Email Alert | RSS

北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (5): 850-856. doi: 10.19723/j.issn.1671-167X.2021.05.007

• 论著 • 上一篇    下一篇

前交叉韧带重建术后膝关节感染的诊断和治疗策略

王成1,孟令宇2,陈拿云1,李玳1,王健全1,敖英芳1,△()   

  1. 1.北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191
    2.北京大学基础医学院,北京 100191
  • 收稿日期:2021-06-02 出版日期:2021-10-18 发布日期:2021-10-11
  • 通讯作者: 敖英芳 E-mail:aoyingfang@163.com

Management algorithm for septic arthritis after anterior cruciate ligament reconstruction

WANG Cheng1,MENG Ling-yu2,CHEN Na-yun1,LI Dai1,WANG Jian-quan1,AO Ying-fang1,△()   

  1. 1. Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
    2. Peking University School of Basic Medical Sciences, Beijing 100191, China
  • Received:2021-06-02 Online:2021-10-18 Published:2021-10-11
  • Contact: Ying-fang AO E-mail:aoyingfang@163.com

RICH HTML

 16   

PDF (PC)

286

摘要：

目的: 探讨关节镜下前交叉韧带重建术后膝关节感染的临床诊断和治疗策略。方法: 选择2001年1月至2020年12月在北京大学第三医院运动医学科行关节镜下前交叉韧带重建手术且术后发生膝关节感染的病例进行回顾性分析。通过对患者术后关节感染的发病过程、临床特征、试验室检查、治疗方法及随访结果进行分析,探讨最佳的临床诊断和治疗策略。结果: 20年间关节镜下前交叉韧带重建手术共27 867例,术后膝关节感染65例,感染率0.23%。临床表现有体温增高[(38.7±0.5) ℃]、膝关节肿痛、关节活动度受限。细菌培养阳性率 69.2%,其中凝固酶阴性葡萄球菌(占75.6%)、金黄色葡萄球菌(占15.6%)最常见。保守治疗组(16例)和手术治疗组(49例)均能有效控制感染,但保守治疗组体温恢复较慢(保守治疗组5.6 d,手术治疗组1.6 d,P=0.042)。结论: 前交叉韧带重建术后膝关节感染是一种发生率低,但后果严重的并发症,临床诊断建议及早进行关节腔穿刺和病原学检查,一旦确诊,建议尽早进行关节镜清理手术,并给予有效抗生素治疗。

关键词: 前交叉韧带, 重建, 并发症, 关节感染, 诊治策略

Abstract:

Objective: To summarize the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction. Methods: A retrospective review was conducted of all the arthroscopic anterior cruciate ligament reconstructions performed at Department of Sports Medicine, Peking University Third Hospital between January 2001 and December 2020. In the study, 65 of 27 867 patients experienced postoperative septic arthritis. The incidence, presentation, laboratory results, treatment, and outcome of all the infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized. Results: A total of 27 867 anterior cruciate ligament reconstructions were performed at our department between January 2001 and December 2020. In the study, 65 (0.23%) patients were identified with postoperative septic arthritis. The most common symptoms of the infected patients were fever (38.7±0.5) ℃, knee swelling, pain, and restricted motion. The mean peripheral white blood cell count (WBC) was (9.2±2.6)×109/L (range 4.2×109/L-19.4×109/L), with (72.5±6.3) % (range 54.9%-85.1%) polymorphonuclear neutrophils (N). The mean erythrocyte sedimentation rate (ESR) was (59.9±24.1) mm/h (range 9-108 mm/h), C-reactive protein (CRP) was (10.9±5.7) mg/dL (range 1.2-30.8 mg/dL), and fibrinogen (FIB) level was (7.0±1.6) g/L (range 3.7-10.8 g/L). All of the laboratory results were statistically higher in the infection group compared with the normal postoperative group (P<0.001). The synovial white blood cell count (SWBC) of aspirated knee joint fluid was (45.0±29.8)×109/L (range 7.1×109-76.5×109/L). Polymorphonuclear cell percentage (PMNC) was (90.27±7.86) % (range 60%-97%). In the study, 45 patients (69.2%) had positive aspirate cultures. Microbiology showed coagulase-negative Staphylococcus (CNS) and Staphylococcus aureus (SA) were the most common bacterium (34 cases and 7 cases, individually). There were 26 methicillin-resistant Staphylococcus. Both conservative (16 patients) and operative (49 patients) treatments were effective, but conservative group had a longer recovery time (5.6 d vs. 1.6 d, P=0.042). Conclusion: Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on synovial fluid analysis and bacterial culture. Our proposed treatment protocol is arthroscopic debridement and antibiotic therapy as quickly as possible.

