Lök Veli, Bal Emin, Sebik Ahmet, Aydinok Hilmi
Department of Orthopedics and Traumatology, Medicine Faculty of Ege University, Izmir, Turkey.
Acta Orthop Traumatol Turc. 2009;43(6):510-4. doi: 10.3944/AOTT.2009.510.
We evaluated long-term results of treatment including creation of a gutter and muscle transposition in patients with chronic sclerosing osteomyelitis (CSO).
Between 1980 and 1996, 11 patients (5 women, 6 men; mean age 36 years; range 17 to 69 years) with CSO were treated with creation of a gutter and muscle transposition. Seven patients had femoral, and four patients had tibial involvement. The main complaint was pain. The patients were evaluated with respect to complaints and radiologically (X-ray, computed tomography, and magnetic resonance imaging) after a mean follow-up of 12.4 years (range 6 to 24 years).
During the follow up period, all the patients remained symptom-free without the need for antibiotic treatment except for one patient with tibial involvement, whose pain recurred after five years. The patient's complaint disappeared following reoperation with the same technique. Histologic examination of surgical biopsies showed nonspecific changes consistent with low-grade chronic osteomyelitis. Cultures were negative in all cases. Control radiographies showed no progression of sclerosis. Computed tomography showed cortical bone formation surrounding the transposed muscle, and magnetic resonance imaging showed fatty degeneration in the transposed muscle, without any signs of active osteomyelitis.
The aim of gutter creation and muscle transposition is to increase blood supply to the diseased bone segment, without the need for microsurgical interventions and secondary reconstructive procedures. Our long-term results show that this technique is efficacious in patients with femoral and tibial involvement.
我们评估了包括建立骨槽和肌肉转位在内的慢性硬化性骨髓炎（CSO）患者的长期治疗效果。
1980年至1996年间，11例CSO患者（5例女性，6例男性；平均年龄36岁；年龄范围17至69岁）接受了骨槽建立和肌肉转位治疗。7例患者累及股骨，4例患者累及胫骨。主要症状为疼痛。在平均随访12.4年（范围6至24年）后，对患者的症状和进行了影像学评估（X线、计算机断层扫描和磁共振成像）。
在随访期间，除1例累及胫骨的患者在5年后疼痛复发外，所有患者均无症状，无需抗生素治疗。该患者再次采用相同技术手术后症状消失。手术活检的组织学检查显示非特异性改变，符合低度慢性骨髓炎。所有病例培养均为阴性。对照X线片显示硬化无进展。计算机断层扫描显示转位肌肉周围有皮质骨形成，磁共振成像显示转位肌肉内有脂肪变性，无任何活动性骨髓炎迹象。
建立骨槽和肌肉转位的目的是增加病变骨段的血供，无需显微手术干预和二次重建手术。我们的长期结果表明，该技术对累及股骨和胫骨的患者有效。
