Ruewe Marc, Siegmund Andreas, Rupp Markus, Prantl Lukas, Anker Alexandra M, Klein Silvan M
Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.
Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.
Life (Basel). 2024 Aug 2;14(8):973. doi: 10.3390/life14080973.
Late-stage pressure sore (PS) patients are particularly susceptible to osteomyelitis (OM), as bony prominences commonly constitute the focal point of the ulcer. There are lack of data regarding the associated factors and the clinical relevance of this diagnosis in the context of PS treatment.
This retrospective analysis investigated the clinical characteristics, blood markers indicative of infection in PS patients, and development of histologically evident OM. A total of 125 patient were included from 2014 to 2019. The patient records were especially scanned for histological diagnosis of OM.
OM was detected in 39% (37/96) of the samples taken during the index procedure. OM prevalence increased to 56% (43/77) at the second and 70% (41/59) at the third debridement. Therefore, the diagnosis of OM was acquired during treatment in 35 cases. Patients diagnosed with initial OM presented significantly higher blood markers, indicative of infection upon admission. Only patients with consistent OM (three positive biopsies) showed higher flap revision rates.
This study found no compelling evidence linking OM to worse clinical outcomes in PS patients. In the absence of elevated inflammatory markers, reducing bone biopsy frequency and adopting a less aggressive bone debridement approach may help prevent OM in PS patients.
晚期压疮（PS）患者特别容易发生骨髓炎（OM），因为骨隆突通常是溃疡的病灶点。在PS治疗背景下，关于这种诊断的相关因素和临床相关性的数据匮乏。
这项回顾性分析调查了PS患者的临床特征、指示感染的血液标志物以及组织学上明显的OM的发生情况。2014年至2019年共纳入125例患者。特别扫描患者记录以进行OM的组织学诊断。
在初次手术期间采集的样本中，39%（37/96）检测到OM。在第二次清创时，OM患病率增至56%（43/77），在第三次清创时增至70%（41/59）。因此，35例患者在治疗期间确诊为OM。最初被诊断为OM的患者入院时指示感染的血液标志物显著更高。只有OM持续存在（三次活检均为阳性）的患者皮瓣翻修率更高。
本研究未发现令人信服的证据表明OM与PS患者更差的临床结局相关。在炎症标志物未升高的情况下，减少骨活检频率并采用不太激进的骨清创方法可能有助于预防PS患者发生OM。
