Department of Orthopaedics and Traumatology, Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
J Orthop Surg Res. 2020 Jun 1;15(1):201. doi: 10.1186/s13018-020-01721-7.
Although various methods have been introduced, the management of chronic tibial osteomyelitis remains a challenge. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis.
Forty-two patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received the treatment method mentioned above were included in the study. The infection remission rate, recurrence rate, complications rate, and bone healing rate were respectively analyzed.
With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients pain, limitation of movement, sinus tracts, topical redness, and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed minor but acceptable discomfort in affected limbs. Five patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-ray examination, bone losses caused by local debridement were generally repaired, though the shape of the tibia was not well-restored to its initial form in 17 limbs. No fracture was recorded during follow-up.
Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.
尽管已经引入了各种方法，但慢性胫骨骨髓炎的治疗仍然是一个挑战。本研究旨在评估局部清创术联合载抗生素硫酸钙植入物治疗 Cierny-Mader Ⅲ型胫骨骨髓炎的疗效。
本研究纳入 2012 年 1 月至 2018 年 12 月采用上述治疗方法的 42 例（43 侧）Cierny-Mader Ⅲ型胫骨骨髓炎患者。分别分析感染缓解率、复发率、并发症发生率和骨愈合率。
平均随访 42.8 个月，38 侧（37 例）（88.4%，38/43）感染缓解且无复发。患者疼痛、活动受限、窦道、局部红肿和肿胀等症状基本消失。仅 4 例患者长距离行走后出现轻度疼痛，6 例患者患肢有轻微但可接受的不适。5 例（11.6%）患者发生骨髓炎复发，需要二次手术和药物治疗，但无需截肢即可消除感染。13 例（30.0%）患者出现长期无菌性引流，通过适当的伤口护理，10 例患者治愈，3 例患者在数月后行手术干预。末次随访 X 线片示，局部清创导致的骨缺损基本得到修复，但 17 侧胫骨外形未完全恢复至初始形态。随访期间未发生骨折。
局部清创术联合载抗生素硫酸钙植入物治疗 Cierny-Mader Ⅲ型胫骨骨髓炎，具有疗效确切、安全性高的特点，可作为一种治疗选择。
