Kanakaris N, Gudipati S, Tosounidis T, Harwood P, Britten S, Giannoudis P V
Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK.
University of Leeds, School of Medicine, Academic Department of Trauma and Orthopaedics, 21 Cricketers Fold, Shadwell, Leeds, LS17 8WE, UK.
Bone Joint J. 2014 Jun;96-B(6):783-8. doi: 10.1302/0301-620X.96B6.32244.
Intramedullary infection in long bones represents a complex clinical challenge, with an increasing incidence due to the increasing use of intramedullary fixation. We report a prospective case series using an intramedullary reaming device, the Reamer-Irrigator-Aspirator (RIA) system, in association with antibiotic cement rods for the treatment of lower limb long bone infections. A total of 24 such patients, 16 men and eight women, with a mean age of 44.5 years (17 to 75), 14 with femoral and 10 with tibial infection, were treated in a staged manner over a period of 2.5 years in a single referral centre. Of these, 21 patients had had previous surgery, usually for fixation of a fracture (seven had sustained an open fracture originally and one had undergone fasciotomies). According to the Cierny-Mader classification system, 18 patients were classified as type 1A, four as 3A (discharging sinus tract), one as type 4A and one as type 1B. Staphylococcus species were isolated in 20 patients (83.3%). Local antibiotic delivery was used in the form of impregnated cement rods in 23 patients. These were removed at a mean of 2.6 months (1 to 5). Pathogen-specific antibiotics were administered systemically for a mean of six weeks (3 to 18). At a mean follow-up of 21 months (8 to 36), 23 patients (96%) had no evidence of recurrent infection. One underwent a planned trans-tibial amputation two weeks post-operatively due to peripheral vascular disease and chronic recalcitrant osteomyelitis of the tibia and foot. The combination of RIA reaming, the administration of systemic pathogen-specific antibiotics and local delivery using impregnated cement rods proved to be a safe and efficient form of treatment in these patients.
长骨骨髓腔内感染是一项复杂的临床挑战，随着髓内固定术使用的增加，其发病率也在上升。我们报告了一个前瞻性病例系列，使用髓腔扩髓装置即扩髓-冲洗-吸引（RIA）系统，联合抗生素骨水泥棒治疗下肢长骨感染。在一个单一的转诊中心，共24例此类患者，16例男性和8例女性，平均年龄44.5岁（17至75岁），14例为股骨感染，10例为胫骨感染，在2.5年的时间里分阶段进行治疗。其中，21例患者曾接受过手术，通常是为了固定骨折（7例最初为开放性骨折，1例接受过筋膜切开术）。根据Cierny-Mader分类系统，18例患者被分类为1A型，4例为3A型（有引流窦道），1例为4A型，1例为1B型。20例患者（83.3%）分离出葡萄球菌属。23例患者采用浸渍骨水泥棒的形式进行局部抗生素给药。这些骨水泥棒平均在2.6个月（1至5个月）时取出。针对病原体的抗生素进行了平均六周（3至18周）的全身给药。平均随访21个月（8至36个月）时，23例患者（96%）无复发感染迹象。1例患者术后两周因外周血管疾病以及胫骨和足部慢性顽固性骨髓炎接受了计划性经胫骨截肢术。RIA扩髓、全身使用针对病原体的抗生素以及使用浸渍骨水泥棒进行局部给药的联合治疗在这些患者中被证明是一种安全有效的治疗方式。
