Traumatology Department of the University Clinical Centre Ljubljana, Slovenia.
Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Injury. 2019 Apr;50(4):827-833. doi: 10.1016/j.injury.2019.02.019. Epub 2019 Mar 5.
Early diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity.
The objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery.
This prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4).
We discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM.
We can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.
早期诊断急性创伤后骨髓炎（POM）对于避免灾难性并发症至关重要。由于缺乏像心肌梗死、中风和颅内出血那样高度特异性和敏感的检测方法，因此诊断 POM 较为困难。血清炎症标志物、C 反应蛋白（CRP）、降钙素原（PCT）、白细胞（WBC）可以支持临床发现，但它们不能以高度特异性和敏感性来区分感染引起的炎症反应和宿主对非感染性损伤的反应。
本研究的目的是探讨患者的生化和免疫炎症特征是否有助于术后监测、指导抗生素治疗和确定翻修手术的时机。
本前瞻性非随机队列研究纳入了 86 例因高能伤致小腿需行初次手术治疗（开放性或闭合性复位内固定胫骨骨折）的患者。在入院时（ADD）、术后第 1 天（POD1）和第 4 天（POD4）测量生化和免疫炎症特征值。
我们在样本中发现，POM 的发生与 ADD、POD1 时 CRP 升高和 POD4 时白蛋白降低有关。需要进一步研究证明这些差异是否有助于诊断感染风险。评估其他重要的危险因素，如软组织损伤的程度、多发骨折、输血率、是否需要将初次外固定改为髓内钉（IM）固定或锁定钢板固定，这些都可以增强我们对 POM 的临床判断。
我们可以通过使用围手术期炎症生物标志物 CRP 结合术后白蛋白水平和其他相关的独立危险因素，提高对创伤后骨髓炎的预测能力。
