Marais Leonard C, Ferreira Nando, Aldous Colleen, Le Roux Theo L B
Tumour, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, School of Clinical Medicine, Grey's Hospital, University of KwaZulu-Natal, Private Bag X9001, Pietermaritzburg, 3201, South Africa.
School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Strategies Trauma Limb Reconstr. 2016 Aug;11(2):135-42. doi: 10.1007/s11751-016-0259-1. Epub 2016 Jul 1.
Previous classification systems of chronic osteomyelitis have failed to provide objective and pragmatic guidelines for selection of the appropriate treatment strategy. In this study, we assessed the short-term treatment outcome in adult patients with long-bone chronic osteomyelitis prospectively where a modified host classification system was integrated with treatment strategy selection through a novel management algorithm. Twenty-six of the 28 enrolled patients were available for follow-up at a minimum of 12 months. The median patient age of was 36.5 years (range 18-72 years). Fourteen patients (54 %) were managed palliatively, and 11 patients (42 %) were managed through the implementation of a curative treatment strategy. One patient required alternative treatment in the form of an amputation. The overall success rate was 96.2 % (95 % CI 80.4-99.9 %) at a minimum of 12-months follow-up. Remission was achieved in all [11/11] patients treated curatively (one-sided 95 % CI 73.5-100.0 %). Palliative treatment was successful in 92.9 % [13/14] of cases (95 % CI 66.1-99.9 %). In patients with lower limb involvement, there was a statistically significant improvement of 28.3 (95 % CI 21.0-35.7; SD 17.0) in the AAOS Lower Limb Outcomes Instrument score (p value < 0.001). The integrated approach proposed in this study appears a useful guideline to the management of chronic osteomyelitis of long bones in adult patients in the developing world. Further investigation is required to validate the approach, and additional development of the algorithm may be required in order to render it useful in other clinical environments.
以往慢性骨髓炎的分类系统未能为选择合适的治疗策略提供客观实用的指导方针。在本研究中，我们前瞻性评估了成年长骨慢性骨髓炎患者的短期治疗结果，其中通过一种新颖的管理算法将改良的宿主分类系统与治疗策略选择相结合。28名入组患者中有26名至少随访了12个月。患者年龄中位数为36.5岁（范围18 - 72岁）。14名患者（54%）接受了姑息治疗，11名患者（42%）通过实施根治性治疗策略进行管理。1名患者需要截肢这种替代治疗。在至少12个月的随访中，总体成功率为96.2%（95%置信区间80.4 - 99.9%）。所有接受根治性治疗的患者[11/11]均实现缓解（单侧95%置信区间73.5 - 100.0%）。姑息治疗在92.9%[13/14]的病例中取得成功（95%置信区间66.1 - 99.9%）。在下肢受累的患者中，美国矫形外科医师学会下肢结局工具评分有统计学意义的改善，提高了28.3（95%置信区间21.0 - 35.7；标准差17.0）（p值<0.001）。本研究中提出的综合方法似乎是发展中国家成年患者长骨慢性骨髓炎管理的有用指南。需要进一步研究来验证该方法，并且可能需要对算法进行进一步开发，以便使其在其他临床环境中有用。
