ObjectiveTo investigate the short-term effectiveness of one-stage radical debridement and total hip arthroplasty (THA) in the treatment of active tuberculosis of the hip. MethodsBetween January 2006 and June 2011,one-stage radical debridement and THA were performed on 12 cases (12 hips) of active tuberculosis of the hip.There were 7 males and 5 females,aged 18-60 years (mean,46.3 years).The disease duration ranged from 6 to 24 months (mean,10.5 months).According to Babhulkar and Pande staging criteria,5 cases were at stage Ⅲ and 7 cases were at stage IV.One case had sinus,and 2 cases had previous pulmonary tuberculosis.Preoperative hip range of motion was (35.83±9.25)°; hip Harris score was 36.83±6.44.Erythrocyte sedimentation rate (ESR) was 45-90 mm/1 h (mean,62.4 mm/1h); C-reactive protein (CRP) was 19-50 mg/L (mean,33.6 mg/L).Perioperatively all the patients accepted the regular anti-tuberculous medication. ResultsThe results of histopathological examination and PCR detection were positive for tuberculosis bacillus.Postoperatively the incisions healed primarily.All the patients were followed up 25-60 months (mean,40.8 months).The ESR and CRP returned to normal level with no liver injury.Tuberculosis recurrence occurred in 1 patient at 4 months after operation,which was cured after revision.X-ray film showed no prosthesis shift,prosthesis loosening,or sinus tract.At 18-24 months after operation,the bilateral sides had the same bone density,which was similar to that at the final follow-up.Hip range of motion was significantly improved to (107.08±13.56)° (t=14.571,P=0.000).Hip Harris score was significantly increased to 88.00±10.78 (t=16.750,P=0.000). ConclusionA combination of one-stage radical debridement and THA is a safe method to treat active tuberculosis of the hip,which can relief symptoms and improve hip function,with low recurrence and satisfactory short-term effectiveness.
ObjectiveTo explore the clinical efficacy of ultrasound debridement combined with autolytic debridement in the treatment of diabetic foot ulcers.MethodsA total of 60 diabetic foot ulcers patients who were diagnosed and treated in Jinshan Hospital of Fudan University from April 2019 to April 2020 were enrolled in the study and randomly divided into two groups, with 30 cases in each group. The trial group received autolytic cleansing combined with ultrasound debridement treatment, and the control group only received autolytic debridement treatment. The baseline conditions, wound treatment efficacy, number of dressing changes, length of hospital stay, treatment cost, wound healing time, wound shrinkage rate, and the time required for the wound to turn into 100% red granulation were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, duration of diabetes or Wagner grade of diabetic foot between the two groups (P>0.05). The efficacy of wound healing in the trial group was better than that in the control group (Z=−2.146, P=0.032). The number of dressing changes [(11.76±2.23) vs. (17.34±4.43) times] and the length of stay [(18.03±3.73) vs. (25.43±4.43) d] in the trial group were lower than those in the control group, and the differences were statistically significant (P<0.05). The difference in treatment cost between the two groups was not statistically significant (P>0.05). The wound healing time of the trial group [(48.43±18.34) vs. (65.24±19.62) d], the wound shrinkage rate [(78.35±8.34)% vs. (56.53±6.54)%] and the time required for the wound to turn into 100% red granulation [(16.34±2.42) vs. (24.55±3.23) d] were better than those of the control group, and the differences were statistically significant (P<0.05). During the treatment process, no patient in the trial group had wound bleeding and had difficulty in stopping bleeding during ultrasonic debridement, and no patient had intolerable pain related to ultrasonic debridement. No patients in either group withdrew early.ConclusionsUltrasound debridement combined with autolytic debridement can effectively improve the curative effect of patients with diabetic foot ulcers and shorten the wound healing time. Therefore, it is worthy of promotion and application in the wound care of patients with diabetic foot ulcers.