Key words: Anterior cruciate ligament, Reconstruction, Complication, Septic arthritis, Management algorithm

中图分类号: 

  • R687

表1

24例ACLR正常术后患者和65例术后关节感染患者血液检查结果"

Items Normal Normal postoperative patients Infectious patients P
WBC/(×109/L) 4-10 6.9±1.8
(4.5-10.5) 9.2±2.6
(4.2-19.4) <0.001
N/% 50-70 60.9±5.1
(53.2-69.2) 72.5±6.3
(54.9-85.1) <0.001
ESR/(mm/h) 0-15 27.5±12.8
(7-44) 59.9±24.1
(9-108) <0.001
CRP/(mg/dL) 0-0.8 2.2±1.8
(0.3-5.6) 10.9±5.7
(1.2-30.8) <0.001
FIB/(g/L) 2-4 5.8±1.1
(4.3-8.0) 7.0±1.6
(3.7-10.8) <0.001

图1

感染治疗后各项感染指标变化趋势"

表2

前交叉韧带重建术后膝关节感染的发生率"

Literature Publication year Period /years Total number of ACLR patients Total number of infected cases Infected rate/%
Williams, et al[2] 1997 5 2 500 7 0.28
McAllister, et al[3] 1999 11 831 4 0.48
Viola, et al[4] 2000 6 1 794 14 0.78
Indelli, et al[5] 2002 6 3 500 5 0.14
Schollin-Borg, et al[6] 2003 3 575 10 1.74
Burks, et al[7] 2003 11 1 918 8 0.42
Fong, et al[8] 2004 3 472 7 1.48
Musso, et al[9] 2005 5 1 094 11 1.01
Judd, et al[11] 2006 8 1 615 11 0.68
Van Tongel, et al[13] 2007 9 1 736 15 0.86
Schulz, et al[14] 2007 10 513 4 0.78
Binnet, et al[12] 2007 18 1 231 6 0.49
Katz, et al[15] 2008 5 801 6 0.75
Iorio, et al[16] 2008 6 1 052 8 0.76
Wang, et al[17] 2009 11 4 068 21 0.52
Sajovic, et al[18] 2009 11 1 283 3 0.23
Nag, et al[19] 2009 9 1 152 26 2.26
Barker, et al[21] 2010 5 3 126 18 0.58
Monaco, et al[20] 2010 8 1 232 12 0.97
Benner, et al[22] 2011 27 5 364 13 0.24
Sonnery-Cottet, et al[23] 2011 5 1 957 12 0.61
Vertullo, et al[24] 2012 7 1 135 4 0.35
Schub, et al[25] 2012 11 831 4 0.48
Torres-Claramunt, et al[26] 2013 3 810 15 1.85
Risti c ', et al[27] 2014 1 425 17 1.19
Abdel-Aziz, et al[28] 2014 7 2 560 24 0.94
Boström, et al[29] 2014 8 4 384 43 0.98
Calvo, et al[30] 2014 11 1 564 7 0.45
Schuster, et al[31] 2015 10 7 096 36 0.51
Hantes, et al[33] 2017 12 1 242 7 0.56
Pérez-Prieto, et al[32] 2017 4 810 15 1.85
Our study 2021 20 27 867 65 0.23
Total - - 87 538 458 0.52

图2

ACLR术后膝关节感染诊断和治疗策略"

