Clinical Characteristics and Treatment of Extremity Chronic Osteomyelitis in Southern China: A Retrospective Analysis of 394 Consecutive Patients.
Clinical Characteristics and Treatment of Extremity Chronic Osteomyelitis in Southern China: A Retrospective Analysis of 394 Consecutive Patients.
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华南地区394例四肢慢性骨髓炎临床特点及治疗回顾性分析
DOI：
10.1097/md.0000000000001874
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发表时间：
2015-10
期刊：
影响因子：
1.6
通讯作者：
Yu B
中科院分区：
文献类型：
--
作者：
Jiang N;Ma YF;Jiang Y;Zhao XQ;Xie GP;Hu YJ;Qin CH;Yu B
尽管四肢慢性骨髓炎在中国患者中很常见，但关于其特征的最新数据仍然有限。本研究旨在探讨南方中国地区四肢慢性骨髓炎的临床特点。对2010年1月至2015年4月在南方中国南方医院就诊的四肢慢性骨髓炎患者进行回顾性分析。收集并分析临床资料。共有394名患者(307名男性和87名女性)纳入研究，性别比为3.53。所有患者首次诊断的平均年龄为42岁。最常见的类型是创伤性骨髓炎(262例，66.50%)，主要由开放性损伤(166例，63.36%)和交通事故(91例，34.73%)引起。单部位感染323例，占81.98%，感染部位以胫骨126例，股骨79例，跟骨37例，足趾37例。术中细菌培养阳性率为70.63%(214/303)，其中单一菌感染占78.97%(169/214)。单菌感染以金黄色葡萄球菌为主(59例)，其次为铜绿假单胞菌(29例)和大肠埃希菌(11例)。术前血清白细胞、血沉、C反应蛋白、降钙素原、白介素6、肿瘤坏死因子α的阳性率分别为21.63%、64.92%、53.27%、42.25%、72.82%、66.67%。最常用的静脉注射抗生素是头孢菌素类。总治愈率为77.74%，总截肢率为16.75%。在这一具有代表性的中国队列中，四肢慢性骨髓炎大多由开放性损伤和交通事故引起，以男性为主，好发于胫骨。金黄色葡萄球菌是最常见的致病微生物。术前血清IL-6、肿瘤坏死因子-α和血沉水平升高可能有助于疾病的诊断。多数患者经适当治疗后取得良好的临床疗效。
Although extremity chronic osteomyelitis is common in China, updated data were still limited regarding its characterizations. The present study aimed to review clinical features of extremity chronic osteomyelitis in Southern China. A retrospective analysis was conducted in the patients who had sought medical attention from January 2010 to April 2015 for extremity chronic osteomyelitis in Nanfang Hospital in Southern China. Clinical data were collected and analyzed. A total of 394 patients (307 males and 87 females) were included, giving a gender ratio of 3.53. The median age at first diagnosis was 42 years for all. The most frequent type was traumatic osteomyelitis (262 cases, 66.50%), which was mainly caused by open injury (166 cases, 63.36%) and during a road accident (91 cases, 34.73%). Single-site infection accounted for 81.98% (323 cases), with tibia (126 cases), femur (79 cases), calcaneus (37 cases), and toes (37 cases) as the top sites. The positive rate of intraoperative culture was 70.63% (214/303), 78.97% (169/214) of which was monomicrobial infection. Staphylococcus aureus (59 cases) was the most frequent bacteria for monomicrobial infection, followed by Pseudomonas aeruginosa (29 cases) and Escherichia coli (11 cases). The positive ratios of preoperative serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were 21.63%, 64.92%, 53.27%, 42.25%, 72.82%, and 66.67%, respectively. The most frequently used intravenous antibiotic was cephalosporins. The overall cure rate was 77.74%, with a total amputation rate of 16.75%. In this representative Chinese cohort, extremity chronic osteomyelitis was mostly caused by open injury and during a road accident, predominated in males and favored the tibia. S. aureus was the most frequent pathogenic organism. Preoperative elevated levels of serum IL-6, TNF-α, and ESR may be helpful diagnostic indicators of the disease. Most patients achieved a favorable clinical efficacy after appropriate treatment.