Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi'an 710038, China.
Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an 710032, China.
Ann Palliat Med. 2020 Jul;9(4):1821-1833. doi: 10.21037/apm.2020.03.23. Epub 2020 Mar 31.
Treatment of chronic osteomyelitis often requires surgical debridement in combination with bone defect reconstruction and antibiotics administration. We aimed at investigating and evaluating the effect of antibiotic-loaded absorbable calcium sulfate/calcium phosphate (CS/CP) composite as bone substitute in the treatment of chronic osteomyelitis compared with CS.
A retrospective study of 31 consecutive patients with chronic osteomyelitis from one medical center was conducted. The treatment involved thorough debridement, antibiotic loaded bone substitutes filling (group A: CS/CP, 21 patients, group B: CS, 10 patients), laboratory and radiographic examination, and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. New bone formation property and resorption kinetics were analyzed through X-ray and CT scan qualitatively and quantitatively. Anti-infection effect was mainly analyzed by postoperative laboratory examination and healing of wound.
The average follow-up in each group was 61.3 and 86.7 weeks, respectively. In group A (CS/ CP), no patient had recurrent infection at 17 months after surgery, 1 case had delayed wound healing and healed after dressing change. In group B (CS), 2 patients had recurrent infection at 18 weeks after surgery, and were managed after further surgical treatment, 3 cases had delayed wound healing and healed after dressing change. The infection in the two groups was mainly caused by staphylococcus aureus. The average percentage of new bone formation was 20.5%, 43.7%, 75.2% at 1, 3, and 6 months in group A and 15.4%, 32.2%, 49.7% at 1, 3, and 6 months in group B after operation (P=0.001 at 1 month, P=0.025 at 3 months, P=0.000 at 6 months). The average percentage of resorption was 23.7%, 56.4%, 81.2% at 1, 3, and 6 months in group A and 47.1%, 96.2%, 100% at 1, 3, and 6 months in group B after operation (P=0.000 at 1 month, P=0.000 at 3 months, P=0.000 at 6 months). There was difference in infection recurrence (P=0.034).
Our preliminary results proved that compared with CS, this novel antibiotic-impregnated CS/CP composite acted as superior scaffold for bone formation with a lower rate of infection recurrence, when choosing bone substitutes in the treatment of chronic osteomyelitis.
慢性骨髓炎的治疗常需要手术清创，结合骨缺损重建和抗生素给药。我们旨在研究和评估载抗生素的可吸收硫酸钙/磷酸钙（CS/CP）复合材料作为骨替代物在慢性骨髓炎治疗中的作用，与 CS 相比。
对来自一家医疗中心的 31 例慢性骨髓炎连续患者进行回顾性研究。治疗包括彻底清创、载抗生素骨替代物填充（A 组：CS/CP，21 例，B 组：CS，10 例）、实验室和影像学检查以及多学科团队指导下的培养特异性全身抗生素治疗。通过 X 射线和 CT 扫描定性和定量分析新骨形成特性和吸收动力学。通过术后实验室检查和伤口愈合主要分析抗感染效果。
两组的平均随访时间分别为 61.3 和 86.7 周。在 A 组（CS/CP）中，手术后 17 个月无 1 例患者发生感染复发，1 例患者伤口愈合延迟，经换药后愈合。在 B 组（CS）中，手术后 18 周有 2 例患者发生感染复发，经进一步手术治疗后痊愈，3 例患者伤口愈合延迟，经换药后愈合。两组感染均主要由金黄色葡萄球菌引起。术后 1、3、6 个月，A 组新骨形成百分比分别为 20.5%、43.7%、75.2%，B 组分别为 15.4%、32.2%、49.7%（术后 1 个月 P=0.001，3 个月 P=0.025，6 个月 P=0.000）。术后 1、3、6 个月，A 组吸收百分比分别为 23.7%、56.4%、81.2%，B 组分别为 47.1%、96.2%、100%（术后 1 个月 P=0.000，3 个月 P=0.000，6 个月 P=0.000）。感染复发有差异（P=0.034）。
我们的初步结果证明，与 CS 相比，这种新型载抗生素 CS/CP 复合材料作为骨形成的优异支架，感染复发率较低，在治疗慢性骨髓炎时选择骨替代物。
