of which re-sponded to functional exercise and 2 of which accepted joint dysfunction because they refused surgery after unsatisfactory functional exercise. Pin tract infection of different severities occurred in 9 cases, one of which was treated by replacement of the K-wires under local anesthesia and the other 8 of which responded to rein-forced dressing change. Conclusions Chronic tibial osteomyelitis of Cierny-Mader typeⅣcan be treated by Ilizarov technique and lesion osteotomy. However, the Ilizarov technique should be improved because of the risks of multiple complications which can be reduced significantly by strengthening postoperative instruction, nursing, and regular follow-up.