Objective To summarize the characteristic manifestations in the middle and old aged people with meniscus injury and the outcome of the treatment under the arthroscope. Methods Fifty-two patients, aged 52-58 years, with meniscus injury to a total of 57 knee joints, were diagnosed and treated under the arthroscope. The history of their knee diseases was 1-21 years. Horizontal tearsoccurred in 19 knee joints, degenerative tears in 13 knee joints, complex tears in 9 knee joints, longitudinal tears in 5 knee joints, oblique tears in 4 knee joints, radial tears in 4 knee joints, and flap tears in 3 knee joints. Three meniscus tears were sutured and 54 meniscus tears were cut fully or partly under thearthroscope. Results All the postoperative patients were followed up for 6-15 months, and the average follow-up period after operation was 9 months. According to the DONG Tianxiang’s standards for the therapy under the arthroscope, the excellent result was achieved in 39 knee joints, good in 12 knee joints, and fair in 6 knee joints, with no failure. The excellent and good rate was 89.5%. Conclusion The clinical manifestations of meniscus injury are not typical in the middle and old aged people. The therapeutic effect with the help of the arthroscope is satisfactory with an advantage of minimal traumatic invasiveness to the knee joint.
摘要:目的:探讨老年耐亚胺培南铜绿假单胞菌(IRPA)感染的危险因素以指导临床救治。 方法:采用病例对照研究,选取四川省人民医院干部科2006年1月~2008年12月IRPA院内感染老年患者32例,并随机选择同时期敏感铜绿假单胞菌院内感染48例作为对照,采用单因素(t检验,χ2检验)及多因素Logistic回归进行分析。结果:IRPA分离率为34.8%,IRPA对抗生素的耐药性远远高于敏感铜绿假单胞菌组,但对阿米卡星敏感率达81.3%。单因素分析发现,下列因素与IRPA感染有关:高龄、住院时间≥4周、高急性生理和慢性健康状况(APACHEⅡ)评分、慢性肺部疾病(慢性阻塞性肺疾病COPD/支气管扩张)、分离出IRPA前2周用过亚胺培南/美罗培南、早期联用抗生素、院内获得性肺炎(HAP)。多因素Logistic回归分析表明:长程住院［比值比(OR)= 14.887］,APACHEⅡ评分≥16分(OR=38.908)以及分离出IRPA前2周用过亚胺培南/美罗培南(OR =12.945)是IRPA感染的独立危险因素。结论:长程住院、APACHEⅡ评分≥16分以及亚胺培南/美罗培南的使用是IRPA感染的危险因素。IRPA对阿米卡星敏感率相对较高,但治疗难度大。Abstract: Objective: To study the infection status and risk factors of nosocomial infection caused by imipenemresistant Pseudomonas aeruginosa (IRPA) in elderly patients. Methods: By a casecontrol study, the data of 32 cases of IRPA nosocomial infections were analyzed from Jan. 2006. to Dec. 2008 in cadres Ward of Sichuan Provincial People’s Hospital; 48 cases of Imipenemsensitive pseudomonas aeruginosa infection were randomized as control. Univariate analysis (T test and chisquare test )and multivariate logistic regression analysis were used for statistics. Results: The resistance to antibiotics of IRPA is much higher than the sensitive group.81.3％ of IRPA were sensitive to amikacin. According to univariate analysis,the factors associated with the infection caused by IRPA were age, length of stay in hospital more than 4 weeks, high score of APACHEⅡ, chronic pulmonary disease (COPD/bronchiectasis),imipenem/meropenem used 2 weeks before isolation of IRPA, early combination therapy of antibiotics and hospital acquired pneumonia (HAP). Multivariate logistic regression analysis identified three independent factors: Length of stay in hospital more than 4 weeks, APACHEⅡ score≥16 and imipenem/meropenem used 2 weeks before isolation of IRPA. Conclusion: Long length of stay in hospital, APACHEⅡ score ≥16 and previous imipenem/meropenem use were independent risk factors for IRPA infection. Although the sensitivity of IRPA to amikacin was relatively high, it was difficult to treat in clinical practice.