RESUMO
BACKGROUND: The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. METHODS: We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. RESULTS: A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. CONCLUSION: Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.
Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas , Antibacterianos , Sulfato de Cálcio , Fixação Intramedular de Fraturas/efeitos adversos , Consolidação da Fratura , Humanos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Although various methods have been introduced, the management of chronic tibial osteomyelitis remains a challenge. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis. METHODS: Forty-two patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received the treatment method mentioned above were included in the study. The infection remission rate, recurrence rate, complications rate, and bone healing rate were respectively analyzed. RESULTS: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients pain, limitation of movement, sinus tracts, topical redness, and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed minor but acceptable discomfort in affected limbs. Five patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-ray examination, bone losses caused by local debridement were generally repaired, though the shape of the tibia was not well-restored to its initial form in 17 limbs. No fracture was recorded during follow-up. CONCLUSION: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.
Assuntos
Antibacterianos/uso terapêutico , Osteomielite/terapia , Tíbia , Adulto , Antibacterianos/administração & dosagem , Sulfato de Cálcio , Terapia Combinada , Desbridamento/métodos , Implantes de Medicamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Management of chronic calcaneal osteomyelitis is challenging. At present, there is still no widely accepted, simple, and effective surgical method to eradicate the infection and prevent osteomyelitis recurrence. The objective of this study was to assess the outcomes of one-stage treatment of chronic calcaneal osteomyelitis with a shape-preserving debridement technique combined with antibiotic-loaded calcium sulphate. METHODS: Between 2012 and 2018, 33 patients (33 limbs) with chronic calcaneal osteomyelitis were treated with a novel debridement technique, named "eggshell-like debridement", plus antibiotic-impregnated calcium sulphate. The infection remission rate, recurrence rate, and amputation rate were analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to assess postoperative hindfoot function. RESULTS: 26 patients (81.8%) achieved infection remission without recurrence. In the patients with osteomyelitis remission, pain, limitation of movement, sinus tracts, and typical redness and swelling were generally eliminated. Most of the patients could tolerate full weight-bearing without pain. The average AOFAS ankle and hindfoot score was 88 points (range, 67-100 points), implying the foot function was mostly restored. 6 patients (18.2%) had osteomyelitis recurrence but no amputation was required to elimilate the infection. CONCLUSIONS: Eggshell-like debridement combined with antibiotic-loaded calcium sulphate is an effective method for one-stage management of chronic calcaneal osteomyelitis. With the application of this technique, secondary autogenous bone or muscle flap grafts are unnecessary. The surgical procedure can be simplified whlie the hindfoot function is well preserved.
Assuntos
Antibacterianos/administração & dosagem , Calcâneo/cirurgia , Desbridamento/métodos , Osteomielite/terapia , Adolescente , Adulto , Idoso , Animais , Antibacterianos/análise , Calcâneo/microbiologia , Sulfato de Cálcio/química , Doença Crônica , Terapia Combinada , Portadores de Fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/microbiologia , Adulto JovemRESUMO
BACKGROUND: Managing with diabetic foot osteomyelitis (DFO) is challenging. Even after infective bone resection and thorough debridement, DFO is still difficult to cure and has a high recurrence rate. This retrospective study aims to compare the outcomes of two treatment methods, infected bone resection combined with adjuvant antibiotic-impregnated calcium sulfate and infected bone resection alone, for the treatment of diabetic foot osteomyelitis. METHODS: Between 2015 to 2017, 48 limbs (46 patients) with DFO met the criteria were included for assessment. 20 limbs (18 patients) were included in the calcium sulfate group (the CS group) in which vancomycin and/or gentamicin-impregnated calcium sulfate was used as an adjuvant after infected bone resection while 28 limbs (28 patients) as the control group were undergone infected bone resection only. Systemic antibiotics, postoperative wound care and offloading were continued to be applied following surgery in both groups. The time to healing, healing rate, recurrence rate and amputation rate were compared between the two groups. RESULTS: In total, 90% (18/20) limbs in the CS group as compared to 78.6% (22/28) infected limbs in the control group went to heal (P = 0.513). The Mean time to healing was 13.3 weeks in the CS group and 11.2 weeks in control group (P = 0.132). Osteomyelitis recurrence rate was 0% (0/18) in the CS group and 36.4% (8/22) in the control group (P = 0.014). Postoperative leakage in calcium sulfate group was 30.0% (6/20) with a mean duration of 8.5 weeks. Amputation rate in the control group was 7.1% (2/28) compared to 0% (0/20) in the CS group (P = 0.153). CONCLUSIONS: Antibiotic-impregnated calcium sulfate as an adjuvant prevents the recurrence of DFO but cannot improve the healing rate, reduce the postoperative amputation rate or shorten the time to healing. Prolonged postoperative leakage as the most common complication can be managed with regular dressing. LEVEL OF EVIDENCE: III, Retrospective Comparative Study.
