Ciclamini Davide, Antonini Andrea, Tos Pierluigi, Crosio Alessandro, Piccato Alice, Battiston Bruno
Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino.
ASL2 Savonese Malattie Infettive e Ortopedia Settica.
Handchir Mikrochir Plast Chir. 2020 Apr;52(2):116-122. doi: 10.1055/a-1075-2402. Epub 2020 Apr 7.
Chronic osteomyelitis is a long-standing infection of the bone. Treatment is often combined, using antibiotics and surgery (with radical debridement and secondary or concomitant reconstruction). One-stage management is an alternative approach, with few reported cases in literature.
PATIENTS/MATERIAL AND METHODS: We carried out an observational retrospective multicenter study to evaluate the results of one-stage reconstructions with vascularized bone flaps. We assessed bone and infection healing in 14 cases, with a mean follow-up of 63.6 months.
Bone union was obtained in 10 cases (71.4 %) in a mean period of 7.9 months. Nonunion occurred in 4 cases (28.6 %), 2 of them with infection persistence. Bone nonunion risk increases in polymicrobial infections (p = 0.0269) and in compromised hosts (p = 0.0110). Infection healing was achieved in 11 cases (78.6 %). Fistula recurred in 3 cases of forearm osteomyelitis (21.4 %) in 10 months on average. Infection recurrence is associated with polymicrobial infections (p = 0.0378) and is higher in internal fixation and compromised hosts with no statistically significant relation.
One-stage surgical treatment seems to be an effective approach in selected patients, in particular when an important impairment of local soft tissue and bone exposure are present, and immediate bone coverage with vascularized soft tissue is needed. Most complications occurred in compromised hosts and in patients with polymicrobial cultures. Further research, with comparison between one and two-stage procedures, is needed in order to strengthen the level of evidence.
慢性骨髓炎是一种长期的骨感染。治疗通常采用联合方法，使用抗生素和手术（包括彻底清创以及二期或同期重建）。一期治疗是一种替代方法，文献报道的病例较少。
患者/材料与方法：我们进行了一项观察性回顾性多中心研究，以评估带血管蒂骨瓣一期重建的结果。我们评估了14例患者的骨愈合和感染愈合情况，平均随访63.6个月。
10例（71.4%）患者在平均7.9个月时实现了骨愈合。4例（28.6%）出现骨不连，其中2例伴有感染持续存在。在混合感染（p = 0.0269）和身体状况较差的宿主（p = 0.0110）中，骨不连风险增加。11例（78.6%）实现了感染愈合。10例前臂骨髓炎患者中有3例（21.4%）平均在10个月时出现瘘管复发。感染复发与混合感染有关（p = 0.0378），在内固定患者和身体状况较差的宿主中更高，但无统计学显著关系。
一期手术治疗似乎是某些特定患者的有效方法，特别是当局部软组织有严重损伤且存在骨外露，需要用带血管蒂软组织立即覆盖骨时。大多数并发症发生在身体状况较差的宿主和有混合培养结果的患者中。需要进一步研究，比较一期和二期手术方法，以加强证据水平。
