Van Vugt Tom A G, Heidotting Jeffrey, Arts Jacobus J, Ploegmakers Joris J W, Jutte Paul C, Geurts Jan A P
Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
Department of Orthopedic Surgery, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
J Bone Jt Infect. 2021 Nov 12;6(9):413-421. doi: 10.5194/jbji-6-413-2021. eCollection 2021.
: Chronic osteomyelitis is a challenging condition in the orthopedic practice and traditionally treated using local and systemic antibiotics in a two-stage surgical procedure. With the introduction of the antimicrobial biomaterial S53P4 bioactive glass (Bonalive), chronic osteomyelitis can be treated in a one-stage procedure. This study evaluated the mid-term clinical results of patients treated with S53P4 bioactive glass for long bone chronic osteomyelitis. : In this prospective multi-center study, patients from two different university medical centers in the Netherlands were included. One-stage treatment consisted of debridement surgery, implantation of S53P4 bioactive glass, and treatment with culture-based systemic antibiotics. If required, wound closure by a plastic surgeon was performed. The primary outcome was the eradication of infection, and a secondary statistical analysis was performed on probable risk factors for treatment failure. : In total, 78 patients with chronic cavitary long bone osteomyelitis were included. Follow-up was at least 12 months (mean 46; standard deviation, SD, 20), and 69 patients were treated in a one-stage procedure. Overall infection eradication was 85 %, and 1-year infection-free survival was 89 %. Primary closure versus local/muscular flap coverage is the only risk factor for treatment failure. : With 85 % eradication of infection, S53P4 bioactive glass is an effective biomaterial in the treatment of chronic osteomyelitis in a one-stage procedure. A major risk factor for treatment failure is the necessity for local/free muscle flap coverage. These results confirm earlier published data, and together with the fundamentally different antimicrobial pathways without antibiotic resistance, S53P4 bioactive glass is a recommendable biomaterial for chronic osteomyelitis treatment and might be beneficial over other biomaterials.
慢性骨髓炎是骨科临床中具有挑战性的病症，传统上采用局部和全身抗生素进行两阶段手术治疗。随着抗菌生物材料S53P4生物活性玻璃（Bonalive）的引入，慢性骨髓炎可采用单阶段手术治疗。本研究评估了使用S53P4生物活性玻璃治疗长骨慢性骨髓炎患者的中期临床结果。
在这项前瞻性多中心研究中，纳入了来自荷兰两个不同大学医学中心的患者。单阶段治疗包括清创手术、植入S53P4生物活性玻璃以及基于培养的全身抗生素治疗。如有需要，由整形外科医生进行伤口闭合。主要结局是感染根除，对治疗失败的可能危险因素进行了二次统计分析。
总共纳入了78例慢性空洞性长骨骨髓炎患者。随访至少12个月（平均46个月；标准差，SD，20个月），69例患者接受了单阶段手术治疗。总体感染根除率为85%，1年无感染生存率为89%。一期缝合与局部/肌瓣覆盖是治疗失败的唯一危险因素。
S53P4生物活性玻璃在单阶段手术治疗慢性骨髓炎中感染根除率达85%，是一种有效的生物材料。治疗失败的一个主要危险因素是需要局部/游离肌瓣覆盖。这些结果证实了早期发表的数据，并且由于其抗菌途径与抗生素耐药性根本不同，S53P4生物活性玻璃是治疗慢性骨髓炎的推荐生物材料，可能比其他生物材料更具优势。
