慢性骨髓炎的诊断与治疗研究进展

doi:10.24920/003493

摘要/Abstract

摘要：

我们回顾了慢性骨髓炎相关的代表性文献,总结近年来对其诊断方法和治疗方案的新见解,分析各种诊断方法和治疗策略的优缺点,并提出了一些有兴趣的领域,以使当前的诊断和治疗策略更加具体。

Abstract:

We review the representatives literatures on chronic osteomyelitis, sum up the new insights in recent years into diagnostic options and treatment regimens, analyze the advantages and disadvantages of various diagnostic approaches and treatment strategies, and propose areas of interest to make current diagnostic and treatment strategies more specific.

Key words: bone infection, chronic osteomyelitis, diagnosis, treatment

Wu Ziquan, Zeng Delu, Yao Jiangling, Bian Yangyang, Gu Yuntao, Meng Zhulong, Fu Jian, Peng Lei. Research Progress on Diagnosis and Treatment of Chronic Osteomyelitis[J].Chinese Medical Sciences Journal, 2019, 34(3): 211-220.

图/表 1

参考文献 81.

1.	McKee MD, Li-Bland EA, Wild LM , et al. A prospective, randomized clinical trial comparing an antibiotic-impregnated bioabsorbable bone substitute with standard antibiotic-impregnated cement beads in the treatment of chronic osteomyelitis and infected nonunion. J Orthop Trauma 2010; 24(8):483-90. doi: 10.1097/BOT.0b013e3181df91d9.
2.	Hung DZ, Tien N, Lin CL , et al. Increased risk of chronic osteomyelitis after hip replacement: a retrospective population-based cohort study in an Asian population. Eur J Clin Microbiol Infect Dis 2017; 36(4):611-7. doi: 10.1007/s10096-016-2836-0.
3.	Schmidt HG, Diefenbeck M, Krenn V , et al. Classification of haematogenous and post-traumatic osteomyelitis. Z Orthop Unfall 2014; 152(4):334-42. doi: 10.1055/s-0034-1368620.
4.	Felice JR, Herranz PG, Casado AM , et al. Chronic recurrent osteomyelitis: a diagnostic and therapeutic challenge. Rev Esp Cir Ortop Traumatol 2017; 61(1):35-42. doi: 10.1016/j.recot.2016.07.004.
5.	Wipff J, Costantino F, Lemelle I , et al. A large national cohort of French patients with chronic recurrent multifocal osteitis: prognostic factors, outcomes, and management of CRMO. Arthritis Rheumatol 2015; 67(4):1128-37. doi: 10.1002/art.39013.
6.	Lew DP, Waldvogel FA . Osteomyelitis. N Engl J Med 1997; 336(14):999-1007. doi: 10.1056/NEJM199704033361406.
7.	Ghanem E, Antoci V Jr, Pulido L , et al. The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and creactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty. Int J Infect Dis 2009; 13(6):e444-9. doi: 10.1016/j.ijid.2009.02.017.
8.	Yoon SH, Chung SK, Kim KJ , et al. Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J 2010; 19(4):575-82. doi: 10.1007/s00586-009-1216-1.
9.	Greidanus NV, Masri BA, Garbuz DS , et al. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg Am 2007; 89(7):1409-16. doi: 10.2106/JBJS.D.02602.
10.	Mouzopoulos G, Kanakaris NK, Kontakis G , et al. Management of bone infections in adults: the surgeon’s and microbiologist’s perspectives. Injury 2011; 42(Suppl 5):S18-23. doi: 10.1016/S0020-1383(11)70128-0.
11.	Pepys MB, Hirschfield GM . C-reactive protein: a critical update. J Clin Invest 2003; 111(12):1805-12. doi: 10.1172/JCI18921.
12.	Simon L, Gauvin F, Amre DK , et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39(2):206-17. doi: 10.1086/421997. doi: 10.1086/421997 pmid: 15307030
