Han Hongshik, Lewis Victor L, Wiedrich Thomas A, Patel Pravin K
Department of Plastic and Reconstructive Surgery, Northwestern University Medical School, 201 East Huron Road, Chicago, IL 60611, USA.
Plast Reconstr Surg. 2002 Jul;110(1):118-22. doi: 10.1097/00006534-200207000-00021.
We present a retrospective review of 108 patients with spinal cord injury who underwent reconstruction of grade IV pressure ulcers between 1989 and 1994. Complications of reconstruction secondary to undetected osteomyelitis, namely, deep abscess and sinus tract formation, and their effect on hospital course after the flap reconstruction were quantitatively evaluated. Specifically, this study assesses whether the use of Jamshidi core needle bone biopsy allows for the accurate diagnosis, and therefore treatment, of osteomyelitis before pressure ulcer closure. Early diagnosis and treatment of osteomyelitis would presumably reduce the complication rate of reconstruction. The 108 patients in the study all underwent intraoperative Jamshidi core needle bone biopsy, and postoperative complications were evaluated by reviewers blinded to results of the biopsies. Of the 25 (23 percent) postoperative complications noted, 14 (13 percent) were attributed to underlying osteomyelitis. Patients with pressure ulcer complicated by osteomyelitis were hospitalized significantly longer than those with no osteomyelitis. On average, the former group stayed for 57 days and the latter 21 days (p < 0.001). All 14 patients who developed complications because of deep abscess and sinus tract formation had intraoperative Jamshidi core needle bone biopsy abnormality consistent with osteomyelitis (positive Jamshidi core needle bone biopsy results). The Jamshidi core needle bone biopsy compares favorably with other published modalities used to diagnose osteomyelitis, including white blood cell count, erythrocyte sedimentation rate, radiologic study, and bone biopsy culture. We propose an algorithm for the management of spinal cord injury patients with grade IV pressure ulcers. This algorithm incorporates the use of preoperative Jamshidi core needle bone biopsy to allow for the diagnosis and treatment of osteomyelitis before the flap reconstruction and to prevent complications of undiagnosed osteomyelitis after reconstruction.
我们对1989年至1994年间接受IV级压疮重建手术的108例脊髓损伤患者进行了回顾性研究。对未被发现的骨髓炎继发的重建并发症，即深部脓肿和窦道形成，以及它们对皮瓣重建后住院病程的影响进行了定量评估。具体而言，本研究评估了使用Jamshidi骨芯针活检是否能在压疮闭合前准确诊断并治疗骨髓炎。骨髓炎的早期诊断和治疗可能会降低重建的并发症发生率。研究中的108例患者均接受了术中Jamshidi骨芯针活检，术后并发症由对活检结果不知情的评估者进行评估。在记录的25例（23%）术后并发症中，14例（13%）归因于潜在的骨髓炎。伴有骨髓炎的压疮患者住院时间明显长于无骨髓炎的患者。平均而言，前一组住院57天，后一组住院21天（p<0.001）。所有因深部脓肿和窦道形成而出现并发症的14例患者，其术中Jamshidi骨芯针活检异常结果均与骨髓炎一致（Jamshidi骨芯针活检结果为阳性）。Jamshidi骨芯针活检与其他已发表的用于诊断骨髓炎的方法相比，具有优势，这些方法包括白细胞计数、红细胞沉降率、影像学检查和骨活检培养。我们提出了一种针对脊髓损伤伴IV级压疮患者的处理方案。该方案采用术前Jamshidi骨芯针活检，以便在皮瓣重建前诊断和治疗骨髓炎，并预防重建后未诊断出的骨髓炎并发症。
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