Treatment of Cavitary Bone Defects in Chronic Osteomyelitis: Biogactive glass S53P4 vs. Calcium Sulphate Antibiotic Beads.
Treatment of Cavitary Bone Defects in Chronic Osteomyelitis: Biogactive glass S53P4 vs. Calcium Sulphate Antibiotic Beads.
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DOI：
10.7150/jbji.20404
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发表时间：
2017
影响因子：
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通讯作者：
Baeza J
中科院分区：
文献类型：
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作者：
Ferrando A;Part J;Baeza J
目的：评价某医疗中心生物玻璃（BAG-S53P4）治疗慢性骨髓炎的疗效，并与硫酸钙抗生素珠治疗效果进行比较。方法：对25例患者进行回顾性分析。纳入标准：2014年至2015年在一家医疗中心临床和影像学诊断为骨髓炎并进行手术治疗的患者（第1组：生物玻璃治疗腔隙骨缺损，第2组：硫酸钙抗生素珠治疗腔隙骨缺损）。结果：1组患者（生物玻璃治疗）：共12例，男11例，女1例，平均年龄50岁（30 ~ 86岁）。平均住院时间22天，平均随访时间23个月（16-33）。术前平均红细胞沉降率（ESR）和平均c反应蛋白（CRP）分别为55mm/hr和54mg /L。末次血检平均ESR为18 mm/hr，平均CRP为8 mg/L。术后出现血清肿形成和伤口愈合延迟2种并发症。感染复发1例。2组患者（硫酸钙抗生素珠治疗）：共13例患者（男9例，女4例），平均年龄48岁（17-67岁）。平均住院时间21天，平均随访时间22个月（16-29）。术前平均ESR和平均CRP分别为51mm/hr和41mg /L。末次血检平均ESR和平均CRP分别为15mm /hr和11mg /L。术后出现肌瓣供区慢性扩张血肿及血肿形成2例并发症。1例感染复发。总体而言，两组感染复发率无差异，p=0.740，并发症发生率无差异，p=0.672。1组11例（91.7%）患者和2组12例（92.3%）患者在最终随访时临床和影像学均无感染复发迹象。第1组骨髓炎的最常见原因是创伤后，而第2组骨髓炎的最常见原因是手术后。胫骨远端是最常见的位置。两组中最常见的病原菌均为甲氧西林敏感金黄色葡萄球菌。结论：合成骨替代物是治疗慢性骨髓炎腔型骨缺损患者的一个进步，尽管目前证据不足。在这项研究中，我们证明了不加局部抗生素的生物玻璃和硫酸钙抗生素珠都是同样有效的治疗选择。总体而言，两组在平均住院时间、并发症发生率和感染复发率方面没有差异。
Aim: To evaluate the efficacy of bioglass (BAG-S53P4) in the treatment of patients with chronic osteomyelitis and compare the results with calcium sulphate antibiotic beads in one medical centre. Methods: Retrospective analysis of 25 cases. Inclusion criteria: patients diagnosed clinically and radiographically of osteomyelitis and treated surgically (Group 1: cavitary bone defects treated with bioglass and Group 2: cavitary bone defects treated with calcium sulphate antibiotic beads) during the period of 2014 and 2015 in one medical centre. Results: Patients in group 1 (bioglass treatment): total of 12 patients (11 males and 1 female) with mean age: 50 years (30-86). Average length of hospital stay was 22 days and mean follow-up time: 23 months (16-33). Mean erythrocyte sedimentation rate (ESR) and mean c-reactive protein (CRP) before surgery: 55mm/hr and 54 mg/L, respectively. Mean ESR and mean CRP in last blood exam: 18 mm/hr and 8 mg/L, respectively. There were 2 postoperative complications: seroma formation and delayed wound healing. Only 1 patient had recurrence of infection. Patients in group 2 (calcium sulphate antibiotic beads treatment): total of 13 patients (9 males and 4 females) with mean age: 48 years (17-67). Average length of hospital stay was 21 days and mean follow-up time 22 months (16-29). Mean ESR and mean CRP before surgery: 51mm/hr and 41 mg/L, respectively. Mean ESR and mean CRP in last blood test: 15 mm/hr and 11 mg/L. 2 postoperative complications were registered: chronic expanding hematoma of the muscle flap donor site and seroma formation. 1 patient had recurrence of infection. Overall, there were no differences in recurrence of infection, p=0.740 and in complication rate, p=0.672. 11 (91,7%) patients in group 1 and 12 (92,3%) patients in group 2 showed no signs of recurrence of infection both clinically and radiologically at final follow-up. The most frequent cause of osteomyelitis in group 1 was post traumatic while a postsurgical aetiology was more frequent in group 2. The distal tibia was the most common location. The most frequent pathogen isolated in both groups was methicillin sensible staphylococcus aureus. Conclusions: An advance in treatment of patients with cavitary bone defects in chronic osteomyelitis is the use of synthetic bone substitutes although current evidence is low. In this study, we demonstrate how bioglass without local antibiotics and calcium sulphate antibiotic beads are both equally effective treatment options. Overall, there were no differences between groups in mean hospital stay, complication rates and recurrence of infection.