Hotchen Andrew J, Dudareva Maria, Corrigan Ruth A, Ferguson Jamie Y, McNally Martin A
Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
Bone Joint J. 2020 Sep 23:1-10. doi: 10.1302/0301-620X.102B9.BJJ-2020-0284.R1.
This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into 'uncomplicated' or 'complex'.
Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome.
In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH 'uncomplicated' osteomyelitis was associated with better QoL compared to BACH 'complex' osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2).
Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis.
本研究展示了长骨骨髓炎手术清创后第一年患者报告的生活质量(QoL)。它评估骨受累情况、抗菌药物选择、软组织覆盖情况以及宿主状态(BACH)分类作为一种预后工具及其将病例分层为“非复杂性”或“复杂性”的能力。
在2010年6月至2015年10月期间前瞻性地确定长骨骨髓炎患者。所有患者在专科骨感染科室接受单阶段手术清创。在术后五个时间点(基线、14天、42天、120天和365天)使用三级欧洲五维健康量表(EQ - 5D - 3L)指数评分和视觉模拟量表(EQ - VAS)前瞻性地评估自我报告的生活质量。由两名对结果不知情的临床医生进行BACH分类的回顾性应用。
总共纳入了71例长骨骨髓炎患者。从手术时到术后一年,平均EQ - VAS(58.2至78.9;p < 0.001)和平均EQ - 5D - 3L指数评分(0.284至0.740;p < 0.001)有显著改善。术后一年,与BACH“复杂性”骨髓炎相比,BACH“非复杂性”骨髓炎的生活质量更好(平均EQ - 5D - 3L 0.900对0.685;p = 0.020;平均EQ - VAS 87.1对73.6;p = 0.043)。与复杂性骨受累(B2,节段性或B3,累及关节的骨髓炎)相比,非复杂性骨受累(BACH B1型,空洞性)患者在所有时间点报告的生活质量更高。与多重耐药菌株患者(A2)相比,抗菌药物选择良好(Ax或A1)的患者结局评分更高。微血管组织转移的需求(C1和C2)对生活质量没有显著影响。与患有严重疾病的患者(复杂性,H2)相比,无主要合并症的患者(非复杂性,H1)报告的生活质量更高。
与复杂性病例相比,BACH定义的非复杂性骨髓炎患者自我报告的生活质量更高。骨受累情况、抗菌药物选择和宿主状态变量能够根据生活质量对患者进行分层。这些数据可用于为正在接受长骨骨髓炎治疗的患者提供预后信息。