McCarthy James, Hartmann Emily, Bentz Michael L, Rao Venkat K, Jee Young, Rivedal David, Poore Samuel O
Division of Plastic and Reconstructive Surgery, University of Wisconsin-Madison, Madison, Wisc.; and University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Plast Reconstr Surg Glob Open. 2017 Mar 28;5(3):e1263. doi: 10.1097/GOX.0000000000001263. eCollection 2017 Mar.
Pressure ulcers represent a particularly difficult disease process and remain a financially important entity. The underlying bone in advanced ulcers may harbor osteomyelitis. Radiologic diagnosis of osteomyelitis is confounded by chronic pressure and shear. We sought to determine the test characteristics of preoperative magnetic resonance imaging (MRI) in the diagnosis of osteomyelitis compared to intraoperative bone culture.
A retrospective review of patients undergoing flap reconstruction who had preoperative MRI and intraoperative bone cultures between 1995 and 2015 was included. Recorded variables included age, sex, level of spinal cord injury and duration, preoperative MRI interpretation, microbiologic bone culture, smoking history, comorbidities, colostomy or urostomy, healing time, complications, length of stay, and discharge facility.
A total of 152 patients (175 flaps) were reconstructed, of which 41 patients (73 flaps) met inclusion criteria. Most patients were male (82.2%) with an average age of 50.4 years. Overall complication rate was 32.4% ( = 23) of which 34.7% ( = 8) were major. Positive and negative predictive MRI values were 84.6% and 16.7%, respectively. There were no significant differences in healing time or complication rate in those with or without osteomyelitis. Intraoperative growth was associated with decreased postoperative complications (hazard ratio = 0.361; = 0.037).
Test properties of MRI for diagnosis of osteomyelitis in patients with chronic pressure ulcers have limited ability to diagnose osteomyelitis and do not aid in surgical management, but do increase health-care expense. The diagnosis of osteomyelitis by intraoperative bone cultures does not predict inferior outcomes and paradoxically may be associated with fewer postoperative complications.
压疮是一种特别棘手的疾病过程，在经济上仍然是一个重要问题。晚期溃疡的深层骨骼可能存在骨髓炎。慢性压力和剪切力会干扰骨髓炎的放射学诊断。我们试图确定术前磁共振成像（MRI）与术中骨培养相比在诊断骨髓炎方面的检测特征。
回顾性纳入1995年至2015年间接受皮瓣重建且术前行MRI检查和术中进行骨培养的患者。记录的变量包括年龄、性别、脊髓损伤水平和持续时间、术前MRI解读、微生物骨培养、吸烟史、合并症、结肠造口术或尿路造口术、愈合时间、并发症、住院时间和出院机构。
共对152例患者（175个皮瓣）进行了重建，其中41例患者（73个皮瓣）符合纳入标准。大多数患者为男性（82.2%），平均年龄50.4岁。总体并发症发生率为32.4%（n = 23），其中34.7%（n = 8）为严重并发症。MRI的阳性和阴性预测值分别为84.6%和16.7%。有无骨髓炎患者的愈合时间或并发症发生率无显著差异。术中培养阳性与术后并发症减少相关（风险比 = 0.361；P = 0.037）。
MRI用于诊断慢性压疮患者骨髓炎的检测特性在诊断骨髓炎方面能力有限，无助于手术管理，但会增加医疗费用。术中骨培养诊断骨髓炎并不能预测不良结局，反而可能与较少的术后并发症相关。
