Timmers Michael S, Graafland Niels, Bernards Alexandra T, Nelissen Rob G H H, van Dissel Jaap T, Jukema Gerrolt N
Department of Trauma Surgery, Free University Medical Centre Amsterdam, The Netherlands.
Wound Repair Regen. 2009 Mar-Apr;17(2):278-86. doi: 10.1111/j.1524-475X.2009.00458.x.
In a retrospective, case-control cohort study an assessment was made of the clinical outcome of patients with osteomyelitis treated with a new modality of negative pressure wound therapy, so called negative pressure instillation therapy. In this approach, after surgical debridement, a site of osteomyelitis is treated with negative pressure of at least 300 mmHg applied through polyvinyl alcohol dressing. The polyvinyl alcohol foam is irrigated through the tubes three times a day with a polyhexanide antiseptic solution. In 30 patients (14 males; mean age 52 [range, 26-81]) admitted between 1999 and 2003 with osteomyelitis of the pelvis or lower extremity, we assessed time to wound closure, number of surgical procedures and rate of recurrence of infection as well as need for rehospitalizations. For comparison, a control group of 94 patients (males, 58; mean age 47 [range, 9-85]), matched for site and severity of osteomyelitis, was identified in hospital records between 1982 and 2002. These patients underwent standard surgical debridement, implantation of gentamicin polymethylmethacrylate beads and long-term intravenous antibiotics. In the Instillation group the rate of recurrence of infection was 3/30 (10%), whereas 55/93 (58.5%) of the controls had a recurrence (p<0.0001). Moreover, in those treated with instillation the total duration of hospital stay was shorter and number of surgical procedures smaller as compared with the controls (all p<0.0001). We conclude that in posttraumatic osteomyelitis negative pressure instillation therapy reduces the need for repeated surgical interventions in comparison with the present standard approach.
在一项回顾性病例对照队列研究中，对采用一种新型负压伤口治疗方式（即所谓的负压灌注疗法）治疗骨髓炎患者的临床结局进行了评估。在这种方法中，手术清创后，通过聚乙烯醇敷料对骨髓炎部位施加至少300 mmHg的负压。每天通过管道用聚己双胍防腐溶液对聚乙烯醇泡沫进行3次冲洗。在1999年至2003年期间收治的30例骨盆或下肢骨髓炎患者（14例男性；平均年龄52岁[范围26 - 81岁]）中，我们评估了伤口闭合时间、手术次数、感染复发率以及再次住院的需求。为作比较，在1982年至2002年的医院记录中确定了一个由94例患者组成的对照组（58例男性；平均年龄47岁[范围9 - 85岁]），这些患者在骨髓炎部位和严重程度方面相匹配。这些患者接受了标准的手术清创、庆大霉素聚甲基丙烯酸甲酯珠植入以及长期静脉使用抗生素治疗。在灌注组中，感染复发率为3/30（10%），而对照组中有55/93（58.5%）复发（p<0.0001）。此外，与对照组相比，接受灌注治疗的患者住院总时长更短，手术次数更少（所有p<0.0001）。我们得出结论，与目前的标准方法相比，负压灌注疗法可减少创伤后骨髓炎患者重复手术干预的需求。
