Elmarsafi Tammer, Oliver Noah G, Steinberg John S, Evans Karen K, Attinger Christopher E, Kim Paul J
Diabetic Limb Salvage Fellow, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC.
Surgeon, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC.
J Foot Ankle Surg. 2017 Mar-Apr;56(2):287-290. doi: 10.1053/j.jfas.2016.10.022. Epub 2017 Jan 6.
When osteomyelitis occurs in the infected foot, cement spacers have been used as a limb salvage tool. The aim of the present study was to assess the longevity and outcomes in high-risk, low-demand patients who have undergone resection of bone and subsequent placement of permanent antibiotic-eluting cement spacers in the foot. A retrospective review case series of 30 patients who had undergone placement of a permanent antibiotic-eluting cement spacer in the foot were evaluated for retention, spacer exchange, removal, amputation, and functional status. The minimum follow-up time for inclusion was 12 months. Two thirds of all patients had successful spacers (n = 20) that were either retained (n = 14) or successfully exchanged (n = 6). One third of all patients experienced spacer failure (n = 10) and required removal. Of the 10 patients requiring spacer removal, 4 underwent removal with subsequent arthrodesis and 6 underwent removal with subsequent pseudoarthrosis. Also, 8 of these patients (26.7%) required partial foot amputation of the ipsilateral foot. These amputations were not directly related to the use or removal of the spacer. The average time to spacer removal or partial amputation was 20.9 (range 0.2 to 60.9) months. The longest retained spacer in the foot was 76 months at the last follow-up visit. The longest exchanged spacer at the last follow-up visit was 111 months. All surviving patients were ambulatory at the last follow-up visit.
当感染的足部发生骨髓炎时，骨水泥间隔物已被用作保肢工具。本研究的目的是评估高危、低需求患者在接受骨切除并随后在足部植入永久性抗生素洗脱骨水泥间隔物后的存留时间和治疗结果。对30例在足部植入永久性抗生素洗脱骨水泥间隔物的患者进行回顾性病例系列研究，评估间隔物的存留、更换、取出、截肢情况以及功能状态。纳入研究的最短随访时间为12个月。所有患者中有三分之二（n = 20）的骨水泥间隔物使用成功，其中14例间隔物被保留，6例成功更换。所有患者中有三分之一（n = 10）的骨水泥间隔物失败，需要取出。在需要取出间隔物的10例患者中，4例取出后进行了关节融合术，6例取出后形成了假关节。此外，这些患者中有8例（26.7%）需要对同侧足部进行部分截肢。这些截肢与间隔物的使用或取出并无直接关系。间隔物取出或部分截肢的平均时间为20.9个月（范围0.2至60.9个月）。在最后一次随访时，足部保留时间最长的间隔物为76个月。在最后一次随访时，更换后使用时间最长的间隔物为111个月。在最后一次随访时，所有存活患者均能行走。
