Wu Hongri, Shen Jie, Yu Xin, Fu Jingshu, Yu Shengpeng, Sun Dong, Xie Zhao
National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China.
Injury. 2017 Feb;48(2):511-518. doi: 10.1016/j.injury.2017.01.007. Epub 2017 Jan 6.
Cierny-Mader (C-M) type IV chronic osteomyelitis represents a complex clinical challenge with permeation of extensive bone and soft tissue involvement. Aggressive debridement through viable tissue margin includes en bloc resection improves the odds of eradication of infection, which creates large bone and soft tissue loss in treating this type of osteomyelitis. The potentially large defects increase reconstruction problems with traditional reconstruction technique. The newly staged induced membrane technique presents length-independent, potential as an alternative reconstruction method for segmental bone defects due to type IV chronic osteomyelitis. The purpose of this study was to assess the result and related factors of C-M type IV chronic osteomyelitis treated with staged methods of aggressive debridement and induced membrane technique.
From January 2012 to January 2014, 36 consecutive adult patients of C-M type IV chronic osteomyelitis were treated by this staged method in our clinical center with a minimum of 2-years follow-up. The clinical and imaging results were retrospectively analyzed.
Five patients had a second debridement and eight needed a local flap transfer to cover the wound in the first stage. Patients formed a mean of 5.5cm (range: 2-10.9) segmental bone defect; Sixteen patients had autograft and twenty had autograft mixed allograft in the second stage. The mean follow-up time was 29.5 months (range: 24-45). No patients required amputation. Bone union was achieved in all patients. Clinical eradication of osteomyelitis was achieved in 35 (97%) patients, 35 (97%) patients were able to walk independently, and 31patients (86%) returned to work. Patients returned to a mean of 82% (46.3%-100%) lower extremity function. Bone union time was not dependent on the length of bone defect, but associated with the infection site (p=0.005) and age (p=0.005).
Staged methods of aggressive debridement and induced membrane technique seems to be a simple, reliable and effective for the treatment of C-M type IV chronic osteomyelitis. Advanced age and poor soft tissue envelope may have adverse affects and are relative contraindications. The combined assessment and management of such patients with a plastic surgeon are advocated.
Cierny-Mader（C-M）IV型慢性骨髓炎是一项复杂的临床挑战，存在广泛骨质受累及软组织累及。通过有活力组织边缘进行的积极清创，包括整块切除，可提高感染根除几率，但在治疗此类骨髓炎时会造成大量骨与软组织缺损。潜在的大缺损增加了传统重建技术的重建难题。新的分期诱导膜技术展现出与长度无关的特性，有潜力作为IV型慢性骨髓炎所致节段性骨缺损的替代重建方法。本研究目的是评估采用积极清创分期方法及诱导膜技术治疗C-M IV型慢性骨髓炎的结果及相关因素。
2012年1月至2014年1月，36例连续性成年C-M IV型慢性骨髓炎患者在我们临床中心接受此分期方法治疗，并进行至少2年随访。对临床及影像学结果进行回顾性分析。
5例患者进行了二次清创，8例患者在第一阶段需要局部皮瓣转移覆盖伤口。患者形成平均5.5cm（范围：2 - 10.9cm）的节段性骨缺损；16例患者在第二阶段进行了自体骨移植，20例患者进行了自体骨与异体骨混合移植。平均随访时间为29.5个月（范围：24 - 45个月）。无患者需要截肢。所有患者均实现骨愈合。35例（97%）患者实现骨髓炎临床根除，35例（97%）患者能够独立行走，31例（86%）患者恢复工作。患者下肢功能平均恢复至82%（46.3% - 100%）。骨愈合时间不取决于骨缺损长度，而是与感染部位（p = 0.005）及年龄（p = 0.005）相关。
积极清创分期方法及诱导膜技术似乎是治疗C-M IV型慢性骨髓炎的一种简单、可靠且有效的方法。高龄及软组织条件差可能产生不利影响，是相对禁忌证。提倡整形外科医生对此类患者进行联合评估与管理。
