Merlet Audrey, Cazanave Charles, Dauchy Frederic-Antoine, Dutronc Hervé, Casoli Vincent, Chauveaux Dominique, De Barbeyrac Bertille, Dupon Michel
From the 1 Department of Infectious and Tropical Diseases.
Scand J Infect Dis. 2014 Aug;46(8):555-60. doi: 10.3109/00365548.2014.914241. Epub 2014 May 20.
Calcaneal osteomyelitis is difficult to manage and requires a multidisciplinary approach. The aim of this study was to describe the characteristics and outcomes of calcaneal osteomyelitis, and to determine prognostic factors.
This was an observational and retrospective study including all patients presenting with calcaneal osteomyelitis referred to a tertiary referral centre between January 2005 and December 2010.
Forty-two patients (mean age 50.7 y, range 22-89 y) were included. Fifteen were female. The mean duration of follow-up was 20 months (range 12-48 months). Twenty-six (62%) were post-traumatic osteomyelitis and 16 (38%) were secondary to neurological damage (sensitivity or motor impairment). All patients underwent surgical management with bone curettage and appropriate antibiotic therapy. Staphylococcus aureus was the most commonly isolated bacterium and was found in 29 patients. Polymicrobial samples were observed in 29 patients. Pseudomonas aeruginosa was associated with calcaneal osteomyelitis secondary to neurological damage (n = 7; 44% p = 0.045). Twenty-eight patients (66.7%) healed without the need to resort to amputation. The mean time to healing was 29 weeks with a range of 4-144 weeks. Relapse of bone infection occurred in 17 patients (40.5%). Seven patients (16.7%) required amputations. Favourable prognostic factors for healing without amputation were an American Society of Anesthesiologists (ASA) score < 2 (p < 10(-4)), post-traumatic calcaneal osteomyelitis (p = 0.001), age < 65 y (p = 0.02), absence of neuropathy (p = 0.005), and absence of diabetes mellitus (p = 0.02).
Calcaneal osteomyelitis is characterized by frequent relapse with delayed wound healing. Clinicians should take into account the impact of older age, as well as co-morbidities such as diabetes mellitus or the presence of neuropathy, during the routine management of patients with this difficult-to-treat bone infection.
跟骨骨髓炎难以治疗，需要多学科方法。本研究的目的是描述跟骨骨髓炎的特征和结局，并确定预后因素。
这是一项观察性回顾性研究，纳入了2005年1月至2010年12月间转诊至三级转诊中心的所有跟骨骨髓炎患者。
纳入42例患者（平均年龄50.7岁，范围22 - 89岁）。15例为女性。平均随访时间为20个月（范围12 - 48个月）。26例（62%）为创伤后骨髓炎，16例（38%）继发于神经损伤（感觉或运动障碍）。所有患者均接受了骨刮除术和适当的抗生素治疗的手术处理。金黄色葡萄球菌是最常分离出的细菌，在29例患者中发现。29例患者观察到混合菌样本。铜绿假单胞菌与继发于神经损伤的跟骨骨髓炎相关（n = 7；44%，p = 0.045）。28例患者（66.7%）愈合，无需截肢。平均愈合时间为29周，范围为4 - 144周。17例患者（40.5%）发生骨感染复发。7例患者（16.7%）需要截肢。无需截肢而愈合的有利预后因素为美国麻醉医师协会（ASA）评分< 2（p < 10⁻⁴）、创伤后跟骨骨髓炎（p = 0.001）、年龄< 65岁（p = 0.02）、无神经病变（p = 0.005）和无糖尿病（p = 0.02）。
跟骨骨髓炎的特点是频繁复发且伤口愈合延迟。在对这种难以治疗的骨感染患者进行常规管理时，临床医生应考虑老年以及糖尿病或神经病变等合并症的影响。