ObjectiveTo explore the effectiveness of intertransverse bone graft after debridement and fusion combined with posterior instrumentation in patients with single segmental thoracic tuberculosis. MethodsBetween March 2014 and May 2015, 17 cases of thoracic tuberculosis were treated by the surgery of intertransverse bone graft after debridement and fusion combined with posterior instrumentation. There were 10 males and 7 females with an average age of 48.5 years (range, 18-70 years), and with a mean disease duration of 4 months (range, 1-9 months). The affected segments included T4, 5 in 2 cases, T6, 7 in 5 cases, T7, 8 in 3 cases, T9, 10 in 2 cases, T10, 11 in 4 cases, and T11, 12 in 1 case. The operation time, intraoperative blood loss, and hospitalization time were recorded. Postoperative plain radiography was taken to assess the decompression and internal fixation, and the fusion effect was evaluated by X-ray or CT examination. The erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS), Oswestry disability index (ODI), and Kyphosis angle were recorded and compared; the nerve function was evaluated by American Spinal Injury Association (ASIA). ResultsThe mean operation time, intraoperative blood loss, and hospitalization time were 184 minutes (range, 165-220 minutes), 231 mL (range, 150-800 mL), and 18 days (range, 12-26 days) respectively. No complication of hematoma or wound dehiscence was found. All patients were followed up 17.9 months on average (range, 9-22 months). No bone graft failure, internal fixation broken, pleural effusion, cerebrospinal fluid leakage, wound infection, fistula formation, and other complications occurred. Satisfactory intervertebral fusion was obtained in all patients at 3-8 months (mean, 5.3 months) after surgery. The ESR, CRP, VAS score, ODI score, and Kyphosis angle were significantly improved at immediate after operation and last follow-up when compared with preoperative ones (P < 0.05), and the ESR, CRP, VAS score and ODI score at last follow-up were significantly better than those at immediate after operation (P < 0.05). At last follow-up, the nerve function was recovered to ASIA grade E from grade C (1 case) and grade D (6 cases). ConclusionIntertransverse bone graft is a reliable, safe, and effective way of bone graft applied to the single segmental thoracic spinal tuberculosis.
ObjectiveTo investigate the effect of arthroscopic debridement combined with oral glucosamine hydrochloride tablets in the treatment of knee osteoarthritis. MethodsSixty-two patients with knee osteoarthritis treated between January 2013 and April 2015 were chosen to be our research subjects. They were randomly divided into trial group (n=31) and control group (n=31). The control group was treated with arthroscopic debridement, and the trial group was given glucosamine hydrochloride tablets for treatment, apart from arthroscopic debridement. We evaluated the clinical effects by visual analogue scale (VAS) score and Lysholm knee joint function score before, and 1 week, 4 weeks, 3 months and 6 months after surgery. ResultsOne week after surgery, the VAS score and Lysholm knee joint function score were not significantly different between the two groups (P>0.05). Four weeks, 3 months and 6 months after surgery, the VAS score of the trial group was respectively 3.08±0.91, 2.46±0.87, and 1.45±0.66, and was 5.47±1.02, 3.55±1.20, and 2.37±0.53 in the control group; the Lysholm score of the trial group was 80.55±2.24, 85.35±1.79, and 89.74±4.58, respectively, and of the control group was 72.55±4.47, 74.68±2.94, and 76.69±5.63. The VAS score and the Lysholm score of the trial group were both better than those of the control group (P<0.05). ConclusionArthroscopic debridement can alleviate the symptoms of knee osteoarthritis, and oral administration of glucosamine hydrochloride tablets after surgery has obvious effects.