[1] Murawski CD, Wolf MR, Araki D, et al. Anatomic anterior cruciate ligament reconstruction: current concepts and future perspective [J]. Cartilage, 2013, 4(3):27S-37S.
doi: 10.1177/1947603513486557
[2] Williams RJ, Laurencin CT, Warren RF, et al. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management [J]. Am J Sports Med, 1997, 25(2):261-267.
doi: 10.1177/036354659702500222
[3] McAllister DR, Parker RD, Cooper AE, et al. Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction [J]. Am J Sports Med, 1999, 27(5):562-570.
doi: 10.1177/03635465990270050301
[4] Viola R, Marzano N, Vianello R. An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function [J]. Arthroscopy, 2000, 16(2):173-177.
pmid: 10705329
[5] Indelli PF, Dillingham M, Fanton G, et al. Septic arthritis in postoperative anterior cruciate ligament reconstruction [J]. Clin Orthop Relat Res, 2002, 398:182-188.
doi: 10.1097/00003086-200205000-00026
[6] Schollin-Borg M, Michaёlsson K, Rahme H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study [J]. Arthroscopy, 2003, 19(9):941-947.
pmid: 14608312
[7] Burks RT, Friederichs MG, Fink B, et al. Treatment of post-operative anterior cruciate ligament infections with graft removal and early reimplantation [J]. Am J Sports Med, 2003, 31(3):414-418.
doi: 10.1177/03635465030310031501
[8] Fong SY, Tan JL. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction [J]. Ann Acad Med Singap, 2004, 33(2):228-234.
pmid: 15098639
[9] Musso AD, McCormack RG. Infection after ACL reconstruction: what happens when cultures are negative [J]. Clin J Sport Med, 2005, 15(5):381-384.
pmid: 16162999
[10] Zalavras CG, Patzakis MJ, Tibone J, et al. Treatment of persistent infection after anterior cruciate ligament surgery [J]. Clin Orthop Relat Res, 2005, 439:52-55.
doi: 10.1097/01.blo.0000181499.49740.e5
[11] Judd D, Bottoni C, Kim D, et al. Infections following arthroscopic anterior cruciate ligament reconstruction [J]. Arthroscopy, 2006, 22(4):375-384.
doi: 10.1016/j.arthro.2005.12.002
[12] Binnet MS, Basarir K. Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction techniques [J]. Arthroscopy, 2007, 23(8):862-868.
doi: 10.1016/j.arthro.2007.02.008
[13] Van Tongel A, Stuyck J, Bellemans J, et al. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, management and outcome [J]. Am J Sports Med, 2007, 35(7):1059-1063.
doi: 10.1177/0363546507299443
[14] Schulz AP, Götze S, Schmidt HG, et al. Septic arthritis of the knee after anterior cruciate ligament surgery: a stage-adapted treatment regimen [J]. Am J Sports Med, 2007, 35(7):1064-1069.
doi: 10.1177/0363546507299744
[15] Katz LM, Battaglia TC, Patino P, et al. A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft [J]. Arthroscopy, 2008, 24(12):1330-1335.
doi: 10.1016/j.arthro.2008.07.015
[16] Iorio R, Vadalà A, Di VI, et al. Tunnel enlargement after anterior cruciate ligament reconstruction in patients with post-operative septic arthritis [J]. Knee Surg Sports Traumatol Arthrosc, 2008, 16(10):921-927.
doi: 10.1007/s00167-008-0575-1
[17] Wang C, Ao Y, Wang J, et al. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause [J]. Arthroscopy, 2009, 25(3):243-249.
doi: 10.1016/j.arthro.2008.10.002
[18] Sajovic M, NiCAGL , Dernovš EMZ. Septic arthritis of the knee following anterior cruciate ligament reconstruction [J]. Orthop Rev (Pavia), 2009, 1(1):e3.