Assuntos
Antibacterianos/administração & dosagem , Substitutos Ósseos/administração & dosagem , Pé Diabético/terapia , Osteomielite/terapia , Osteotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica/estatística & dados numéricos , Substitutos Ósseos/química , Sulfato de Cálcio/administração & dosagem , Terapia Combinada , Pé Diabético/complicações , Feminino , Pé , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Cicatrização/efeitos dos fármacosRESUMO
AIMS: We sought to compare the efficacy of antibiotic-loaded calcium sulphate with wound irrigation-suction in patients with lower limb chronic osteomyelitis. PATIENTS AND METHODS: Adult patients with lower limb chronic osteomyelitis treated at our hospital by means of segmental bone resection, antibiotic-loaded calcium sulphate implantation or wound irrigation-suction, followed by bone transport with external fixator from January 2011 to July 2015 were retrospectively evaluated. The clinical presentation, laboratory results, complications, docking obstruction, infection recurrence were compared. RESULTS: There were totally 74 patients met the inclusion criteria. Docking obstruction rate and infection recurrence were higher in the irrigation group with significant difference. The success rate of the first operation was 90.74% in the calcium sulphate group compared with 45% in the irrigation group. Postoperaton leakage of the incision happened more in the calcium sulphate group, but it wasn't a risk factor for docking obstruction and infection recurrence. Patients in the calcium sulphate group had shorter hospital stay and systemic antibiotic treatment, also with less external fixator index. CONCLUSIONS: The findings of our study suggest that antibiotic-loaded calcium sulphate implantation for lower chronic limb osteomyelitis was a more successful method than wound irrigation-suction, it greatly decreased infection recurrence and docking obstruction. Postoperative leakage after implantation didn't worsen patient's outcome.
Assuntos
Antibacterianos/administração & dosagem , Sulfato de Cálcio/administração & dosagem , Doença Crônica/terapia , Extremidade Inferior/patologia , Osteomielite/terapia , Sucção/métodos , Irrigação Terapêutica/métodos , Adulto , Antibacterianos/farmacologia , Sulfato de Cálcio/farmacologia , Estudos de Coortes , Desbridamento , Sistemas de Liberação de Medicamentos , Feminino , Humanos , Masculino , Osteomielite/patologia , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
OBJECTIVE: To compare the efficacy difference between acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages. METHODS: The randomized controlled prospective study method was adopted. Sixty cases of avascular necrosis of femoral head at Ficat-Arletâ to â ¡ stages were randomized into an acupotomy group (32 cases) and an acupuncture group (28 cases) by the third part. In the acupotomy group, the acupotomy was adopted for the loose solution at the treatment sites of hip joint, once every two weeks, totally for 3 times. In the acupuncture group, ashi points around the hip joint were selected and stimulated with warm acupuncture therapy, once every day, for 6 weeks. Harris hip score was observed before and after treatment. The efficacy was evaluated in the two groups. RESULTS: Harris hip score was improved significantly after treatment in the two groups (both P<0.05). The result in acupotomy group was better than that in the acupuncture group (P<0.05). The effective rate was 90.6% (29/32) in the acupotomy group, better than 75.0% (21/28) in the acupuncture group after treatment (P<0.05). CONCLUSIONS: Harris hip score and the effective rate in the acupotomy group are better than those in the treatment with routine acupuncture for avascular necrosis of femoral head at the early and middle stages.
Assuntos
Terapia por Acupuntura/métodos , Necrose da Cabeça do Fêmur/terapia , Necrose da Cabeça do Fêmur/patologia , Humanos , Estudos Prospectivos , Projetos de Pesquisa , Resultado do TratamentoRESUMO
OBJECTIVE: To explore the objective evaluation index of acupuncture effect through study on the differences of surface electromyography of deltoid before and after acupuncture at some specific points. METHODS: Twenty-six cases of periarthritis were treated with acupuncture at Jianyu (LI 15), Jianqian (Extra), Jianliao (TE 14) and Binao (LI 14). The treatment was given once every other day, six treatments were required. The deltoid myoelectricity indices were collected and analyzed before treatment, after treatment and after 5 s manipulations at each acupoint. RESULTS: Compared with the deltoid myoelectricity before treatment, there were statistically significant differences in the 2nd, 3rd and 5th manipulations during the acupuncture stimulation at Jianqian (Extra), the 2nd, 3rd and 6th manipulations at Binao ( LI 14) (all P < 0.05) and all the 6 manipulations at Jianyu (LI 15) (all P < 0.05). However, there was no statistically significant difference in all the 6 manipulations at Jianliao (TE 14) (all P > 0.05). And the differences of deltoid surface myoelectricity before and after the 6 acupuncture treatments were all with statistic significance (all P < 0.05). CONCLUSION: A certain therapeutic effect can be found in treatment of periarthritis with acupuncture. And the effect at Jianyu (LI 15) is proved to be the most obvious. Jianqian (Extra) and Binao (LI 14) are considered as the second obvious. While no significant effect can be found at Jianliao (TE 14).