Garabano Germán, Amadei Enghelmayer Rafael E, Perez Alamino Leonel, Viollaz Gonzalo M, Pesciallo Cesar Angel
Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
Scientific Advisory Committee, British Hospital of Buenos Aires, Buenos Aires, Argentina.
Eur J Orthop Surg Traumatol. 2024 Feb;34(2):789-797. doi: 10.1007/s00590-023-03689-6. Epub 2023 Sep 13.
This study evaluated whether polymicrobial infection affects reoperation rates due to infection recurrence and treatment failure with the Masquelet technique in infected posttraumatic segmental bone defects of the femur and tibia.
We retrospectively analyzed patients treated between 2012 and 2021 in two trauma referral centers. We evaluated demographic data, injury, treatment, infection recurrence, failures, and bone healing rates according to whether the infection was mono- or polymicrobial. After uni-bivariate analysis between patients with polymicrobial and monomicrobial infection, we identified the variables associated with infection recurrence and failure through multivariate analysis.
We analyzed 54 patients, 30 (55.55%) with tibial and 24 (44.44%) femoral segmental bone defects, with a mean follow-up of 41.7 ± 15.0 months. Forty-four (81.48%) presented monomicrobial, and 10 (18.51%) polymicrobial infections. Comparatively, the need for soft tissue reconstruction and the infection recurrence rate was significantly higher in patients with polymicrobial infections. There was no significant difference in the failure rate (20 vs. 6.81% p = 0.23). Multivariable logistic regression analysis identified the polymicrobial infection as the only independent variable associated with infection recurrence (Odds Ratio = 11.07; p = 0.0017).
Our analysis suggests that polymicrobial infection is associated with a higher risk of infection recurrence in treating the femur and tibia segmental bone defects with the Masquelet technique. This information can help surgeons to inform patients about this and give them a realistic expectation of the outcome and the possibility of reoperation.
本研究评估了在股骨和胫骨创伤后感染性节段性骨缺损中，混合微生物感染是否会因感染复发和治疗失败而影响采用Masquelet技术的再次手术率。
我们回顾性分析了2012年至2021年在两个创伤转诊中心接受治疗的患者。我们根据感染是单一微生物还是混合微生物，评估了人口统计学数据、损伤情况、治疗方法、感染复发情况、治疗失败情况和骨愈合率。在对混合微生物感染和单一微生物感染患者进行单变量分析后，我们通过多变量分析确定了与感染复发和治疗失败相关的变量。
我们分析了54例患者，其中30例（55.55%）为胫骨节段性骨缺损，24例（44.44%）为股骨节段性骨缺损，平均随访时间为41.7±15.0个月。44例（81.48%）为单一微生物感染，10例（18.51%）为混合微生物感染。相比之下，混合微生物感染患者的软组织重建需求和感染复发率显著更高。治疗失败率无显著差异（20%对6.81%，p=0.23）。多变量逻辑回归分析确定混合微生物感染是与感染复发相关的唯一独立变量（比值比=11.07；p=0.0017）。
我们的分析表明，在采用Masquelet技术治疗股骨和胫骨节段性骨缺损时，混合微生物感染与更高的感染复发风险相关。这些信息可以帮助外科医生向患者告知这一情况，并让他们对治疗结果和再次手术的可能性有一个现实的预期。