13.	Nijsten MW, Olinga P, The TH , et al. Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro. Crit Care Med 2000; 28(2):458-61. doi: 10.1097/00003246-200002000-00028.
14.	Butbul-aviel Y, Koren A, Halevy R , et al. Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis. Pediatr Emerg Care 2005; 21(12):828-32. doi: 10.1097/01.pec.0000190226.12610.24.
15.	Mutluo?lu M, Uzun G, ?pcio?lu OM , et al. Can procalcitonin predict bone infection in people with diabetes with infected foot ulcers? A pilot study. Diabetes Res Clin Pract 2011; 94(1):53-6. doi: 10.1016/j.diabres.2011.05.023.
16.	Michail M, Jude E, Liaskos C , et al. The performance of serum inflammatory markers for the diagnosis and follow-up of patients with osteomyelitis. Int J Low Extrem Wounds 2013; 12(2):94-9. doi: 10.1177/1534734613486152.
17.	Brandon JS, Grant SB, Franklin DS . A comparison of imaging modalities for the diagnosis of osteomyelitis. Marshall J Med 2016; 2(3):83-92. doi: 10.18590/mjm.2016.vol2.iss3.10.
18.	Adrian M, Anna N, Leszek K . Review of contemporary knowledge of osteomyelitis diagnosis. World Scientific News 2018; 92(2):272-82.
19.	York B, Cha J, Dao A , et al. Diagnosis: chronic osteomyelitis. Eplasty 2014; 14:ic8.
20.	Carek PJ, Dickerson LM, Sack JL . Diagnosis and management of osteomyelitis. Am Fam Physician 2001; 63(12):2413-20. doi: 10.1016/j.jmatprotec.2005.03.039.
21.	Hui CL, Naidoo P . Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis. Australas Radiol 2003; 47(4):443-6.
22.	Tehranzadeh J, Wong E, Wang F , et al. Imaging of osteomyelitis in the mature skeleton. Radiol Clin North Am 2001; 39(2):223-50. doi: 10.1016/S0033-8389(05)70275-X.
23.	Palestro CJ . FDG-PET in musculoskeletal infections. Semin Nucl Med 2013; 43(5):367-76. doi: 10.1053/j.semnuclmed.2013.04.006.
24.	Termaat MF, Raijmakers PG, Scholten HJ , et al. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87(11):2464-71. doi: 10.2106/JBJS.D.02691.
25.	Pineda C, Espinosa R, Pena A . Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg 2009; 23(2):80-9. doi: 10.1055/s-0029-1214160.
26.	Von Kalle T, Heim N, Hospach T , et al. Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO). Rofo 2013; 185(7):655-61. doi: 10.1055/s-0033-1335283.
27.	Roderick M, Shah R, Finn A , et al. Efficacy of pamidronate therapy in children with chronic non-bacterial osteitis: disease activity assessment by whole body magnetic resonance imaging. Rheumatology 2014; 53(11):1973-6. doi: 10.1093/rheumatology/keu226. doi: 10.1093/rheumatology/keu226
28.	Fritz J . The contributions of whole-body magnetic resonance imaging for the diagnosis and management of chronic recurrent multifocal osteomyelitis. J Rheumatol 2015; 42(8):1359-60. doi: 10.3899/jrheum.150676.
29.	Berkowitz YJ, Greenwood SJ, Cribb G , et al. Complete resolution and remodeling of chronic recurrent multifocal osteomyelitis on MRI and radiographs. Skeletal Radiol 2018; 47(4):563-8. doi: 10.1007/s00256-017-2812-5.
30.	Bohndorf K . Infection of the appendicular skeleton. Eur Radiol 2004; 14(Suppl 3):E53-63. doi: 10.1007/s00330-003-2039-9.
31.	Palestro CJ . Radionuclide imaging of osteomyelitis. Semin Nucl Med 2015; 45(1):32-46. doi: 10.1053/j.semnuclmed.2014.07.005.
