Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, South Korea.
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
J Orthop Surg (Hong Kong). 2024 May-Aug;32(2):10225536241264977. doi: 10.1177/10225536241264977.
Fracture-related infections (FRIs) encompass a broad range of infections associated with bone fractures; they remain a significant clinical challenge. Here, we aimed to investigate the viability of focusing on soft-tissue management in patients suspected of chronic FRI, who exhibit no significant bony uptake on bone single photon emission computed tomography (SPECT)/computed tomography (CT) scans.
Between January 2016 and January 2022, we managed 25 patients with chronic FRI or post-traumatic osteomyelitis using technetium 99m-methyl diphosphonate bone SPECT/CT to assess infection depth. Among them, 13 patients showing negligible bony uptake were included and categorized into two groups based on wound discharge reaching the bone/implant (Criteria 1, = 6) or not (Criteria 2, = 7).
Patients in the Criteria 1 group were treated with antibiotics and soft tissue debridement without bony procedure. The average duration of antibiotic therapy was 6.7 weeks. Treatments were individualized, including implant changes, local flaps, skin grafts, and negative pressure wound therapy. No recurrence was reported in the mean follow-up of 21.3 months. Patients in the Criteria 2 group were treated with oral antibiotics (mean duration: 5.9 weeks) and daily wound dressings. No recurrence was reported in the mean follow-up of 26.0 months, and no surgical interventions were required.
This study demonstrates the feasibility of focusing on soft-tissue management in patients with chronic FRI showing minimal bony uptake on bone SPECT/CT. Our treatment protocol avoided unnecessary surgical bone procedures, resulting in successful clinical outcomes with no recurrences.
骨折相关感染（FRIs）涵盖了与骨折相关的广泛感染；它们仍然是一个重大的临床挑战。在这里，我们旨在研究在慢性 FRI 患者中关注软组织管理的可行性，这些患者在骨单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）扫描中没有明显的骨摄取。
在 2016 年 1 月至 2022 年 1 月期间，我们使用锝 99m-甲基二膦酸盐骨 SPECT/CT 评估感染深度来管理 25 例慢性 FRI 或创伤后骨髓炎患者。其中，13 例患者显示出微不足道的骨摄取，根据伤口分泌物是否达到骨/植入物（标准 1，n=6）或未达到（标准 2，n=7）将其分为两组。
标准 1 组患者接受抗生素和软组织清创术，而无需进行骨手术。抗生素治疗的平均持续时间为 6.7 周。治疗是个体化的，包括植入物更换、局部皮瓣、皮肤移植和负压伤口治疗。在 21.3 个月的平均随访中，没有复发的报告。标准 2 组患者接受口服抗生素（平均持续时间：5.9 周）和每日伤口敷料治疗。在 26.0 个月的平均随访中，没有复发的报告，也不需要手术干预。
本研究表明，在慢性 FRI 患者中，在 SPECT/CT 显示最小骨摄取的情况下，关注软组织管理是可行的。我们的治疗方案避免了不必要的手术骨操作，取得了成功的临床结果，没有复发。
