Mereddy Praveen, Nallamilli Somasekhar R, Gowda Veda P, Kasha Srinivas, Godey Shashi K, Nallamilli Rajyalakshmi R, Gprk Rohit, Meda Venu G R
Yashoda Hospitals, Hyderabad, India.
Apollo Hospitals, Hyderabad, India.
Bone Jt Open. 2023 Jul 10;4(7):516-522. doi: 10.1302/2633-1462.47.BJO-2023-0036.R1.
Musculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and joint infections.
Between January 2019 and December 2022, 106 patients with bone and joint infections were treated by five surgeons in five hospitals. Surgical debridement and calcium sulphate bead insertion was performed for local elution of antibiotics in high concentration. In all, 100 patients were available for follow-up at regular intervals. Choice of antibiotic was tailor made for each patient in consultation with microbiologist based on the organism grown on culture and the sensitivity. In majority of our cases, we used a combination of vancomycin and culture sensitive heat stable antibiotic after a thorough debridement of the site. Primary wound closure was achieved in 99 patients and a split skin graft closure was done in one patient. Mean follow-up was 20 months (12 to 30).
Overall, six out of 106 patients (5.6%) presented with sepsis and poorly controlled comorbid conditions, and died in the hospital within few days of index surgery. Out of the remaining 100 patients, control of infection was achieved in 95 patients (95%). Persistence of infection was noted in five (5%) patients. Out of these 95 patients that had good control of infection, four patients (4.2%) with gap nonunion needed Masquelet procedure to achieve union.
Our multicentre experience confirmed that surgical debridement along with calcium sulphate bead insertion was effective in treating bone and joint infections without any side effects and complications.
肌肉骨骼感染是创伤和择期骨科手术中一种极具破坏性的并发症，可导致严重的发病情况。本研究的目的是评估局部抗生素浸渍的可溶解合成硫酸钙珠（Stimulan Rapid Cure）在多个中心不同外科医生手中用于手术治疗骨与关节感染的有效性及并发症。
2019年1月至2022年12月期间，五家医院的五名外科医生对106例骨与关节感染患者进行了治疗。进行手术清创并植入硫酸钙珠，以实现抗生素的高浓度局部洗脱。共有100例患者可定期接受随访。根据培养出的病原体及其敏感性，与微生物学家协商后为每位患者量身定制抗生素选择。在我们的大多数病例中，在对感染部位进行彻底清创后，我们使用了万古霉素和对培养敏感的热稳定抗生素的联合用药。99例患者实现了一期伤口闭合，1例患者进行了植皮闭合。平均随访时间为20个月（12至30个月）。
总体而言，106例患者中有6例（5.6%）出现败血症且合并症控制不佳，在初次手术后数天内死于医院。在其余100例患者中，95例（95%）实现了感染控制。5例（5%）患者存在感染持续情况。在这95例感染得到良好控制的患者中，4例（4.2%）出现骨不连间隙的患者需要采用Masquelet技术来实现骨愈合。
我们的多中心经验证实，手术清创联合硫酸钙珠植入在治疗骨与关节感染方面有效，且无任何副作用和并发症。