Objective To evaluate the effectiveness of induced membrane technique in the treatment of infectious bone defect. Methods Thirty-six patients (37 bone lesions) with infectious bone defects were treated with induced membrane technique between January 2011 and June 2014. There were 28 males and 8 females with an average age of 36 years (range, 20-68 years). All bone defects were post-traumatic infectious bone defect. The bone defect was located at the tibia and fibula in 24 cases (25 bone lesions), at femurs in 6 cases (6 bone lesions), at ulnas and radii in 2 cases (2 bone lesions), at calcanei in 3 cases (3 bone lesions), and at clavicle in 1 case (1 bone lesion). The average time between onset and the treatment of induced membrane technique was 6.2 months (range, 0.5-36.0 months); 15 patients were acute infections (disease duration was less than 3 months). At the first stage, after the removal of internal fixator (applicable for the patients who had internal fixation), complete debridement of infection necrotic bone tissue and surrounding soft tissue was performed and the bone defects were filled with antibiotic-impregnated cement spacers. If the bone was unstable after debridement, external fixator or plaster could be used for stabilization. Patients received sensitive antibiotics postoperatively. At the second stage (usually 6-8 weeks later), the cement spacer were removed, with preservation of the induced membrane formed by the spacer, and filled the bone defect with autologous iliac bone graft within the membrane. Results The hospitalization time after debridement was 17-30 days (mean, 22.2 days), and the hospitalization time after the second stage was 7-14 days (mean, 10 days). All the flaps healed uneventfully in 16 cases treated with local flap transposition or free flap grafting after debridement. One patient of femur fracture received Ilizarov treatment after recurrence of infection at 11 months after operation; 1 patient of distal femoral fracture received amputation after recurrence of infection at 1 month after operation; 1 patient of distal end of tibia and fibula fractures received ankle arthrodesis after repeated debridements due to the recurrence of infection; 1 patient of tibia and fibula fractures lost to follow-up. The other 32 patients (33 bone lesions) were followed up 1-5 years (mean, 2 years) without infection recurrence, and the infection control rate was 91.7% (33/36). All the patients had bony union, and the healing time was 4-12 months (mean, 7.5 months); no refracture occurred. One patient of femur bone defect had a lateral angulation of 15° and leg discrepancy of 1.5 cm. Superficial pin infection was observed in 7 cases and healed after intensive wound care and oral antibiotics. Adjacent joint function restriction were observed in 6 cases at last follow-up. Conclusion Induced membrane technique is a simple and reliable technique for the treatment of infectious bone defect. The technique is not limited to the size of the bone defect and the effectiveness is satisfactory.
ObjectiveTo evaluate the effects of two different autolytic debridment on subcutaneous wounds. MethodsThirty-eight patients with subcutaneous wounds treated from January to December 2015 were numbered according to the sequence of admission, and were randomly divided into trial group and control group, with 19 patients in each group. All the patients had yellow surface. Patients in the control group were treated with amorphous hydrogel, while those in the trial group were treated with both amorphous hydrogel and alginate dressing. Then, we compared the two groups in terms of the debridement time, frequency of changing dressing, granulation growth, wound contraction rate at the end of debridement period, and leakage rate. ResultsThe debridement time in the trial group was (21.11±5.86) days, and it was significantly shorter than that in the control group[(26.69±9.68) days] (P<0.05); the frequency of changing dressing was (7.21±2.12) times, which was less than that in the control group[(9.37±3.32) times] (P<0.05); and granulation growth was better than that in the control group (2.58±0.61 vs. 1.95±0.71, P<0.05). The wound contraction rate at the end of debridement period in the trial group was (47.00±26.24)%, which was higher than that in the control group[(29.03±22.62)%] (P<0.05); and the leakage rate (0.0%) was lower than the control group (3.3%) (P<0.05). ConclusionUsing amorphous hydrogel and alginate dressing for subcutaneous wounds is better than amorphous hydrogel alone for autolytic debridement, and can lower the leakage rate.