[19] Nag HL, Neogi DS, Nataraj AR, et al. Tubercular infection after arthroscopic anterior cruciate ligament reconstruction [J]. Arthroscopy, 2009, 25(2):131-136.
doi: 10.1016/j.arthro.2008.09.009
[20] Monaco E, Maestri B, Labianca L, et al. Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction [J]. J Orthop Sci, 2010, 15(2):198-203.
doi: 10.1007/s00776-009-1447-3
[21] Barker JU, Drakos MC, Maak TG, et al. Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction [J]. Am J Sports Med, 2010, 38(2):281-286.
doi: 10.1177/0363546509346414
[22] Benner RW, Shelbourne KD, Freeman H. Infections and patellar tendon ruptures after anterior cruciate ligament reconstruction: a comparison of ipsilateral and contralateral patellar tendon autografts [J]. Am J Sports Med, 2011, 39(3):519-525.
doi: 10.1177/0363546510388163
[23] Sonnery-Cottet B, Archbold P, Zayni R, et al. Prevalence of septic arthritis after anterior cruciate ligament reconstruction among professional athletes [J]. Am J Sports Med, 2011, 39(11):2371-2376.
doi: 10.1177/0363546511417567 pmid: 21856928
[24] Vertullo CJ, Quick M, Jones A, et al. A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction [J]. Arthroscopy, 2012, 28(3):337-342.
doi: 10.1016/j.arthro.2011.08.301
[25] Schub DL, Schmitz LM, Sakamoto FA, et al. Long-term outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction [J]. Am J Sports Med, 2012, 40(12):2764-2770.
doi: 10.1177/0363546512461903
[26] Torres-Claramunt R, Pelfort X, Erquicia J, et al. Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes [J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(12):2844-2849.
doi: 10.1007/s00167-012-2264-3
[27] RisticV , Maljanovic M, Harhaji V, et al. Infections after reconstructions of anterior cruciate ligament [J]. Med Pregl, 2014, 67(1/2):11-15.
doi: 10.2298/MPNS1402011R
[28] Abdel-Aziz A, Radwan YA, Rizk A. Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case-control study [J]. Int Orthop, 2014, 38(1):73-82.
doi: 10.1007/s00264-013-2123-y pmid: 24100920
[29] Boström WH, Mikkelsen C, Forssblad M, et al. Postoperative septic arthritis after anterior cruciate ligament reconstruction: does it affect the outcome? a retrospective controlled study [J]. Arthroscopy, 2014, 30(9):1100-1109.
doi: 10.1016/j.arthro.2014.03.019
[30] Calvo R, Figueroa D, Anastasiadis Z, et al. Septic arthritis in ACL reconstruction surgery with hamstring autografts. eleven years of experience [J]. Knee, 2014, 21(3):717-720.
doi: 10.1016/j.knee.2014.01.007
[31] Schuster P, Schulz M, Immendoerfer M, et al. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: evaluation of an arthroscopic graft-retaining treatment protocol [J]. Am J Sports Med, 2015, 43(12):3005-3012.
doi: 10.1177/0363546515603054 pmid: 26403209
[32] Pérez-Prieto D, Trampuz A, Torres-Claramunt R, et al. Infections after anterior cruciate ligament reconstruction: which antibiotic after arthroscopic debridement? [J]. J Knee Surg, 2017, 30(4):309-313.
doi: 10.1055/s-0036-1584559 pmid: 27367205
[33] Hantes ME, Raoulis VA, Doxariotis N, et al. Management of septic arthritis after arthroscopic anterior cruciate ligament reconstruction using a standard surgical protocol [J]. Knee, 2017, 24(3):588-593.
doi: 10.1016/j.knee.2017.02.007
[34] Torres-Claramunt R, Gelber P, Pelfort X, et al. Managing septic arthritis after knee ligament reconstruction [J]. Int Orthop, 2016, 40(3):607-614.
