Su Yu, Li Dongchen, Du Bing, Li Zhao, Lu Yao, Xu Yibo, Wang Qian, Li Zhong, Ren Cheng, Ma Teng
Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Front Bioeng Biotechnol. 2024 May 14;12:1368818. doi: 10.3389/fbioe.2024.1368818. eCollection 2024.
We aimed to evaluate the efficacy of antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in the treatment of limb-localized osteomyelitis (Cierny-Mader type III) and analyze the causes and risk factors associated with infection recurrence.
Clinical data of 163 patients with localized osteomyelitis of the extremities treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in Xi'an Honghui Hospital from January 2017 to December 2022 were retrospectively analyzed. All patients were diagnosed with localized osteomyelitis through clinical examination and treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone. Based on the infection recurrence status, the patients were divided into the recurrence group and the non-recurrence group. The clinical data of the two groups were compared using univariate analysis. Subsequently, the distinct datasets were included in the binary logistic regression analysis to determine the risk and protective factors.
This study included 163 eligible patients, with an average age of 51.0 years (standard deviation: 14.9). After 12 months of follow-up, 25 patients (15.3%) experienced infection recurrence and were included in the recurrence group; the remaining 138 patients were included in the non-recurrence group. Among the 25 patients with recurrent infection, 20 required reoperation, four received antibiotic treatment alone, and one refused further treatment. Univariate analysis showed that education level, smoking, hypoproteinemia, open injury-related infection, and combined flap surgery were associated with infection recurrence ( < 0.05). Logistic regression analysis showed that open injury-related infection (odds ratio [OR] = 35.698; 95% confidence interval [CI]: 5.997-212.495; < 0.001) and combined flap surgery (OR = 41.408; 95% CI: 5.806-295.343; < 0.001) were independent risk factors for infection recurrence. Meanwhile, high education level (OR = 0.009; 95% CI: 0.001-0.061; < 0.001) was a protective factor for infection recurrence.
Antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation is an effective method for treating limb-localized osteomyelitis. Patients without previous combined flap surgery and non-open injury-related infections have a relatively low probability of recurrence of infection after treatment with this surgical method. Additionally, patients with a history of smoking and hypoproteinemia should pay attention to preventing the recurrence of infection after operation. Providing additional guidance and support, particularly in patients with lower education levels and compliance, could contribute to the reduction of infection recurrence.
我们旨在评估载抗生素硫酸钙联合自体髂骨移植治疗肢体局限性骨髓炎（Cierny-Mader III型）的疗效，并分析与感染复发相关的原因和危险因素。
回顾性分析2017年1月至2022年12月在西安红会医院接受载抗生素硫酸钙联合自体髂骨移植治疗的163例肢体局限性骨髓炎患者的临床资料。所有患者均通过临床检查确诊为局限性骨髓炎，并接受载抗生素硫酸钙联合自体髂骨治疗。根据感染复发情况，将患者分为复发组和非复发组。采用单因素分析比较两组的临床资料。随后，将不同数据集纳入二元逻辑回归分析，以确定风险和保护因素。
本研究纳入163例符合条件的患者，平均年龄51.0岁（标准差：14.9）。随访12个月后，25例患者（15.3%）发生感染复发，纳入复发组；其余138例患者纳入非复发组。在25例复发感染患者中，20例需要再次手术，4例仅接受抗生素治疗，1例拒绝进一步治疗。单因素分析显示，教育程度、吸烟、低蛋白血症、开放性损伤相关感染和联合皮瓣手术与感染复发有关（P<0.05）。逻辑回归分析显示，开放性损伤相关感染（比值比[OR]=35.698；95%置信区间[CI]：5.997-212.495；P<0.001）和联合皮瓣手术（OR=41.408；95%CI：5.806-295.343；P<0.001）是感染复发的独立危险因素。同时，高教育程度（OR=0.009；95%CI：0.001-0.061；P<0.001）是感染复发的保护因素。
载抗生素硫酸钙联合自体髂骨移植是治疗肢体局限性骨髓炎的有效方法。既往未行联合皮瓣手术且无开放性损伤相关感染的患者，采用该手术方法治疗后感染复发的概率相对较低。此外，有吸烟史和低蛋白血症的患者术后应注意预防感染复发。为患者提供额外的指导和支持，特别是对教育程度较低和依从性较差的患者，可能有助于减少感染复发。