Objective To systematically evaluate the effectiveness of intra-articular hyaluronic acid injection after arthroscopic debridement for knee osteoarthritis (KOA). Methods Databases including The Cochrane Library, SCI, MEDLINE, EMbase, CBM and WanFang Data were searched from inception to 2012, so as to collect randomized controlled trials (RCTs) on intra-articular hyaluronic acid injection after arthroscopic debridement (combined therapy) vs. monotherapy in treating KOA. Two reviewers independently screened literature according to inclusion and exclusion criteria, evaluated quality, and extracted data. Then the meta-analysis was conducted using RevMan5.0 software. Results A total of 7 RCTs involving 526 patients were included. The results of meta-analyses showed that: there was no significant difference in the excellent-good rate between the combined therapy group and the monotherapy groups including either the intra-articular hyaluronic acid injection group (RR=1.40, 95%CI 0.99 to 1.98, P=0.06) or the arthroscopic debridement group (RR=1.09, 95%CI 0.93 to 1.26, P=0.29). But the intra-articular hyaluronic acid injection group was inferior to the combined therapy group in improving Lysholm score, with a significant difference (MD=–14.81, 95%CI –17.55 to –12.08, Plt;0.000 01). Conclusion Arthroscopic debridement combined with intra-articular hyaluronic acid injection for KOA shows no significant difference in the excellent-good rate compared with the monotherapy, but it is superior to the monotherapy of hyaluronic acid injection in improving Lysholm score, so it is believed the combined therapy group is superior to the control groups in therapeutic effects. Due to the limited quantity and quality of the included studies, this conclusion needs to be proved by performing more high quality RCTs
ObjectiveTo compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach.MethodsBetween June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification.ResultsExcept that the operation time of group B was significantly longer than that of group A (t=–2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups (P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups (P<0.05); and there was no significant difference between 2 groups at last follow-up (P>0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up (Z=–2.716, P=0.007).ConclusionPosterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.
ObjectiveTo investigate the mid-term effectiveness of debridement with prosthesis retention for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), and analyze the influence factors that affected the effectiveness.MethodsA clinical data of 45 cases with PJI after THA (16 cases) and TKA (29 cases) that were treated with debridement with prosthesis retention between January 2011 and January 2015 were collected and analyzed. There were 19 males and 26 females with a mean age of 58.4 years (range, 23-78 years). PJI occurred after primary joint arthroplasty in 40 cases and after revision in 5 cases. The mean time interval between the performance of infection symptoms and the arthroplasty or revision was 15.5 months (range, 0.5-72.0 months). The time interval between the performance of infection symptoms and debridment was 35 days (range, 3-270 days). There were early postoperative infections in 13 cases, acute hematogenous infections in 24 cases, and late chronic infections in 8 cases. X-ray films showed that the location of prosthesis was good. The results of bacilli culture showed that 28 cases were positive and 17 were negative. Twelve cases had sinuses. Length of stay, Hospital for Special Surgery (HSS) score, and Harris score were recorded to evaluate risk factors by using a multivariate logistic regression.ResultsThe mean length of stay was 22.6 days (range, 5-79 days). All patients were followed up 24-74 months (mean, 52 months). There were 33 cases that retained the prosthesis without further evidence of infection with the success rate was 73.3%. There were significant differences in Harris score and HSS score between pre- and post-operation (P<0.05). The univariate analysis results showed that the failure of debridement with prosthesis retention had a significant correlation with sinus developing and duration of infection symptoms more than 14 days (P<0.05). Multivariate logistic regression analysis results showed that sinus developing was an independent risk factor of failure (P<0.05).ConclusionDebridement with prosthesis retention plays an important role in treating PJI after THA and TKA. These patients with sinus performing and duration of infection symptoms more than 14 days have higher risk to develop infection again.
ObjectiveTo investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis.MethodsA clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group (group A, 29 patients) and traditional incision group (group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration, segment of lesion, American Spinal Cord Injury Association (ASIA) grading, preoperative pain visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Cobb angle of spinal kyphosis between 2 groups (P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard.ResultsThe length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B (P<0.05). All patients in both groups were followed up 12-29 months (mean, 20 months). There were 4 cases (13.8%) and 14 cases (38.9%) of postoperative complications in groups A and B respectively, showing significant difference (χ2=5.050, P=0.025). The ESR and CRP in 2 groups all returned to normal at 6 months after operation, and there was no significant difference in ESR and CRP between 2 groups at 3 months, 6 months, and last follow-up (P>0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups (Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation (P<0.05); the VAS score in group A was significantly lower than that in group B (t=−2.317, P=0.024) at 1 day after operation, but there was no significant difference between 2 groups (t=−0.862, P=0.392) at last follow-up. Among the patients with kyphosis, the Cobb angle was significantly decreased at 1 day after operation and last follow-up when compared with preoperative angle (P<0.05); but there was no significant difference between 1 day after operation and last follow-up (P>0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation (P>0.05). The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up (P>0.05). At last follow-up, all patients cured, and no recurrence occurred.ConclusionIn the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.