doi: 10.1007/s00264-015-2884-6 pmid: 26239533
[35] Wang C, Lee YH, Siebold R. Recommendations for the management of septic arthritis after ACL reconstruction [J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(9):2136-2144.
doi: 10.1007/s00167-013-2648-z
[36] Muscolo DL, Carbo L, Aponte-Tinao LA, et al. Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction [J]. Clin Orthop Relat Res, 2009, 467(9):2420-2425.
doi: 10.1007/s11999-009-0714-0
[37] Wang C, Ao Y, Fan X, et al. C-reactive protein and erythrocyte sedimentation rate changes after arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection [J]. Arthroscopy, 2014, 30(9):1110-1115.
doi: 10.1016/j.arthro.2014.03.025
[38] Paci JM, Schweizer SK, Wilbur DM, et al. Results of laboratory evaluation of acute knee effusion after anterior cruciate ligament reconstruction: what is found in patients with a noninfected, painful postoperative knee [J]. Am J Sports Med, 2010, 38(11):2267-2272.
doi: 10.1177/0363546510374573
[1] 李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报（医学版）, 2022, 54(1): 177-181.
[2] 印钰,梅宇,王泽刚,宋首一,刘鹏飞,何鹏峰,武文杰,谢兴. 固定袢和可调节袢在粗骨道中的长度对股骨骨道增宽及膝关节功能的影响[J]. 北京大学学报（医学版）, 2021, 53(5): 883-890.
[3] 苗欣,黄红拾,胡晓青,时会娟,任爽,敖英芳. 膝关节前交叉韧带断裂后单腿位置觉测试时脑电功率谱的变化特征[J]. 北京大学学报（医学版）, 2021, 53(5): 871-876.
[4] 任爽,时会娟,张家豪,刘振龙,邵嘉艺,朱敬先,胡晓青,黄红拾,敖英芳. 前交叉韧带重建术后移植物应力的有限元分析[J]. 北京大学学报（医学版）, 2021, 53(5): 865-870.
[5] 蒋艳芳,王健,王永健,刘佳,裴殷,刘晓鹏,敖英芳,马勇. 前交叉韧带翻修重建术后中长期临床疗效及影响因素[J]. 北京大学学报（医学版）, 2021, 53(5): 857-863.
[6] 耿志宇,高为华,王东信. 全身麻醉气管插管患者术后声带运动不良的临床结局[J]. 北京大学学报（医学版）, 2021, 53(2): 337-340.
[7] 王怡平,蔡志刚,彭歆,张杰,孙志鹏,李巍,张雷,俞光岩. 下颌下腺质量和体积的实体体外检测[J]. 北京大学学报（医学版）, 2021, 53(1): 126-132.
[8] 唐祖南,Hui Yuh Soh,胡耒豪,于尧,章文博,彭歆. 混合现实技术在口腔颌面部肿瘤手术中的应用[J]. 北京大学学报（医学版）, 2020, 52(6): 1124-1129.
[9] 董文敏,王明瑞,胡浩,王起,许克新,徐涛. Allium覆膜金属输尿管支架长期留置治疗输尿管-回肠吻合口狭窄的初期临床经验及随访结果[J]. 北京大学学报（医学版）, 2020, 52(4): 637-641.
[10] 高健,胡立宝,陈尘,郅新,徐涛. 经皮肾镜去石术后出血的介入治疗[J]. 北京大学学报（医学版）, 2020, 52(4): 667-671.
[11] 郑蒙蒙,丁光璞,朱伟杰,杨昆霖,樊书菠,关豹,李新飞,蔡宇坤,张进生,李学松,周利群. 术前三维影像重建在治疗肾盂输尿管连接部梗阻中的应用[J]. 北京大学学报（医学版）, 2020, 52(4): 705-710.
[12] 王顺吉,章文博,于尧,谢晓艳,杨宏宇,彭歆. 术前虚拟设计在股前外侧皮瓣修复口腔颌面部缺损中的应用[J]. 北京大学学报（医学版）, 2020, 52(1): 119-123.
[13] 马凯,曲星珂,许清泉,熊六林,叶雄俊,安立哲,陈伟男,黄晓波. 肾移植术后移植肾输尿管膀胱吻合口狭窄的腔内治疗:13例报道[J]. 北京大学学报（医学版）, 2019, 51(6): 1155-1158.
[14] 洪洪,钱宇婷,付磊,王武,李成辉,尹毅青. 困难气道中运用CT 三维重建技术指导硬质纤维气管镜行气管插管[J]. 北京大学学报（医学版）, 2019, 51(5): 870-874.
[15] 齐伟,李健男,赵静仁,邢海霞,潘洁. 角形切口设计和愈合方式与下颌阻生智齿拔除术后并发症[J]. 北京大学学报（医学版）, 2019, 51(5): 949-953.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究（英文稿）[J]. 北京大学学报（医学版）, 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报（医学版）, 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报（医学版）, 2009, 41(2): 135 -140 .
[4] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报（医学版）, 2009, 41(2): 158 -161 .
[5] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报（医学版）, 2009, 41(2): 217 -220 .
[6] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报（医学版）, 2009, 41(1): 52 -55 .
[7] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报（医学版）, 2009, 41(1): 109 -111 .
[8] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报（医学版）, 2009, 41(3): 297 -301 .
[9] Jian-wei GU, Emily YOUNG, Zhi-jun PAN, Kevan B. TUCKER, Megan SHPARAGO, Min HUANG, Amelia Purser BAILEY. SD大鼠长期高盐饮食可导致其高血压并改变肾细胞因子基因表达谱[J]. 北京大学学报（医学版）, 2009, 41(5): 505 -515 .
[10] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报（医学版）, 2009, 41(5): 599 -601 .
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部