32.	Love C, Palestro CJ . Nuclear medicine imaging of bone infections. Clin Radiol 2016; 71(7):632-46. doi: 10.1016/j.crad.2016.01.003.
33.	Gross T, Kaim AH, Regazzoni P , et al. Current concepts in posttraumatic osteomyelitis: a diagnostic challenge with new imaging options. J Trauma 2002; 52(6):1210-9. doi: 10.1097/00005373-200206000-00032.
34.	Horger M, Eschmann SM, Pfannenberg C , et al. The value of SPET/CT in chronic osteomyelitis. Eur J Nucl Med Mol Imaging 2003; 30(12):1665-73. doi: 10.1007/s00259-003-1321-z.
35.	Beckbroichsitter BE, Smeets R, Heiland M . Current concepts in pathogenesis of acute and chronic osteomyelitis. Curr Opin Infect Dis 2015; 28(3):240-5. doi: 10.1097/QCO.0000000000000155.
36.	Mackowiak PA, Jones SR, Smith JW . Diagnostic value of sinus-tract cultures in chronic osteomyelitis. JAMA 1978; 239(26):2772-5. doi: 10.1001/jama.239.26.2772.
37.	Aragónsánchez J . Clinical-pathological characterization of diabetic foot infections: grading the severity of osteomyelitis. Int J Low Extrem Wounds 2012; 11(2):107-12. doi: 10.1177/1534734612447617.
38.	Rao N, Ziran BH, Lipsky BA . Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg 2011; 127(suppl 1):177S-87S. doi: 10.1097/PRS.0b013e3182001f0f.
39.	Lew DP, Waldvogel FA . Osteomyelitis. Lancet 2004; 364(9431):369-79. doi: 10.1016/S0140-6736(04)16727-5.
40.	Kerimaa P, Marttila A, Hyv?nen P , et al. MRI-guided biopsy and fine needle aspiration biopsy (FNAB) in the diagnosis of musculoskeletal lesions. Eur J Radiol 2013; 82(12):2328-33. doi: 10.1016/j.ejrad.2013.09.005. doi: 10.1016/j.ejrad.2013.09.005
41.	Vemu L, Sudhaharan S, Mamidi N , et al. Need for appropriate specimen for microbiology diagnosis of chronic osteomyelitis. J Lab Physicians 2018; 10(1):21-5. doi: 10.4103/JLP.JLP_14_17.
42.	Stengel D, Bauwens K, Sehouli J , et al. Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infect Dis 2001; 1(3):175-88. doi: 10.1016/S1473-3099(01)00094-9.
43.	Shea JE, Miller SC . Skeletal function and structure: implications for tissue-targeted therapeutics. Adv Drug Deliv Rev 2005; 57(7):945-57. doi: 10.1016/j.addr.2004.12.017.
44.	Kamath J, Jayasheelan N, Bansal A , et al. A simple innovative alternative for irrigation-aspiration in orthopedic infections using a Foley catheter. Surg Infect 2016; 17(6):745-8. doi: 10.1089/sur.2015.221.
45.	Ambrose CG, Clyburn TA, Louden K , et al. Effective treatment of osteomyelitis with biodegradable microspheres in a rabbit model. Clin Orthop Relat Res 2004; ( 421):293-9. doi: 10.1097/01.blo.0000126303.41711.a2.
46.	Pillai RR, Somayaji SN, Rabinovich M , et al. Nafcillin-loaded PLGA nanoparticles for treatment of osteomyelitis. Biomed Mater 2008; 3(3):7-10.doi: 0.1088/1748-6041/3/3/034114.
47.	Hernigou P, Dubory A, Homma Y , et al. Single-stage treatment of infected tibial non-unions and osteomyelitis with bone marrow granulocytes precursors protecting bone graft. Int Orthop 2018; 42(10):2443-50. doi: 10.1007/s00264-017-3687-8.
48.	Kadry AA, Alsuwayeh SA, Abdallah AR , et al. Treatment of experimental osteomyelitis by liposomal antibiotics. J Antimicrob Chemother 2004; 54(6):1103-8. doi: 10.1093/jac/dkh465.
49.	Gitelis S, Brebach GT . The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant. J Orthop Surg 2002; 10(1):53-60. doi: 10.1177/230949900201000110.
