Study of the extent of surgical osteotomy in Cierny-Mader stages III and IV chronic osteomyelitis.

Purpose: To determine an optimal osteotomy criterion for patients with Cierny-Mader stages III and IV chronic osteomyelitis.

Methods: Seventy patients with Cierny-Mader stages III and IV chronic osteomyelitis admitted to the Department of Orthopedics of a Class III Grade A Hospital from January 2018 to March 2022 were selected for retrospective analysis and study. The following patient data were collected: gender, age, site of infection, bacterial culture results, internal fixation status, bone defect length, BMI, history of diabetes mellitus, smoking history, and history of preoperative antibiotic use. The patients were treated with sensitive antibiotics after surgery, followed up regularly, and venous blood C-reactive protein (CRP), sedimentation (ESR), white blood cells (WBC) and muscle strength (MTT scale), joint mobility (neutral 0° method), and bony healing time were measured to observe the recurrence rate of osteomyelitis and to assess the recovery of limb function according to the Enneking scale.

Results: Among the 70 patients, 20 cases were guided by X-ray, 30 cases by MRI, and 20 cases by SPECT. All patients underwent thorough debridement under the guidance of imaging modalities followed by external fixation. All cases were followed up and with a mean follow-up time of (12.2 ± 3.2) months. The recurrence rate of 35% in patients with X-ray as a guide was significantly higher than that of patients with MRI as a guide (10%) and SPECT as a guide (5%), and the difference between the three groups was statistically significant (P < 0.05).

Conclusion: For patients with osteomyelitis without metal internal fixation, the osteotomy surgical technique with MRI to guide the expansion of 0.5 cm distally and proximally, or with SPECT imaging to guide the surgical procedure in the area with 30-40% of the radioactive count contour (isocontour, ISO) had the advantages of low recurrence rate and good recovery of limb function, and the differences were not statistically significant. For patients with osteomyelitis with metal internal fixation, the osteotomy surgical technique with SPECT to guide the surgical procedure had the advantages of low recurrence rate and good recovery of limb function. In patients with osteomyelitis with metal internal fixation, SPECT was used as a guide to determine the extent of the osteomyelitis lesion, and osteotomy in the area with 30-40% of ISO was more effective than MRI.