Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic-loaded cement spacer for definitive bone defect treatment.

IF 4.7 2区 医学 Q2 CELL & TISSUE ENGINEERING
Hongri Wu, Dong Sun, Shulin Wang, Chao Jia, Jie Shen, Xiaohua Wang, Chunli Hou, Zhao Xie, Fei Luo
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Abstract

Aims: This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis.

Methods: We included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients' demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed.

Results: In total, 314 patients with a mean age of 52.1 years (SD 12.1) were enrolled. After a mean of 50 months' (24 to 96) follow-up, 53 (16.9%) patients had infection recurrence including 32 tibiae, ten femora, ten calcanea, and one humerus. Of all patients with recurrence, 30 (9.6%) occurred within one year and 39 (12.4%) within two years. Among them, 41 patients needed reoperation, five received antibiotics treatment only, and seven ultimately required amputations. Following multivariable analysis, we found that patients infected with Gram-negative bacilli were more likely to have a recurrence (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.20 to 6.94; p = 0.046) compared to Staphylococcus aureus; segmental bone defects (OR 5.25, 95% CI 1.80 to 15.26; p = 0.002) and smoking (OR 3.00, 95% CI 1.39 to 6.50; p = 0.005) were also independent risk factors for recurrence after treatment.

Conclusion: Permanent ALCS might be an alternative strategy for definitive bone defect management in selected osteomyelitis cases. However, the overall high recurrence found suggests that it should be cautiously treated. Additionally, segmental defects, Gram-negative infections, and smoking were associated with an increased risk of infection recurrence.

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四肢骨髓炎患者应用抗生素骨水泥垫片治疗骨缺损后复发的发生率及危险因素。
目的:本研究旨在描述载抗生素水泥间隔剂(ALCS)用于肢体骨髓炎明确骨缺损治疗的复发率和危险因素。方法:我们纳入了2013年至2020年在我们临床中心接受清创和ALCS插入骨缺损作为最终治疗的成年肢体骨髓炎患者。随访时间至少为两年。回顾性收集和分析患者的人口统计学、临床特征和感染复发数据。结果:共纳入314例患者,平均年龄52.1岁(SD 12.1)。经过平均50个月(24 ~ 96)的随访,53例(16.9%)患者感染复发,包括32例胫骨、10例股骨、10例跟骨和1例肱骨。在所有复发患者中,30例(9.6%)发生在1年内,39例(12.4%)发生在2年内。其中41例需要再次手术,5例仅接受抗生素治疗,7例最终需要截肢。通过多变量分析,我们发现感染革兰氏阴性杆菌的患者更容易复发(优势比(OR) 2.38, 95%可信区间(CI) 1.20 ~ 6.94;p = 0.046)与金黄色葡萄球菌相比;节段性骨缺损(OR 5.25, 95% CI 1.80 ~ 15.26;p = 0.002)和吸烟(OR 3.00, 95% CI 1.39 ~ 6.50;P = 0.005)也是治疗后复发的独立危险因素。结论:对于特定的骨髓炎病例,永久性ALCS可能是治疗决定性骨缺损的另一种策略。然而,总体高复发率提示应谨慎治疗。此外,节段性缺陷、革兰氏阴性感染和吸烟与感染复发风险增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Bone & Joint Research
Bone & Joint Research CELL & TISSUE ENGINEERING-ORTHOPEDICS
CiteScore
7.40
自引率
23.90%
发文量
156
审稿时长
12 weeks
期刊介绍: The gold open access journal for the musculoskeletal sciences. Included in PubMed and available in PubMed Central.
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