Frank Florian A, Pomeroy Eoghan, Hotchen Andrew J, Stubbs David, Ferguson Jamie Y, McNally Martin
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom; Musculoskeletal Infections Centre (ZMSI), Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland.
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom.
Strategies Trauma Limb Reconstr. 2024 Jan-Apr;19(1):21-25. doi: 10.5005/jp-journals-10080-1607.
This study has investigated cases of pin site infection (PSI) which required surgery for persistent osteomyelitis (OM) despite pin removal.
Patients requiring surgery for OM after PSI between 2011 and 2021 were included in this retrospective cohort study. Single-stage surgery was performed in accordance with a protocol at one institution. This involved deep sampling, debridement, implantation of local antibiotics, culture-specific systemic antibiotics and soft tissue closure. A successful outcome was defined as an infection-free interval of at least 24 months following surgery.
Twenty-seven patients were identified (the sites were 22 tibias, 2 humeri, 2 calcanei, 1 radius); about 85% of them were males with a median age of 53.9 years. The majority of infections (21/27) followed fracture treatment. Fifteen patients were classified as BACH uncomplicated and 12 were BACH complex. were the most common pathogens, polymicrobial infections were detected in five cases (19%). Seven patients required flap coverage which was performed in the same operation.After a median of 3.99 years (2.00-8.05) follow-up, all patients remained infection free at the site of the former OM. Wound leakage after local antibiotic treatment was seen in 3/27 (11.1%) cases but did not require further treatment.
Osteomyelitis after PSI is uncommon but has major implications for the patient as 7 patients needed flap coverage. This reinforces the need for careful pin placement and pin site care to prevent deep infection. These infections were treated in accordance with a protocol and were not managed simply by curettage. All patients treated in this manner remained infection-free after a minimum follow-up of 2 years suggesting that this protocol is effective.
Pin site infection is a very common complication in external fixation. The sequela of a chronic pin site OM is rare but the implications to the patient are huge. In this series, more than a quarter of patients required flap coverage as part of the treatment of the deep infection.
Frank FA, Pomeroy E, Hotchen AJ, . Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection. Strategies Trauma Limb Reconstr 2024;19(1):21-25.
本研究调查了尽管已拔除钢针，但仍因持续性骨髓炎（OM）需要手术治疗的针道感染（PSI）病例。
本回顾性队列研究纳入了2011年至2021年间因PSI后OM需要手术的患者。在一家机构按照方案进行了一期手术。这包括深部采样、清创、局部抗生素植入、针对培养结果的全身抗生素治疗以及软组织闭合。成功的结果定义为术后至少24个月无感染间隔期。
共确定了27例患者（部位为22例胫骨、2例肱骨、2例跟骨、1例桡骨）；其中约85%为男性，中位年龄为53.9岁。大多数感染（21/27）发生在骨折治疗后。15例患者被分类为BACH简单型，12例为BACH复杂型。 是最常见的病原体，5例（19%）检测到多微生物感染。7例患者需要皮瓣覆盖，在同一次手术中进行。中位随访3.99年（2.00 - 8.05年）后，所有患者原OM部位均无感染。局部抗生素治疗后3/27（11.1%）病例出现伤口渗漏，但无需进一步治疗。
PSI后骨髓炎并不常见，但对患者有重大影响，因为有7例患者需要皮瓣覆盖。这强化了谨慎放置钢针和护理针道以预防深部感染的必要性。这些感染按照方案进行治疗，并非单纯通过刮除术处理。以这种方式治疗的所有患者在至少随访2年后均无感染，表明该方案有效。
针道感染是外固定中非常常见的并发症。慢性针道OM的后遗症很少见，但对患者的影响巨大。在本系列中，超过四分之一的患者需要皮瓣覆盖作为深部感染治疗的一部分。
Frank FA, Pomeroy E, Hotchen AJ, 。针道感染所致严重骨髓炎治疗后的临床结果。《创伤肢体重建策略》2024；19(1):21 - 25。
