Geetala Rahul, Zhang James, Maghsoudi Daniel, Madigasekara Amindu, Krkovic Matija
Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom.
Strategies Trauma Limb Reconstr. 2024 Jan-Apr;19(1):32-35. doi: 10.5005/jp-journals-10080-1613.
Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex, requiring eradication through debridement before limb reconstruction, for which the Taylor spatial frame (TSF) is one option. This study evaluates patient outcomes after reconstruction and identifies factors associated with post-operative complications.
Fifty-one cases of tibial osteomyelitis were treated by the Ilizarov technique from 2015 to 2021 at a major trauma centre. Bacterial samples and treatment factors were assessed. Patient outcomes were complication rates and time to bony union. Complications were expressed as odds-ratios (OR) with 95% confidence intervals. Linear regression was used to assess factors associated with time to union.
The mean follow-up was 24.1 months with the mean time to radiological union being 11 months. Post-operative complications were noted in 76.5% of patients with pin-site infections most common (52.9%), followed by fracture malunion (29.4%). Smoking was associated with increased fracture malunion (OR = 4.148, 95% confidence Interval [1.13-15.18], = 0.031). The time to union was positively associated with complications, age and time to full weight-bearing (FWB). All other measured factors were found not significant.
Tibial osteomyelitis is treated reliably by debridement and reconstruction using the Ilizarov technique using a TSF application. The most common complication was pin-site infection. Optimising patients through cessation of smoking and encouraging post-operative weight-bearing can reduce the complication rate and improve time to union.
The Ilizarov technique using a TSF can treat significant deformities that result from the management of tibial osteomyelitis.
Geetala R, Zhang J, Maghsoudi D, . The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024;19(1):32-35.
胫骨骨髓炎可继发于开放性骨折，细菌在伤口定植，并通过生物膜和死骨形成持续存在。治疗较为复杂，需要在肢体重建前通过清创术根除感染，泰勒空间框架（TSF）是其中一种选择。本研究评估重建后的患者预后，并确定与术后并发症相关的因素。
2015年至2021年，一家主要创伤中心采用伊里扎洛夫技术治疗了51例胫骨骨髓炎病例。对细菌样本和治疗因素进行了评估。患者预后指标为并发症发生率和骨愈合时间。并发症以比值比（OR）及95%置信区间表示。采用线性回归评估与愈合时间相关的因素。
平均随访24.1个月，放射学愈合的平均时间为11个月。76.5%的患者出现术后并发症，其中最常见的是针道感染（52.9%），其次是骨折畸形愈合（29.4%）。吸烟与骨折畸形愈合增加相关（OR = 4.148，95%置信区间[1.13 - 15.18]，P = 0.031）。愈合时间与并发症、年龄及完全负重时间呈正相关。其他所有测量因素均无显著意义。
采用TSF应用的伊里扎洛夫技术进行清创和重建，可可靠地治疗胫骨骨髓炎。最常见的并发症是针道感染。通过戒烟和鼓励术后负重来优化患者情况，可降低并发症发生率并缩短愈合时间。
采用TSF的伊里扎洛夫技术可治疗因胫骨骨髓炎处理导致的严重畸形。
Geetala R, Zhang J, Maghsoudi D, 。泰勒空间框架在治疗创伤性胫骨骨折后胫骨骨髓炎中的应用。创伤肢体重建策略2024;19(1):32 - 35。