50.	Xie Z, Liu X, Jia W , et al. Treatment of osteomyelitis and repair of bone defect by degradable bioactive borate glass releasing vancomycin. J Control Release 2009; 139(2):118-26. doi: 10.1016/j.jconrel.2009.06.012.
51.	Zhu YG, Zhang DW, Zhao GY , et al. Post-osteomyelitis posterior tibial bone defects repaired with antibiotic bone cement combined with autologous bone graft and ilizarov external fixator. Chin J Tissue Engineering Res 2015; 19(25):3942-6. doi: 10.3969/j.issn.2095-4344.2015.25.002.
52.	Pf?rringer D, Obermeier A, Kiokekli M , et al. Antimicrobial formulations of absorbable bone substitute materials as drug carriers based on calcium sulfate. Antimicrob Agents Chemother 2016; 60(7):3897-905. doi: 10.1128/AAC.00080-16.
53.	Pei Y, Mohamed MF, Seleem MN , et al. Particle engineering for intracellular delivery of vancomycin to methicillin-resistant, Staphylococcus aureus, (MRSA)-infected macrophages. J Control Release 2017; 267:133-43. doi: 10.1016/j.jconrel.2017.08.007.
54.	Karr JC . Lower-extremity osteomyelitis treatment using calcium sulfate/hydroxyapatite bone void filler with antibiotics seven-year retrospective study. J Am Podiatr Med Assoc 2018; 108(3):210-4. doi: 10.7547/16-096.
55.	Cunha MT, Mur?a MA, Nigro S , et al. In vitro antibacterial activity of bioactive glass S53P4 on multiresistant pathogens causing osteomyelitis and prosthetic joint infection. BMC Infect Dis 2018; 18(1):157. doi: 10.1186/s12879-018-3069-x.
56.	Lazzarini L, Lipsky BA, Mader JT . Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis 2005; 9(3):127-38. doi: 10.1016/j.ijid.2004.09.009.
57.	Inzana JA, Schwarz EM, Kates SL . Biomaterials approaches to treating implant-associated osteomyelitis. Biomaterials 2016; 81:58-71. doi: 10.1016/j.biomaterials.2015.12.012.
58.	Thaddeus Chika A, Emeka OM . Whole claviclese questration from chronic osteomyelitis in a 10 years old boy: a case report and review of the literature. Ann Med Surg (Lond) 2016; 6:92-5. doi: 10.1016/j.amsu.2016.02.011.
59.	Haidar R, Der Boghossian A, Atiyeh B . Duration of post-surical antibiotics in chronic osteomyelitis: empiric or evidence based? Int J Infect Dis 2010; 14(9):e752-8. doi: 10.1016/j.ijid.2010.01.005.
60.	Ding GH, Liu XW, Liu B , et al. Masquelet technique combined with antibiotic coated intramedullary nail fixation for the treatment of lower limb infected bone defects. Chin J Orthop 2018; 38(9):530-5. doi: 10.3760/cma.j.issn.0253-2352.2018.09.004.
61.	Wang X, Wang Z, Fu J , et al. Induced membrane technique for the treatment of chronic hematogenous tibia osteomyelitis. BMC Musculoskeletal Disorders 2017; 18(1):33. doi: 10.1186/s12891-017-1395-6.
62.	Karger C, Kishi T, Schneider L , et al. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 2012; 98(1):97-102. doi: 10.1016/j.otsr.2011.11.001.
63.	Niu F, Fu Q, Yang C , et al. Treatment of the postoperative infection of limbs fracture after internal fixation with vacuum sealing drainage (VSD) combined with continual irrigation. Zhongguo Gu Shang 2016; 29(7):651-4. doi: 10.3969/j.issn.1003-0034.2016.07.014.
64.	Du Q, Cong H, Shi Y , et al. Treatment of tibial traumatic osteomyelitis with vacuum sealing drainage combined with open bone graft. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28(5):562-5.
