Jiang Nan, Chen Peng, Liu Guan-Qiao, Huang Mou-Zhang, Deng Ming-Ye, Song Ming-Rui, Zhu Run-Jiu, Zhong Hong-Fa, Xiang Da-Yong, Yu Bin
Division of Orthopaedics & Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University.
Guangdong Provincial Institute of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou.
Int J Surg. 2024 Oct 1;110(10):6810-6821. doi: 10.1097/JS9.0000000000001815.
Calcaneal osteomyelitis (CO) still poses great challenges to orthopedic surgeons due to the unique anatomic and functional features of the calcaneus. This study summarized the current data regarding clinical characteristics, treatment and efficacy of CO, based on an analysis of literature-reported cases.
The authors searched the PubMed, Embase, and Cochrane Library databases to find English and Chinese studies reporting on CO patients published between 2000 and 2021, with available data for synthesis analysis. The quality of the included studies was evaluated by the National Institutes of Health (NIH) assessment scale. Effective data were extracted and pooled for analysis.
Altogether 198 studies involving 1118 patients were included, with a male-to-female ratio of 2.3 (724 males and 310 females). The median age at CO diagnosis was 46 years, with a median symptom duration of 3 months. Injury-related infections (524 cases) and diabetic foot infections (336 cases) were the two most common causes, with ulcers (468 cases) and wound sinus or exudation (209 cases) being the predominant symptoms. The overall positive culture rate was 80.2%, with polymicrobial infections accounting for 18.1%. Staphylococcus aureus was the most frequently detected pathogen (42.7%), with fungal-related infections isolated in 17 cases. Although most patients received surgical interventions (96.9%), the recurrence rate was 20.1%. The incidence of infection relapse following partial calcanectomy, total calcanectomy, debridement with implantation of local antibiotics, and debridement with or without flap or skin coverage were 31.7%, 45.0%, 16.8%, and 15.1%, respectively. The overall incidence of limb amputation was 12.4%, with all-cause and CO-related mortalities of 2.8% and 0.2%, separately.
CO shared similar characteristics with extremity chronic osteomyelitis, primarily affecting young males, with trauma and diabetic foot as the leading causes and Staphylococcus aureus as the most frequently detected pathogen. Despite surgery being the primary treatment modality, clinical outcomes remained unsatisfactory, marked by high rates of infection recurrence and limb amputation.
由于跟骨独特的解剖和功能特点，跟骨骨髓炎（CO）仍然给骨科医生带来巨大挑战。本研究在分析文献报道病例的基础上，总结了有关CO临床特征、治疗及疗效的现有数据。
作者检索了PubMed、Embase和Cochrane图书馆数据库，以查找2000年至2021年间发表的关于CO患者的英文和中文研究，获取可用于综合分析的数据。纳入研究的质量采用美国国立卫生研究院（NIH）评估量表进行评估。提取有效数据并汇总进行分析。
共纳入198项研究，涉及1118例患者，男女比例为2.3（男性724例，女性310例）。CO诊断时的中位年龄为46岁，中位症状持续时间为3个月。与损伤相关的感染（524例）和糖尿病足感染（336例）是两个最常见的原因，溃疡（468例）和伤口窦道或渗出（209例）是主要症状。总体培养阳性率为80.2%，混合菌感染占18.1%。金黄色葡萄球菌是最常检测到的病原体（42.7%），17例分离出真菌相关感染。尽管大多数患者接受了手术干预（96.9%），但复发率为20.1%。部分跟骨切除术、全跟骨切除术、局部抗生素植入清创术以及有或无皮瓣或皮肤覆盖的清创术后感染复发率分别为31.7%、45.0%、16.8%和15.1%。肢体截肢的总体发生率为12.4%，全因死亡率和与CO相关的死亡率分别为2.8%和0.2%。
CO与肢体慢性骨髓炎具有相似特征，主要影响年轻男性，创伤和糖尿病足是主要病因，金黄色葡萄球菌是最常检测到的病原体。尽管手术是主要治疗方式，但临床结果仍不尽人意，感染复发率和肢体截肢率较高。
