Department of Trauma & Orthopaedics, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK.
J Orthop Surg Res. 2019 Nov 28;14(1):393. doi: 10.1186/s13018-019-1388-2.
Despite advances in surgery, the treatment of chronic osteomyelitis remains complex and is often associated with a significant financial burden to healthcare systems. The aim of this systematic review was to identify the different single-stage procedures that have been used to treat adult chronic osteomyelitis and to evaluate their effectiveness.
Ovid Medline and Embase databases were searched for articles on the treatment of chronic osteomyelitis over the last 20 years. A total of 3511 journal abstracts were screened by 3 independent reviewers. Following exclusion of paediatric subjects, animal models, non-bacterial osteomyelitis and patients undergoing multiple surgical procedures, we identified 13 studies reported in English with a minimum follow-up period of 12 months. Data extraction and quality assessment were performed for all studies. Non-recurrence was defined as resolution of pain without recurrence of sinuses or need for a second procedure to treat infection within the described follow-up period.
A total of 505 patients with chronic osteomyelitis underwent attempted single-stage procedures. Following debridement, a range of techniques have been described to eliminate residual dead space including biologic and non-biologic approaches. These include musculocutaneous flaps, insertion of S53P4 glass beads or packing with antibiotic-loaded ceramic or calcium-sulphate pellets. The average follow-up ranged from 12 to 110 months. The most common organism isolated was Staphylococcus aureus (35.2%). Non-recurrence ranged from 0 to 100%. Debridement alone was statistically significantly inferior to approaches that included dead space management (54.5% versus 90% non-recurrence). Biologic and non-biologic approaches to dead space management were comparable (89.8% versus 94.2% non-recurrence).
A wide range of single-stage procedures have been performed for the treatment of chronic osteomyelitis. In general, studies were small and observational with various reporting deficiencies. No one dead space management technique appears to be superior, but debridement alone that leaves residual dead space should be avoided.
尽管手术技术不断进步，但慢性骨髓炎的治疗仍然复杂，且常给医疗系统带来巨大的经济负担。本系统评价旨在确定过去 20 年来用于治疗成人慢性骨髓炎的不同单阶段手术，并评估其疗效。
检索过去 20 年 Ovid Medline 和 Embase 数据库中关于慢性骨髓炎治疗的文章。3 位独立评审员筛选了 3511 篇期刊摘要。排除儿科患者、动物模型、非细菌性骨髓炎和接受多次手术的患者后，我们确定了 13 项用英文报告、随访时间至少 12 个月的研究。对所有研究均进行数据提取和质量评估。非复发定义为在描述的随访期内疼痛缓解，无窦道复发或需要再次手术治疗感染。
共有 505 例慢性骨髓炎患者接受了单阶段手术尝试。清创后，为消除残余死腔，已描述了多种技术，包括生物和非生物方法。这些方法包括肌皮瓣、S53P4 玻璃珠植入或用载抗生素的陶瓷或硫酸钙颗粒填充。平均随访时间为 12 至 110 个月。最常分离到的病原体是金黄色葡萄球菌（35.2%）。非复发率为 0 至 100%。单纯清创与包括死腔管理的方法相比，差异具有统计学意义（54.5%与 90%的非复发率）。生物和非生物死腔管理方法的效果相当（89.8%与 94.2%的非复发率）。
为治疗慢性骨髓炎，已开展了多种单阶段手术。总体而言，这些研究规模较小，为观察性研究，且存在各种报告缺陷。目前尚无一种死腔管理技术具有明显优势，但应避免单纯清创导致的残余死腔。
