OSTEOMYELITIS OF STERNUM: DIAGNOSIS AND SURGICAL TREATMENT

Q4 Medicine

International Medical Journal Pub Date : 2020-12-24 DOI:10.37436/2308-5274-2020-4-4

Valerii Volodymyrovych Boiko, V. N. Lykhman, D. Myroshnychenko, Ya. V. Shafer, S. V. Tkach, Andrei Alekseevich Merkulov, Ye. O. Bilodid, O. V. Nedilko

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引用次数: 0

Abstract

Postoperative sternomediastinal infections significantly affect morbidity and mortality, as well as the hospitalization duration and treatment cost for cardiac surgery patients. The use of median sternotomy has a number of complications, primarily infectious, which can occur with the formation of superficial or deep wound infection, diastase and fragmentation of the sternum, and sometimes with destabilization of the chest bony skeleton. The development of sternal osteomyelitis is associated with a significant reduction in long−term survival. The results of treatment for the patients with the sternum osteomyelitis after sternotomies, being at the State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the NAMS of Ukraine" in Kharkiv within the period of 2014−2020, have been analyzed. Diagnosis of patients with osteomyelitis of the sternum comprised fistulography, multispiral computed tomography, ultrasound. The material for the bacterial study was the discharges of a sternal wound. Antibiotic susceptibility of isolated bacterial cultures was studied by disco−diffusion and in agar. There were 32 strains of microorganisms, representatives of different taxa. S. aureus was dominant and accounted for 23.81 % of the total number of isolates of this genus. Among antibiotics, the most effective in vitro were lincomycin and especially carbapenems (imipenem). When treating the patients with sternal osteomyelitis, VAC therapy was used, as well as open wound management by dressings depending on the wound process stage. The results of the study suggest that multi−slice computed tomography should be preferred in the diagnosis of osteomyelitis of sternum, which allows the diagnosis verification in 98 % of cases, and the use of ultrasonography is important to monitor the clearance and healing of sternotomy wounds. The use of VAC therapy has helped to reduce the length of hospital stay of patients. Key words: sternum osteomyelitis, VAC therapy, multispiral computed tomography, bacterial culture.

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胸骨骨髓炎的诊断与手术治疗

术后胸纵膈感染对心脏手术患者的发病率、死亡率、住院时间和治疗费用均有显著影响。胸骨正中切开术有许多并发症，主要是感染性的，可发生在浅表或深部伤口感染、胸骨淀粉酶和碎裂，有时还会导致胸骨不稳定。胸骨骨髓炎的发展与长期生存率的显著降低有关。分析了2014 - 2020年期间在哈尔科夫国立机构“乌克兰国家科学院普通外科和急诊外科研究所”对胸骨截骨术后胸骨骨髓炎患者的治疗结果。胸骨骨髓炎的诊断包括瘘管造影、多层螺旋计算机断层扫描、超声检查。细菌研究的材料是胸骨伤口的分泌物。采用迪斯科扩散法和琼脂法研究了分离细菌培养物的抗生素敏感性。共有32株微生物，代表了不同的分类群。金黄色葡萄球菌为优势菌，占该属总分离株数的23.81%。在抗生素中，体外治疗效果最好的是林可霉素，尤其是碳青霉烯类(亚胺培南)。当治疗胸骨骨髓炎患者时，使用VAC治疗，以及根据伤口处理阶段通过敷料进行开放性伤口管理。本研究结果提示，胸骨骨髓炎的诊断应优先采用多层计算机断层扫描，其诊断率可达98%，超声检查对监测胸骨切开术创面的清除和愈合具有重要意义。使用真空疗法有助于减少病人的住院时间。关键词:胸骨骨髓炎，VAC治疗，多层螺旋ct，细菌培养。

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来源期刊

International Medical Journal 医学-医学：内科

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： The International Medical Journal is intended to provide a multidisciplinary forum for the exchange of ideas and information among professionals concerned with medicine and related disciplines in the world. It is recognized that many other disciplines have an important contribution to make in furthering knowledge of the physical life and mental life and the Editors welcome relevant contributions from them. The Editors and Publishers wish to encourage a dialogue among the experts from different countries whose diverse cultures afford interesting and challenging alternatives to existing theories and practices. Priority will therefore be given to articles which are oriented to an international perspective. The journal will publish reviews of high quality on contemporary issues, significant clinical studies, and conceptual contributions, as well as serve in the rapid dissemination of important and relevant research findings. The International Medical Journal (IMJ) was first established in 1994.