ObjectiveTo evaluate the effect of bundle strategies on the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), in order to effectively prevent and control the severe situation of multiple drug-resistant bacteria in ICU.MethodsWe selected patients who admitted into the ICU from January 2016 to December 2017 as study subjects, and monitored 6 types of MDROs. Basic information was surveyed and collected from January to December 2016 (before intervention), while bundle strategies on MDROs were implemented from January to December 2017 (after intervention), including issusing isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, implementing hand hygiene, etc. Then we compared the MDRO detection rate, nosocomial infection rate, MDRO nosocomial infection rate, and compliance rates of interventions between the two periods.ResultsThe MDRO detection rate before intervention was 77.10%, and that after intervention was 49.12%, the difference between the two periods was statistically significant (χ2=69.834, P<0.001). The nosocomial infection rate of ICU decreased from 23.51% before intervention to 15.23% after intervention, the MDRO nosocomial infection rate decreased from 13.70% before intervention to 5.84% after intervention, and the differences between the two periods were statistically significant (χ2=8.594, P=0.003; χ2=13.722, P<0.001). The compliance rates of doctor’s isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, and hand hygiene, as well as the correct rate of hand hygiene after intervention (92.12%, 93.55%, 81.77%, 84.24%, 82.90%, 77.39%, and 96.37%) were significantly higher than those before intervention (31.94%, 52.00%, 23.43%, 48.18%, 67.16%, 59.46%, and 88.64%), and the differences were all statistically significant (P<0.001).ConclusionThe implementation of the above bundle strategies on the prevention and control of MDROs can decrease the MDRO detection rate and MDRO nosocomial infection rate.
Objective To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures. Methods Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
【Abstract】 Objective To evaluate the method and the early effectiveness of total hip arthroplasty in the treatment of protrusio acetabuli. Methods Between January 2006 and February 2010, 16 cases (16 hips) of protrusio acetabuli were treated, including 6 males and 10 females with an average age of 56.5 years (range, 39-72 years). The median disease duration was 6.4 years (range, 1 year and 6 months to 35 years). Involved hips included 7 left hips and 9 right hips; 3 patients had primary protrusio acetabuli and 13 patients had secondary protrusio acetabuli. The preoperative Harris score was 49.5 ± 5.5. According to Dunlop et al. classification criterion, there were 3 cases of mild, 9 cases of moderate, and 4 cases of severe. All patients received total hip arthroplasty with bone graft and cementless prosthesis for recovery of femoral offset and acetabular center of rotation. Results All incisions healed by first intention without complication of infection, deep venous thrombosis, or nerve injury. All patients were followed up 12-62 months with an average of 37 months. The Harris score at last follow-up was 90.5 ± 4.5, showing significant difference (t=49.578, P=0.000) when compared with preoperative score. The X-ray films showed that no prosthesis loosening or subsidence was observed, and bone graft healed with no sign of re-protrusion. Conclusion In treatment of protrusio acetabuli, total hip arthroplasty with bone graft and cementless prosthesis can recover the femoral offset and acetabular center of rotation and provide satisfactory early effectiveness.
目的 为贯彻落实卫生部《医院感染管理办法》、《抗菌药物合理应用指导原则》，了解成都三六三医院医院感染的现状，对医院感染控制工作进行评价，提高医务人员的感染控制意识。 方法 制定统一调查方案与措施，逐一查看2011年9月21日全院住院患者在架病历，对全院住院患者通过床旁询问和体检的方式进行调查。 结果 全院共有住院患者621例，实查621例，实查率100%。发生医院感染19例，现患率为3.06%。抗生素使用率46.38%。病原学送检率21.88%。 结论 加强医务人员医院感染知识的培训是提高其医院感染防控意识的重要手段；提高感染患者病原学送检率，减少经验性用药，依据药敏结果合理使用抗生素，达到有效减少耐药菌产生的目的。
Objective To summarize the short-term effectivness of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy. Methods Between January 2007 and January 2010, 15 cases of type IV Pi pkin fracture were treated through transtrochanteric approach with trochanteric osteotomy. There were 9 males and 6 females with an average age of 42.5 years (range, 27-55 years). The causes of fractures included traffic accident (12 cases), fall ing from height (2 cases), and heavy pound injury (1 case). The time from injury to hospital ization was 4 hours to 7 days (mean, 2.3 days). All patients had l imitation of activity in the injured hips. The X-ray films and CT three-dimensional reconstruction indicated posterior dislocation of the hip joints and fractures of the femoral head and acetabulum, with no fracture of femoral neck. The locations of the femoral head fractures were under the round l igament in 9 cases and above the round l igament in 6 cases. Compl ications were treated firstly in all patients. The time from hospital ization to operation ranged from 2 to 10 days (mean, 4.5 days). Results All patients got primary wound heal ing with no early compl ication. All the patients were followed up 12-48 months with an average of 26 months. All osteotomies and acetabular fractures healed within 6 to 8 weeks. All patients achieved heal ing of femoral head fracture after 6-10 months. Mild heterotopic ossification occurred in 2 cases at 3 months after operation which were left untreated; and necrosis of the femoral head occurred in 1 case at 8 months after operation, was treated by total hip arthroplasty. At last follow-up, the flexion of the injuried hips ranged from 60 to 120° (mean, 92.5°). Based on Thompson et al. scoring scales, the results were excellent in 5 cases, good in 7 cases, fair in 2 cases, and poor in 1 case; the excellent and good rate was 80%. Conclusion Treatment of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy can provide good visual ization and protection of the blood supply of the femoral head.
