Downey Emilie-Ann, Jaime Kayla M, Reif Taylor J, Makhdom Asim M, Rozbruch S Robert, Fragomen Austin T
Department of Orthopaedics, Pierre-Boucher Hospital, Longueuil, QC, Canada.
Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA.
J Bone Jt Infect. 2022 Apr 22;7(2):101-107. doi: 10.5194/jbji-7-101-2022. eCollection 2022.
: The study was done (1) to report on our recent experience with antibiotic-loaded calcium sulfate-coated interlocking intramedullary nails (CS-IMN) for infection prevention or infection eradication and (2) to compare the efficacy of CS-IMN versus antibiotic-loaded polymethylmethacrylate-coated IMN (PMMA-IMN) for infection eradication. : We retrospectively reviewed the medical records of consecutive patients who underwent a limb salvage procedure for infection cure or infection prevention with PMMA-IMN or CS-IMN. We reviewed patient demographics, host-type, pre-operative infecting organisms, intraoperative cultures, as well as our main outcomes: infection control rate, achievement of union/fusion, and limb salvage. : 33 patients were treated with CS-IMN: 9 patients with goal of infection cure and 24 patients for infection prophylaxis. When used for infection prophylaxis, there was a 100 % ( patients) prevention of infection rate, 95.5 % union rate ( patients), and 100 % ( patients) limb salvage rate. Nine patients were treated with CS-IMN to eradicate infection and were compared to a cohort of 28 patients who were treated with PMMA-IMN. The infection was eradicated in patients (77.8 %) in the CS-IMN group versus 21/26 patients (80 %) in the PMMA-IMN group ( ). Bone union/fusion was achieved in patients (88.9 %) in the CS-IMN group versus 21/24 patients (87.5 %) in the PMMA-IMN group ( ). The limb salvage rate in the CS-IMN group was 100 % ( patients) versus 89 % ( patients) in the PMMA-IMN group. : CS-IMN are safe and easy to use, and we have therefore expended our indications for them. CS-IMN are very effective at infection prophylaxis in high-risk cases where infection is suspected. Early analysis suggests that CS-IMN are non-inferior to PMMA-IMN for infection eradication. This is our preliminary data that show this novel technique to be safe in a small cohort and may be as effective as the more established method. Future studies with larger cohorts of patients will be required to confirm these findings.
（1）报告我们近期使用载抗生素硫酸钙涂层交锁髓内钉（CS-IMN）预防感染或根除感染的经验；（2）比较CS-IMN与载抗生素聚甲基丙烯酸甲酯涂层髓内钉（PMMA-IMN）根除感染的疗效。
我们回顾性分析了连续接受PMMA-IMN或CS-IMN保肢手术以治愈感染或预防感染患者的病历。我们评估了患者的人口统计学特征、宿主类型、术前感染病原体、术中培养结果，以及主要结局指标：感染控制率、骨愈合/融合情况和保肢率。
33例患者接受了CS-IMN治疗：9例以治愈感染为目标，24例用于预防感染。用于预防感染时，感染预防率为100%（24例患者），骨愈合率为95.5%（23例患者），保肢率为100%（24例患者）。9例患者接受CS-IMN治疗以根除感染，并与28例接受PMMA-IMN治疗的患者进行比较。CS-IMN组7/9例患者（77.8%）感染得到根除（p=0.641），而PMMA-IMN组为21/26例患者（80%）。CS-IMN组8/9例患者（88.9%）实现了骨愈合/融合（p=0.884），而PMMA-IMN组为21/24例患者（87.5%）。CS-IMN组保肢率为100%（9例患者），而PMMA-IMN组为89%（25例患者）。
CS-IMN安全且易于使用，因此我们扩大了其适应证。CS-IMN在疑似感染的高危病例中预防感染非常有效。早期分析表明，CS-IMN在根除感染方面不劣于PMMA-IMN。这是我们的初步数据，表明这种新技术在一小群患者中是安全的，可能与更成熟的方法一样有效。未来需要更大规模的患者队列研究来证实这些发现。
