Sambri Andrea, Cevolani Luca, Passarino Valentina, Bortoli Marta, Parisi Stefania Claudia, Fiore Michele, Campanacci Laura, Staals Eric, Donati Davide Maria, De Paolis Massimiliano
Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Microorganisms. 2023 Jun 21;11(7):1623. doi: 10.3390/microorganisms11071623.
This retrospective study reports on the treatment of chronic osteomyelitis with local debridement combined with PerOssal. The diagnosis of chronic osteomyelitis was confirmed in all cases and classified according to the Cierny-Mader (C-M) classification. The primary outcome was the eradication of infection at a minimum of one year after surgery. A total of 93 patients (median age: 40 years) were included. The most represented sites were the femur (24, 25.8%) and tibia (52, 55.9%). Twenty-six patients (28.0%) had significant local or systemic comorbidities (C-M Class B hosts). According to anatomic type, 31 cases were type I, 13 type II, 21 type III and 28 type IV. Vancomycin was added to PerOssal in most cases (80, 86.0%). In 24 (25.8%) cases, Vancomycin and Rifampicin were combined. In 32 (34.4%) cases, intraoperative cultures were negative. was isolated in 39 (63.9%) patients, and Gram-negative bacteria were isolated in 12 cases. The median follow-up was 21 months (range 12-84). A total of 21 (22.6%) patients developed an infection recurrence (IR) after a median follow-up of 11 months (range: 1-47). PerOssal holds several practical advantages compared to other bone void fillers. Thus, due to its good biocompatibility and sufficient antibiotic release, it represents a viable adjuvant treatment in chronic osteomyelitis.
这项回顾性研究报告了局部清创联合PerOssal治疗慢性骨髓炎的情况。所有病例均确诊为慢性骨髓炎，并根据Cierny-Mader（C-M）分类法进行分类。主要结局是术后至少一年感染得到根除。共纳入93例患者（中位年龄：40岁）。最常见的发病部位是股骨（24例，25.8%）和胫骨（52例，55.9%）。26例患者（28.0%）有明显的局部或全身合并症（C-M B级宿主）。根据解剖类型，I型31例，II型13例，III型21例，IV型28例。大多数病例（80例，86.0%）在PerOssal中添加了万古霉素。24例（25.8%）病例联合使用了万古霉素和利福平。32例（34.4%）病例术中培养结果为阴性。39例（63.9%）患者分离出革兰氏阳性菌，12例分离出革兰氏阴性菌。中位随访时间为21个月（范围12 - 84个月）。共有21例（22.6%）患者在中位随访11个月（范围：1 - 47个月）后出现感染复发（IR）。与其他骨缺损填充材料相比，PerOssal具有几个实际优势。因此，由于其良好的生物相容性和充足的抗生素释放，它是慢性骨髓炎一种可行的辅助治疗方法。
