Tsang Shao-Ting J, Epstein Gadi Z, Ferreira Nando
Department of Trauma and Orthopaedic Surgery, Oxford University Hospitals, Oxford, Oxfordshire, United Kingdom.
Department of Orthopaedic Surgery, Tygerberg Hospital, University of Stellenbosch, South Africa.
Strategies Trauma Limb Reconstr. 2024 Jan-Apr;19(1):26-31. doi: 10.5005/jp-journals-10080-1610.
The Cierny and Mader classification assists with decision-making by stratifying host status and the pathoanatomy of the disease. However, the anatomical type IV represents a heterogenous group with regard to treatment requirements and outcomes. We propose that modification of the Cierny and Mader anatomical classification with an additional type V classifier (diffuse corticomedullary involvement with an associated critical bone defect) will allow more accurate stratification of patients and tailoring of treatment strategies.
A retrospective review of 83 patients undergoing treatment for Cierny and Mader anatomical type IV osteomyelitis of the appendicular skeleton at a single centre was performed.
Risk factors for the presence of a critical bone defect were female patients [OR 3.1 (95% CI, 1.08-8.92)] and requirement for soft tissue reconstruction [OR 3.35 (95% CI, 1.35-8.31)]; osteomyelitis of the femur was negatively associated with the presence of a critical bone defect [OR 0.13 (95% CI, 0.03-0.66)]. There was no statistically significant risk of adverse outcomes (failure to eradicate infection or achieve bone union) associated with the presence of a critical-sized bone defect. The median time to the bone union was ten months (95% CI, 7.9-12.1 months). There was a statistically significant difference in the median time to bone union between cases with a critical bone defect [12.0 months (95% CI, 10.2-13.7 months)] and those without [6.0 months (95% CI, 4.8-7.1 months)].
This study provided evidence to support the introduction of a new subgroup of the Cierny and Mader anatomical classification (Type V). Using a standardised approach to management, comparable early outcomes can be achieved in patients with Cierny and Mader anatomical type V osteomyelitis. However, to achieve a successful outcome, there is a requirement for additional bone and soft tissue reconstruction procedures with an associated increase in treatment time.
Tsang STJ, Epstein GZ, Ferreira N. Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis. Strategies Trauma Limb Reconstr 2024;19(1):26-31.
Cierny和Mader分类法通过对宿主状态和疾病的病理解剖进行分层来辅助决策。然而，解剖学IV型代表了一个在治疗需求和结果方面具有异质性的群体。我们建议，对Cierny和Mader解剖学分类法进行修改，增加一个V型分类器（弥漫性皮质髓质受累并伴有严重骨缺损），将能更准确地对患者进行分层，并制定更具针对性的治疗策略。
对在单一中心接受Cierny和Mader解剖学IV型骨髓炎治疗的83例患者进行回顾性研究。
存在严重骨缺损的危险因素为女性患者[比值比（OR）3.1（95%置信区间，1.08 - 8.92）]和需要进行软组织重建[OR 3.35（95%置信区间，1.35 - 8.31）]；股骨骨髓炎与严重骨缺损的存在呈负相关[OR 0.13（95%置信区间，0.03 - 0.66）]。存在临界大小骨缺损与不良结局（未能根除感染或实现骨愈合）之间无统计学显著风险关联。骨愈合的中位时间为10个月（95%置信区间，7.9 - 12.1个月）。存在严重骨缺损的病例[12.0个月（95%置信区间，10.2 - 13.7个月）]与不存在严重骨缺损的病例[6.0个月（95%置信区间，4.8 - 7.1个月）]在骨愈合中位时间上存在统计学显著差异。
本研究提供了证据支持引入Cierny和Mader解剖学分类法的一个新亚组（V型）。采用标准化的管理方法，Cierny和Mader解剖学V型骨髓炎患者可取得相当的早期治疗效果。然而，为实现成功的治疗结果，需要额外的骨和软组织重建手术，且治疗时间会相应增加。
曾圣杰、爱泼斯坦·G·Z、费雷拉·N。影响解剖学IV型慢性骨髓炎治疗结果的严重骨缺损。《创伤肢体重建策略》2024；19(1)：26 - 31。
