AAOS:2012年骨科受关注十大新闻

美国骨科医师学会（AAOS）于1月2日在线刊登了2012年最受骨科医生关注的10条新闻。这10条新闻涵盖了8条研究和2条时事新闻。以下是这10条新闻：

1.儿童闭合性胫骨干骨折可允许负重

来自《骨与关节外科杂志》（美国版）的一项研究报告指出，石膏固定胫骨干骨折后立刻参与负重的儿童与非负重者相比，愈合时间相同，成角或胫骨缩短均无差异。

在这项研究中，研究人员对低能量骨折儿童分别使用屈膝10度石膏模具参与负重和使用屈膝60度石膏模具不参与负重进行比较。两组在愈合时间（10.8周）、平均冠状面排列和矢状面排列以及平均胫骨缩短上的结果相同。尽管儿童行为可视活动量表(ASKp)显示，两组一段时间下肢功能均得到改善，但在6周时负重组获得更好评分（P=0.03）和更好的站立功能。

A Comparison of Two Approaches for the Closed Treatment of Low-Energy Tibial Fractures in Children

2. 受污染类固醇也可引发关节感染风险；其它两类可疑药品名称被披露

到目前为止，尽管有关受污染的类固醇注射液的报告集中在背部注射，但接受注射醋酸甲基强的松龙缓解如膝、肩和髋关节疼痛的患者也可能发生（感染）危险。据美国国立卫生研究院称，美国疾病控制中心（CDC）报道了两例接受类固醇注射治疗关节疼痛的患者可能已经发生真菌感染。一例来自密西根州，一例来自新罕布什尔州，美国女发言人说，他们是否感染真菌还需要时间确认。关节感染可能需较长时间才表现症状，较脊柱感染者很少发生死亡。

另外，美国食品药品监督管理局（FDA）称，在同一配方中心生产的其它两类药品涉及到脊髓膜炎病例，这可能与真菌感染有关。一例接受该中心心停搏液治疗的患者已发生感染，另一例接受类固醇氟羟泼尼松龙治疗的患者极可能发生髓膜炎。

FDA: More drugs may be linked to meningitis outbreak

3. 局部联合用药或可降低关节成形术、脊柱融合术后伤口感染风险

根据ID Week2012年会议上报告的资料显示，术前鼻用莫匹罗星联合局部葡萄糖胺氯己定（CHG）可降低外科手术部位金黄的葡萄球菌感染的风险。

该研究团队开展了一项开放标签、随机试验，术前关节成形术或脊柱融合术患者接受局部CHG联合鼻用聚维酮碘（PI）或鼻用5天莫匹罗星软膏治疗，比较术后两种用药方法对SSI的影响。研究者发现， 聚维酮碘组发生深部金黄色葡萄球菌SSI的比例是1/887（887次手术中有1次发生感染），而莫匹罗星组比例是5/879。另外，聚维酮碘组发生1例浅表金黄葡萄球菌SSI，而莫匹罗星组无感染病例。

IDweek是由美国传染病学会、美国医疗保健流行病学学会、艾滋病医学学会和儿科传染病学会召开的联合会议。

LB-3. Preventing Staphylococcus aureus Surgical Site Infections: an Open-label, Randomized Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

4.《 新英格兰医学杂志》一评论文章谈髓膜炎疫情

在2012年10月19日出版的《新英格兰医学杂志》上发表的一篇评论谈到，真菌（感染）与近期受污染的甲泼尼龙注射的报告有关，而且暴发了200多例髓膜炎。该评论作者建议，应警告患者向医生报告任何新发的头痛、颈项僵直、畏光、发热或类中风症状。他们指出，中枢神经系统（CNS）真菌感染的症状比常见的细菌性脑膜炎的症状更敏感，因此建议，提示可能CNS真菌感染的任何症状一旦出现，行腰椎穿刺术。作者认为，无症状患者不应该做腰椎穿刺术或关节吸引术，但一旦出现症状，应立刻告知医生。

Fungal Infections Associated with Contaminated Methylprednisolone Injections — Preliminary Report

5. NASS：硬膜外类固醇注射与椎体骨折风险增加有关

北美脊柱年会上（NASS）报告的数据提示，使用硬膜外类固醇注射（ESI）治疗背痛的患者发生椎体骨折的可能性较大。该研究团队回顾性研究了2007-2010年6000例治疗背痛的患者，其中3840例女性，2160例男性，平均年龄66岁。一半患者接受至少一次类固醇注射，另一半患者不接受。研究者分析每组骨折发生率时发现，每注射一次类固醇，骨折风险增加29%。

Steroid Injection Linked to Increased Risk of Bone Fractures

6.计算机辅助与传统全膝关节置换术疗效相似

A study published in the Nov. 21 issue of the Journal of Bone and Joint Surgery—American (JBJS-A) finds no difference in clinical function, alignment, or survivorship of the knees of patients who underwent computer-navigated total knee arthroplasty (TKA) and those who underwent conventional TKA. The authors conducted a prospective randomized trial of 520 patients with osteoarthritis who underwent computer-navigated total knee arthroplasty for one knee and conventional total knee arthroplasty for the other. At 10.8-year follow-up, they found no significant differences between groups in the areas of total knee scores, knee function scores, pain scores, WOMAC scores, knee motion, and activity scores, and alignment and survivorship of the components were not statistically different across groups.