ObjectiveTo explore the clinical effects of combined operation involving tibial tubercle distalization for the recurrent patellar dislocation with patella alta.MethodsBetween April 2010 and May 2016, 14 cases of recurrent patellar dislocation with patella alta were treated with combined operation involving tibial tubercle distalization. There were 5 males and 9 females with an average age of 18.5 years (range, 13-26 years). The left knee was involved in 9 cases and the right knee in 5 cases. The patella had dislocated 3.3 times on average (range, 2-5 times). The interval between the first dislocation and admission was 19.7 months on average (range, 4-60 months), and the main symptoms were knee pain and limited knee movement. Preoperative X-ray films, CT, and MRI examinations of knee joint showed that the epiphyseal plate closed in all patients. Of all patients, 3 patients had avulsion fracture of the inner edge of patella, and 2 patients had free body in articular cavity. The tibial tuberosity-trochlear groove (TT-TG) distance, patellar-trochlear-groove distance, Caton-Deschamps index, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, Kujala score, and Tegner score were compared pre- and post-operation.ResultsAll patients had primary wound healing. All patients were followed up 24-72 months with an average of 34.6 months. X-ray film and CT examination showed that the patellar dislocation was corrected and the osteotomy of the tibial tubercle healed with an average healing time of 3.8 months (range, 3-5 month). At 1 day and 1 year after operation, the TT-TG distance, patellar-trochlear-groove distance, and Caton-Deschamps index showed significant differences when compared with preoperative values (P<0.05), but there was no significant difference between 1 day and 1 year after operation (P>0.05). At the 1 year and 2 years after operation, the knee ROM, Lysholm score, IKDC score, Kujala score, and Tegner score showed significant differences when compared with preoperative values (P<0.05), and there was no significant difference between the 1 year and 2 years after operation (P>0.05).Conclusion Combined operation involving tibial tubercle distalization is a safe and reliable method, which has satisfactory short-term effectiveness for the recurrent patellar dislocation with patella alta.
Objective To observe the outcome of arthroscopic meniscal plasty and suture repair to treat torn discoid lateral meniscus involving popl iteal hiatus. Methods Between January 2008 and May 2009, 21 cases of torn discoid lateral meniscus involving popl iteal hiatus were treated by arthroscopic surgery. There were 9 males and 12 females with an average ageof 22.5 years (range, 12-45 years), including 12 left knees and 9 right knees. Seven cases had the history of injury and other 14 cases had uncertain trauma. The average disease duration was 6.4 months (range, 3 months to 2 years). All patients complained knee pain or locking with positive McMurray test and mill ing test before surgery. All cases had torn discoid lateral meniscus, and the tear extended to the popl iteal hiatus, including 17 cases of complete type and 4 cases of incomplete type according to the Watanabe classification. After meniscal plasty, suture repair of torn popl iteal lateral hiatus was performed. The anterior part to hiatus was repaired by the outside-in technique, and the posterior part underwent repair of all inside technique by FasTFix. Results All wounds healed by first intention with no compl ications such as infection, stiffness of knee, or injury of common peroneal nerve. All patients were followed up 12-28 months with an average of 18 months. The symptoms of knee pain or locking disappeared postoperatively with negative McMurray test and mill ing test in all patients. The Lysholm score was improved from 54.0 ± 13.4 to 90.0 ± 6.6 at 12 months postoperatively, showing significant difference (t=— 12.00, P=0.00). Based on the improved Lysholm classification standard, the results were excellent in 14 cases, good in 5, and fair in 2; the excellent and good rate was 90.5%. Conclusion For torn discoid lateral meniscus involving popl iteal hiatus, based on meniscal plasty, suture repair of the popl iteal hiatus would contribute to preserve the peripheral part and restore its stabil ity.