Selvaratnam Veenesh, Roche Andrew, Narayan Badri, Giotakis Nikolaos, Mukhopadhaya Shoumit, Aniq Hifz, Nayagam Selvadurai
Joint Reconstruction Unit, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Department of Trauma and Orthopaedic Surgery, Chelsea and Westminster Hospital and The Fortius Clinic, London, United Kingdom.
Strategies Trauma Limb Reconstr. 2023 Sep-Dec;18(3):148-154. doi: 10.5005/jp-journals-10080-1602.
The surgical management of chronic intramedullary osteomyelitis involves debridement of affected non-viable tissue and the use of antibiotics. Where surgery leaves a cavity, dead-space management is often through antibiotic-impregnated bone cement. These depots of local antibiotics are variable in elution properties and need removal. We review our unit's experience using a bioabsorbable synthetic calcium sulphate to deliver gentamicin as an adjunct in the treatment of osteomyelitis involving the medullary canal.
We retrospectively reviewed 34 patients with chronic osteomyelitis who were treated using this method in our institute. Variables recorded included aetiology, previous interventions, diagnostic criteria, radiological features, serology, and microbiology. The Cierny-Mader system was used to classify. Follow-up involved a survival analysis to time to recurrence, clinical and functional assessment (AOFAS-Ankle/IOWA knee/Oxford Hip/DASH scores) and a general health outcome questionnaire (SF36). The primary outcome measure was clinical recurrence of infection.
There were 24 male and 10 female patients. The mean age at presentation was 47 years (20-67). Clinical, laboratory, radiological, and patient reported outcomes were obtained at a median follow-up of 2.5 years (1.4-6.6 years). The bones involved were the femur (14, 41%), tibia (16, 47%), radius (1, 3%), and humerus (3, 9%). There were 13 cases classified as Cierny-Mader stage IV (diffuse with intramedullary osteomyelitis) and 21 cases as Cierny-Mader stage I. The median Oxford Hip score was 38 (11 patients, range 9-48). The median AOFAS score was 78 (14 patients, range 23-100). The median IOWA knee score was 71 (25 patients, range 22-95). The median DASH score was 33 (2 patients, range 1.7-64.2). There were two recurrences. The treatment success to date is 94%.
In our series of patients, bioabsorbable carriers of antibiotics appear to be effective adjuncts to surgical treatment of osteomyelitis and were associated with high clinical success rates.
Selvaratnam V, Roche A, Narayan B, . Effectiveness of an Antibiotic-impregnated Bioabsorbable Carrier for the Treatment of Chronic Intramedullary and Diffuse Osteomyelitis. Strategies Trauma Limb Reconstr 2023;18(3):148-154.
慢性骨髓炎的外科治疗包括清除受影响的失活组织并使用抗生素。手术造成骨腔时，死腔管理通常采用含抗生素的骨水泥。这些局部抗生素储存库的洗脱特性各不相同且需要取出。我们回顾了本单位使用可生物吸收的合成硫酸钙输送庆大霉素作为治疗累及髓腔的骨髓炎辅助手段的经验。
我们回顾性分析了在我院采用该方法治疗的34例慢性骨髓炎患者。记录的变量包括病因、既往干预措施、诊断标准、放射学特征、血清学和微生物学。采用Cierny-Mader系统进行分类。随访包括复发时间的生存分析、临床和功能评估（美国矫形足踝协会踝关节评分/爱荷华膝关节评分/牛津髋关节评分/上肢功能障碍评分）以及一般健康状况问卷（SF36）。主要结局指标为感染的临床复发。
男性24例，女性10例。就诊时的平均年龄为47岁（20 - 67岁）。中位随访时间为2.5年（1.4 - 6.6年），获得了临床、实验室、放射学及患者报告的结局。受累骨骼包括股骨（14例，41%）、胫骨（16例，47%）、桡骨（1例，3%）和肱骨（3例，9%）。Cierny-Mader分期为IV期（弥漫性髓内骨髓炎）13例，I期21例。牛津髋关节评分中位数为38分（11例患者，范围9 - 48分）。美国矫形足踝协会踝关节评分中位数为78分（14例患者，范围23 - 100分）。爱荷华膝关节评分中位数为71分（25例患者，范围22 - 95分）。上肢功能障碍评分中位数为33分（2例患者，范围1.7 - 64.2分）。有2例复发。目前的治疗成功率为94%。
在我们的患者系列中，抗生素的可生物吸收载体似乎是骨髓炎外科治疗的有效辅助手段，且临床成功率较高。
Selvaratnam V, Roche A, Narayan B, . 抗生素浸渍的可生物吸收载体治疗慢性髓内和弥漫性骨髓炎的有效性。创伤肢体重建策略2023;18(3):148 - 154。