A related commentary in the same issue of JBJS—A discusses the findings of the study and points out that the skill set of the surgeon is important to the outcomes described. The authors recommend that, because individual results may vary among orthopaedic surgeons, the choice to use the computer as a surgical tool should not be based on data from any single study.

7.运动损伤者膝软骨修复自体骨软骨移植较微骨折术好

Findings from a study published in the November issue of the American Journal of Sports Medicine suggest that the osteochondral autologous transplantation (OAT) technique for repair of articular cartilage defect (ACD) or osteochondral defect (OCD) in the knee may allow athletes a higher rate of return to and maintenance of sports at preinjury levels compared with microfracture (MF). The research team conducted a randomized controlled trial of 60 athletes with symptomatic ACD or OCD in the knee. At 10-year follow-up, there were 4 failures (14 percent) in the OAT group and 11 failures (38 percent) in the MF group. In addition, the ICRS and Tegner scores of athletes younger than 25 years at the time of primary surgery remained significantly higher after 10 years compared with older patients, and 15 of 20 patients (75 percent) in the OAT group and 8 of 22 patients (37 percent) in the MF group maintained the same physical activity level.

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8.随访12年，前十字韧带重建的开放式手术和内镜手术疗效相似

Study data published in the November issue of the American Journal of Sports Medicine suggest that open reconstruction of the anterior cruciate ligament (ACL) may not increase risk of functional problems or osteoarthritis (OA), compared to endoscopic repair. The authors conducted a randomized, controlled trial of 67 patients with subacute or chronic rupture of the ACL. Patients were randomly assigned to open (n = 33) or endoscopic (n = 34) reconstruction. Of 53 patients evaluated at 12-year follow-up, no significant differences were found between the 2 surgical procedures with respect to pain, function, muscle strength, hop test, patellar height, or prevalence of OA. However, the authors noted a greater prevalence of OA in the tibiofemoral joint on the operated side compared to uninvolved knees

9.紫外线消毒、去菌落化可降低医院获得性感染

An article published in the Journal of the American Medical Association summarizes findings from two studies on hospital-acquired infection (HAI) presented at the annual scientific meeting of the Infectious Diseases Society of America. The first study examined the efficacy of using a robot that emits ultraviolet (UV) light to disinfect hospital rooms after a patient infected with Clostricium difficile, Acinetobacter, or Vancomycin-resistant Enterococcus (VRE) was discharged. The researchers found that, in rooms that had housed patients with VRE or Acinetobacter, there was a more than 90 percent reduction in colony-forming units of VRE or Acinetobacter after UV treatment, and no environmental samples taken from UV-treated rooms that housed patients with C. difficile yielded cultures of the organism.

A second study assigned 43 hospitals to one of three cohorts: screen and isolate intensive care unit (ICU) patients who tested positive for methicillin-resistant Staphylococcus aureus (MRSA), screen and perform targeted decolonization of patients who tested positive for MRSA, or decolonize all ICU patients without screening. The researchers found that universal decolonization was most effective at reducing MRSA infections in the ICU, with a 37 percent reduction in the risk of MRSA colonization and a 44 percent reduction in bloodstream infections.

10.自体条件血浆比透明质酸治疗膝关节病疗效好

According to data from an Italian study published in the December issue of the American Journal of Sports Medicine, autologous conditioned plasma (ACP) may offer better clinical outcomes than hyaluronic acid (HA) for the treatment of gonarthrosis. The authors conducted a randomized, controlled trial of 120 patients affected by clinically and radiographically documented gonarthrosis. Overall, 60 patients received 4 intra-articular injections of ACP while 60 patients received 4 intra-articular injections of HA. Researchers found that treatment with a local injection of ACP was linked to significant improvement on Western Ontario and McMaster (WOMAC) score shortly after final infiltration, and a continuously improving sustained effect up to 24 weeks, at which point clinical outcomes were better compared with the results with HA. For patients in the HA group, the worst results were obtained for grade III gonarthrosis. Clinical results obtained in the ACP group did not show any statistically significant difference in terms of the grade of gonarthrosis.