目的 探讨肾移植患者非结核分枝杆菌（NTM）病临床特点及分子诊断。 方法 回顾性分析2011年4月1例皮肤软组织NTM感染的肾移植患者的临床特点，并以其病变组织DNA为模板，聚合酶链反应（PCR）扩增hsp65基因和rpoB基因序列，测序比对鉴定其NTM菌种。结合文献复习NTM病及分析分子生物学技术在移植患者NTM感染诊断中的作用。 结果 该肾移植患者系皮肤软组织胞内分枝杆菌感染，临床特点与结核病极其相似，难以进行鉴别诊断。PCR扩增、测序的结果显示hsp65产物和rpoB产物序列与胞内分枝杆菌GeneBank中FJ643456.1及CP003324.1序列100%一致。 结论 NTM病的临床表现与结核病相似，分子生物学方法鉴定菌种对移植患者胞内分枝杆菌病的诊断有帮助。
Objective To discuss skills for the treatment of complex soft tissue problems in osteomyelitis using Ilizarov techniques. Methods The clinical data of 31 patients with complex soft tissue problems during the treatment of osteomyelitis with Ilizarov technique between January 2015 and June 2017 were retrospectively analyzed. There were 23 males and 8 females, with an age of 14-67 years (mean, 37.8 years). All the patients were post-traumatic chronic osteomyelitis, the disease duration was 12 days to 16 months (mean, 6.3 months). They went through 2-8 times surgeries (mean, 3.8 times). There were 29 cases of soft tissue insertion after bone grafting; 1 case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect; 1 case of the open tibial fracture postoperative infection, the skin defect of infection was more than that of bone defect. The soft tissue defect area was 4.5 cm×4.0 cm to 16.5 cm×8.5 cm. Soft tissue depression and insertion was corrected by subcutaneous insertion of Kirschner wire after slow elastic retraction. Soft tissue defects were gradually resolved through slow traction. Results All patients were followed up 6-24 months (mean, 11.5 months). All wounds healed by first intention, and skin graft and flap repair were not performed in the two stage. One case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect was treated with slow skin traction, no secondary suture was performed; no skin ulceration was found after walking for 3 months, and the feeling was slightly lower than normal. One case of soft tissue transverse traction wound completely covered, with no bone exposure and no obvious pigmentation of local soft tissue, the feeling was slightly lower than normal, the skin elasticity was worse than normal, and the color, temperature had no obvious abnormalities. There was no severe needle eye reactions in 29 patients with skin depressions corrected by Kirschner wire. Six cases of Kirschner wire showed elastic retraction and lacerate skin; 1 case of plantar skin traction had 2 times of exudation of the needle eye and local skin reddish phenomenon; the symptoms relieved when the traction needle was changed once, the traction was stopped for 1 week, the dressing was changed and antibiotics were used once. One patient with transverse traction had 3 times of pin-eye infection, and the treatment was completed after adjusting the traction device and symptomatic treatment. Conclusion For most of the complex soft tissue problems in osteomyelitis, early and effective intervention with Ilizarov technique can be easily, economically, and effectively solved, which provides a new way for clinical treatment.