Rambam Medical Center, Orthopedic Surgery, POB 9602, Haifa 31096, Israel.
Foot Ankle Int. 2012 Mar;33(3):213-9. doi: 10.3113/FAI.2012.0213.
Florid infection and osteomyelitis of the forefoot in patients with diabetic neuropathy often requires minor amputation, with risk of subsequent reulceration, reamputation, and patient dissatisfaction. We investigated use of an antibiotic-impregnated cement spacer (ACS) to release antibiotic locally to resolve residual infection and to fill the cavity created by debridement.
We report 23 cases of osteomyelitis and associated severe infection of forefoot joints in 20 consecutive patients, age 60.3 +/- 13.4 years. Antibiotic-impregnated cement, extensive meticulous debridement, and ACS placement to fill the gap were employed in all cases. Deep cultures were taken routinely. Fixation with Kirschner wires was used as necessary. Mean followup was 21.2 +/- 10.2 months. A successful result was resolution of infection and wound healing to full skin closure without amputation.
Of 23 cases, 21 (91.3%) healed and two required toe amputation. ACS was left permanently in 10 patients, removed with arthrodesis in six, and removed without arthrodesis in five. One patient recovered but subsequently underwent transtibial amputation due to infection of a different site.
Severe infection associated with osteomyelitis of the foot in diabetic patients was successfully treated with extensive debridement and use of ACS, which filled the void created by debridement. Amputation was avoided in most patients. This procedure allowed extensive debridement through filling large voids with ACS, with prolonged antibiotic release.
患有糖尿病性神经病的患者的前足出现化脓性感染和骨髓炎时,通常需要进行小截肢,其存在溃疡复发、再次截肢和患者不满的风险。我们研究了使用抗生素浸渍水泥间隔物(ACS)来局部释放抗生素以解决残留感染并填充清创术所产生的腔隙。
我们报告了 20 例连续患者的 23 例前足关节骨髓炎和相关严重感染病例,患者年龄 60.3 ± 13.4 岁。所有病例均采用抗生素浸渍水泥、广泛细致清创术和 ACS 填充间隙。常规进行深部培养。必要时使用克氏针固定。平均随访 21.2 ± 10.2 个月。成功的结果是感染得到解决,伤口愈合至完全皮肤闭合,无需截肢。
23 例中,21 例(91.3%)治愈,2 例需要行趾截肢。10 例患者永久保留 ACS,6 例行关节融合术取出 ACS,5 例未行关节融合术取出 ACS。1 例患者恢复后因不同部位感染而接受了经胫骨截肢。
通过广泛清创术和使用 ACS 成功治疗了糖尿病患者足部的严重感染合并骨髓炎,ACS 填充了清创术所产生的空洞。大多数患者避免了截肢。该方法允许通过使用 ACS 填充大的空洞进行广泛清创,从而延长抗生素的释放时间。