65.	Salgado CJ, Mardini S, Jamali AA , et al. Muscle versus non-muscle flaps in the econstruction of chronic osteomyelitis defects. Plast Reconstr Surg 2006; 118(6):1401-11. doi: 10.1097/01.prs.0000239579.37760.92.
66.	Cheng L, Yang X, Chen T , et al. Peroneal artery perforator flap for the treatment of chronic lower extremity wounds. J Orthop Sur Res 2017; 12(1):170. doi: 10.1186/s13018-017-0675-z.
67.	Gonzalez MH, Weinzweig N . Muscle flaps in the treatment of osteomyelitis of the lower extremity. J Trauma 2005; 58(5):1019-23. doi: 10.1097/01.ta.0000162733.72969.d5.
68.	Gonenci R, Tabur M, Ozsoy SY . Preventive and curative effects of medical ozone in rats exposed to experimental osteomyelitis. Pakistan Vet J 2017; 37(3):355-9.
69.	Bilge A, ?ztürk ?, Adali Y , et al. Could ozone treatment be a promising alternative for osteomyelitis? an experimental study. Acta Ortop Bras 2018; 26(1):67-71. doi: 10.1590/1413-785220182601179926.
70.	Goerger E, Honnorat E, Savini H , et al. Anti-infective therapy without antimicrobials: apparent successful treatment of multidmg resistant osteomyelitis with hyperbaric oxygen therapy. IDCases 2016; 6:60-4. doi: 10.1016/j.idcr.2016.09.008.
71.	Rose D . Hyperbaric oxygen therapy for chronic refractory osteomyelitis. Am Fam Physician 2012; 86(10):888-9.
72.	Shields RC, Nichols FC, Buchta WG , et al. Hyperbaric oxygen therapy for chronic refractory osteomyelitis of the sternum. Ann Thorac Surg 2010; 89(5):1661-3. doi: 10.1016/j.athoracsur.2009.10.018. doi: 10.1016/j.athoracsur.2009.10.018
73.	Liu BB, Li FY, Wen ZG , et al. Interventional arterial catheter placement in the treatment of chronic osteomyelitis in 21 cases. Chin J Pract Nurs 2003; 19(23):19-20.
74.	Nickel JC, Ruseska I, Wright JB , et al. Tobramycin resistance of Pseudomonas aeruginosa cells growing as a biofilm on urinary catheter material. Antimicrob Agents Chemother 1985; 27(4):619-24. doi: 10.1128/aac.27.4.619.
75.	Mader JT, Shirtliff ME, Bergquist SC , et al. Antimicrobial treatment of chronic osteomyelitis. Clin Orthop Relat Res 1999; 360(360):47-65. doi: 10.1097/00003086-199903000-00008.
76.	Siqueira JF, Lopes HP . Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J 1999; 32(5):361-9. doi: 10.1046/j.1365-2591.1999.00275.x.
77.	Athanassiadis B, Abbott PV, George N , et al. An in vitro study of the antimicrobial activity of some endodontic medicaments against Enteroccus faecalis biofilms. Aust Dent J 2010; 55(2):150-5. doi: 10.1111/j.1834-7819.2010.01222.x.
78.	Imlay JA, Linn S . DNA damage and oxygen radical toxicity. Science 1988; 240(4857):1302-9. doi: 10.1126/science.3287616.
79.	Mohammadi Z, Dummer PM . Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011; 44(8):697-730. doi: 10.1111/j.1365-2591.2011.01886.x. doi: 10.1111/j.1365-2591.2011.01886.x
80.	Ambard AJ, Mueninghoff L . Calcium phosphate cement: review of mechanical and biological properties. J Prosthodont 2006; 15(5):321-8. doi: 10.1111/j.1532-849X.2006.00129.x.
81.	Pioletti DP, Takei H, Lin T , et al. The effects of calcium phosphate cement particles on osteoblast functions. Biomaterials 2000; 21(11):1103-14. doi: 10.1016/s0142-9612(99)00250-1.

