Martini M, Daoud A, Saïghi-Bouaouina A, Ziani F, Burny F, Donkerwolcke M
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Universitaire de Douera (Centre Hospitalo-universitaire de Blida), Tipaza, Algérie.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(7):642-50.
Chronic hematogenous osteomyelitis (C.H.O.) is still a scourge of the non-industrialized countries. The authors operated on 420 cases of C.H.O. in Algeria between 1968 and 1987. A computerized analysis of the results of the surgical treatment of these 420 cases was made in Brussels, Belgium, by two of the authors. The results of this computerized study are exposed.
67.1 per cent of the patients were male and 37.9 female. 68 per cent were operated before 16 y. of age. 381 lesions involved tubular bones: femur, tibia and humerus were the most frequent locations. Only 4 per cent of the cases had never presented a suppuration. Cultures of Staphylococcus were positive in 82 per cent of the cases. Surgical procedure was classical--bone window opening, sequestrectomy and saucerisation--in 359 cases. Operation was limited to soft tissues in 22 cases and bone resection was performed in 39 cases. Post-operative antibiotherapy was administered for a period of 10 to 60 days according to the patients.
After the first operation with the classical procedure, results were satisfactory in 72 per cent of the cases but "healing" was achieved in 95 per cent of the cases after 2, 3, 4 and up to 6 operations. After bone resection, the rate of permanent healing was of 100 per cent. Follow-up was of more of 1 year (up to 22 y.) in 80 per cent of the cases.
As far as classical procedure is concerned, a computerized analysis made according to 34 variables, led to the conclusions that the following variables could have a positive influence upon the prognosis: surgical team's experience, young age of the patient at the time of operation, subacute onset of the disease, location on the humerus, diaphysis of long bones, membranous and short bones, small number of sinuses, sclero-geodic radiologic appearance of the lesions, thin perifocal radiologic condensation, periosteal reaction, post-operative administration of two antibiotics. Excellent results of bone resection are pointed out but attention is drawn on the dangers of extending the indications for resection to the tubular bones.
The authors conclude that improvement in the results of the surgical treatment of C.H.O. may only take place after improvement of the quality and duration of chemotherapy: that is confirmed by the results of a clinical trial they organized on the role of post-operative administration of Amoxicilline + Clavulanic Acid for a period of 60 days after surgery: 44 patients, 2 lost to follow-up, 4 failures and 38 "healings" (90.5 per cent) at 2 years and more.
慢性血源性骨髓炎（C.H.O.）仍是欠发达国家的一大祸患。1968年至1987年间，作者们在阿尔及利亚对420例慢性血源性骨髓炎患者进行了手术治疗。其中两位作者在比利时布鲁塞尔对这420例手术治疗结果进行了计算机分析。现将该计算机化研究结果公布如下。
患者中67.1%为男性，37.9%为女性。68%的患者在16岁之前接受手术。381处病变累及管状骨：股骨、胫骨和肱骨是最常见的发病部位。仅4%的病例从未出现过化脓。82%的病例葡萄球菌培养呈阳性。359例采用经典手术方式——骨窗切开、死骨切除术和碟形手术。22例手术仅限于软组织，39例进行了骨切除术。术后根据患者情况给予10至60天的抗生素治疗。
首次采用经典手术方式后，72%的病例结果令人满意，但经过2、3、4次甚至6次手术后，95%的病例实现了“愈合”。骨切除术后，永久愈合率为100%。80%的病例随访时间超过1年（最长达22年）。
就经典手术方式而言，根据34个变量进行的计算机分析得出结论，以下变量可能对预后产生积极影响：手术团队的经验、患者手术时年龄较小、疾病亚急性起病、肱骨发病、长骨干、膜性骨和短骨、窦道数量少、病变的硬化-地理放射学表现、病灶周围放射学低密度影、骨膜反应、术后使用两种抗生素。指出了骨切除术的良好效果，但也提请注意将切除指征扩大到管状骨的风险。
作者得出结论，慢性血源性骨髓炎手术治疗效果的改善只有在化疗质量和疗程得到改善之后才会出现：他们组织的一项关于术后使用阿莫西林+克拉维酸60天作用的临床试验结果证实了这一点：44例患者，2例失访，4例失败，38例“愈合”（2年及以上时愈合率为90.5%）。