[1]	刘长宜, 刘晓清, 侍效春. 自发缓解的经典型不明原因发热的临床特征[J]. Chinese Medical Sciences Journal, 2022, 37(2): 134-141.
[2]	欧阳思文, 康维明. 角蛋白在胃肠道肿瘤中的作用和研究进展[J]. Chinese Medical Sciences Journal, 2022, 37(1): 73-78.
[3]	杨威, 张梅. 抗癌治疗中对心脏毒性效应具有潜在预测价值的生物标志物[J]. Chinese Medical Sciences Journal, 2021, 36(4): 333-341.
[4]	徐潋滟, 闫轲, 吕乐, 张伟宏, 陈旭, 霍晓菲, 陆菁菁. CT图像中多器官占位性病变的计算机辅助检测模型的外部和内部验证[J]. Chinese Medical Sciences Journal, 2021, 36(3): 210-217.
[5]	刘婕妤, 王嘉祥, 许力, 邓飞艳. 骨质疏松性骨折风险评估的潜在生物分子：一项综述回顾[J]. Chinese Medical Sciences Journal, 2021, 36(2): 135-149.
[6]	王轶,吴婵媛,王迁. 声带竹节病 —— 14例临床病例研究[J]. Chinese Medical Sciences Journal, 2021, 36(1): 43-49.
[7]	刘炬,徐志坚,毕晓峰,孙萍,黄佳琴. 135个父母双亲和子女均患癌症的中国家庭发病特征回顾性分析[J]. Chinese Medical Sciences Journal, 2021, 36(1): 27-34.
[8]	陈琼,阳学风. 肝细胞癌靶向治疗研究进展[J]. Chinese Medical Sciences Journal, 2021, 36(1): 57-65.
[9]	李大胜,王大为,王娜娜,徐海旺,黄河,董建平,夏晨. 北京首例由输入病例导致社区感染的新型冠状病毒肺炎患者：深度学习CT辅助诊断的作用[J]. Chinese Medical Sciences Journal, 2021, 36(1): 66-71.
[10]	王小磊, 孟珊珊, 段科行, 胡耀炜, 魏锋. 诊治1例腹膜后海绵状淋巴管瘤[J]. Chinese Medical Sciences Journal, 2020, 35(3): 283-285.
[11]	徐龙明,代水平,左云霞. 术前吸烟和戒烟时间对男性肺癌患者术前外周血炎性相关指标及住院治疗结局的影响[J]. Chinese Medical Sciences Journal, 2020, 35(2): 170-178.
[12]	刘昕超, 叶素素, 王文泽, 张月秋, 张丽帆, 潘晓承, 周子月, 张妙颜, 刘江浩, 梁智勇, 刘晓清. γ干扰素释放试验对结核性淋巴结炎的诊断价值研究[J]. Chinese Medical Sciences Journal, 2019, 34(4): 233-240.
[13]	陈强, 张丽伟, 黄党生, 张春红, 王秋霜, 沈东, 熊敏俊, 杨菲菲. 冠状动脉疾病合并糖尿病患者经StentBoost技术指导的经皮冠状动脉介入治疗后5年的随访分析[J]. Chinese Medical Sciences Journal, 2019, 34(3): 177-183.
[14]	王英伟, 张兴华, 王波涛, 王叶, 刘梦琦, 王海屹, 叶慧义. 体素内不相干运动成像参数的纹理分析在胰腺神经内分泌肿瘤和胰腺癌鉴别诊断中的价值[J]. Chinese Medical Sciences Journal, 2019, 34(1): 1-9.
[15]	王波涛, 刘明霞, 陈志晔. 磁共振T2加权成像纹理特征分析在脑胶质母细胞瘤与脑原发性中枢神经系统淋巴瘤鉴别诊断中的价值[J]. Chinese Medical Sciences Journal, 2019, 34(1): 10-17.

优先出版

当期目次

过刊浏览

虚拟专题

作者中心

评阅者中心