Jamie Ferguson, Jonathan Bourget-Murray, David Stubbs, Martin McNally, Andrew J Hotchen
{"title":"两种不同的可生物降解局部抗生素载体用于长骨骨髓炎单期手术治疗的临床和放射学结果的比较。","authors":"Jamie Ferguson, Jonathan Bourget-Murray, David Stubbs, Martin McNally, Andrew J Hotchen","doi":"10.1302/2046-3758.127.BJR-2022-0305.R2","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Dead-space management, following dead bone resection, is an important element of successful chronic osteomyelitis treatment. This study compared two different biodegradable antibiotic carriers used for dead-space management, and reviewed clinical and radiological outcomes. All cases underwent single-stage surgery and had a minimum one-year follow-up.</p><p><strong>Methods: </strong>A total of 179 patients received preformed calcium sulphate pellets containing 4% tobramycin (Group OT), and 180 patients had an injectable calcium sulphate/nanocrystalline hydroxyapatite ceramic containing gentamicin (Group CG). Outcome measures were infection recurrence, wound leakage, and subsequent fracture involving the treated segment. Bone-void filling was assessed radiologically at a minimum of six months post-surgery.</p><p><strong>Results: </strong>The median follow-up was 4.6 years (interquartile range (IQR) 3.2 to 5.4; range 1.3 to 10.5) in Group OT compared to 4.9 years (IQR 2.1 to 6.0; range 1.0 to 8.3) in Group CG. The groups had similar defect sizes following excision (both mean 10.9 cm<sup>3</sup> (1 to 30)). Infection recurrence was higher in Group OT (20/179 (11.2%) vs 8/180 (4.4%), p = 0.019) than Group CG, as was early wound leakage (33/179 (18.4%) vs 18/180 (10.0%), p = 0.024) and subsequent fracture (11/179 (6.1%) vs 1.7% (3/180), p = 0.032). Group OT cases had an odds ratio 2.9-times higher of developing any one of these complications, compared to Group CG (95% confidence interval 1.74 to 4.81, p < 0.001). The mean bone-void healing in Group CG was better than in Group OT, in those with ≥ six-month radiological follow-up (73.9% vs 40.0%, p < 0.001).</p><p><strong>Conclusion: </strong>Local antibiotic carrier choice affects outcome in chronic osteomyelitis surgery. A biphasic injectable carrier with a slower dissolution time was associated with better radiological and clinical outcomes compared to a preformed calcium sulphate pellet carrier.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"12 7","pages":"412-422"},"PeriodicalIF":4.7000,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/d9/BJR-12-2046-3758.127.BJR-2022-0305.R2.PMC10317575.pdf","citationCount":"2","resultStr":"{\"title\":\"A comparison of clinical and radiological outcomes between two different biodegradable local antibiotic carriers used in the single-stage surgical management of long bone osteomyelitis.\",\"authors\":\"Jamie Ferguson, Jonathan Bourget-Murray, David Stubbs, Martin McNally, Andrew J Hotchen\",\"doi\":\"10.1302/2046-3758.127.BJR-2022-0305.R2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Dead-space management, following dead bone resection, is an important element of successful chronic osteomyelitis treatment. This study compared two different biodegradable antibiotic carriers used for dead-space management, and reviewed clinical and radiological outcomes. All cases underwent single-stage surgery and had a minimum one-year follow-up.</p><p><strong>Methods: </strong>A total of 179 patients received preformed calcium sulphate pellets containing 4% tobramycin (Group OT), and 180 patients had an injectable calcium sulphate/nanocrystalline hydroxyapatite ceramic containing gentamicin (Group CG). Outcome measures were infection recurrence, wound leakage, and subsequent fracture involving the treated segment. Bone-void filling was assessed radiologically at a minimum of six months post-surgery.</p><p><strong>Results: </strong>The median follow-up was 4.6 years (interquartile range (IQR) 3.2 to 5.4; range 1.3 to 10.5) in Group OT compared to 4.9 years (IQR 2.1 to 6.0; range 1.0 to 8.3) in Group CG. The groups had similar defect sizes following excision (both mean 10.9 cm<sup>3</sup> (1 to 30)). Infection recurrence was higher in Group OT (20/179 (11.2%) vs 8/180 (4.4%), p = 0.019) than Group CG, as was early wound leakage (33/179 (18.4%) vs 18/180 (10.0%), p = 0.024) and subsequent fracture (11/179 (6.1%) vs 1.7% (3/180), p = 0.032). Group OT cases had an odds ratio 2.9-times higher of developing any one of these complications, compared to Group CG (95% confidence interval 1.74 to 4.81, p < 0.001). The mean bone-void healing in Group CG was better than in Group OT, in those with ≥ six-month radiological follow-up (73.9% vs 40.0%, p < 0.001).</p><p><strong>Conclusion: </strong>Local antibiotic carrier choice affects outcome in chronic osteomyelitis surgery. 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引用次数: 2
摘要
目的:死骨切除后的死腔管理是慢性骨髓炎治疗成功的重要因素。本研究比较了两种不同的用于死亡空间管理的可生物降解抗生素载体，并回顾了临床和放射学结果。所有病例均接受单期手术，随访至少1年。方法:179例患者接受含有4%妥布霉素的预制硫酸钙微球治疗(OT组)，180例患者接受含有庆大霉素的硫酸钙/纳米羟基磷灰石陶瓷注射(CG组)。观察结果为感染复发、伤口漏出和随后涉及治疗节段的骨折。术后至少6个月影像学评估骨空隙填充。结果:中位随访时间为4.6年(四分位数间距(IQR) 3.2 ~ 5.4;范围为1.3至10.5)，而同期为4.9年(IQR 2.1至6.0;范围1.0至8.3)。两组切除后的缺陷大小相似(均为10.9 cm3(1 ~ 30))。OT组感染复发率(20/179 (11.2%)vs 8/180 (4.4%)， p = 0.019)高于CG组，早期创面渗漏(33/179 (18.4%)vs 18/180 (10.0%)， p = 0.024)和后续骨折(11/179 (6.1%)vs 1.7% (3/180)， p = 0.032)。与CG组相比，OT组患者发生上述任何一种并发症的优势比高2.9倍(95%可信区间1.74 ~ 4.81,p < 0.001)。放疗随访≥6个月时，CG组骨空隙愈合平均优于OT组(73.9% vs 40.0%， p < 0.001)。结论:局部抗生素载体的选择影响慢性骨髓炎手术的预后。与预成型硫酸钙颗粒载体相比，溶解时间较慢的双相注射载体具有更好的放射学和临床结果。
A comparison of clinical and radiological outcomes between two different biodegradable local antibiotic carriers used in the single-stage surgical management of long bone osteomyelitis.
Aims: Dead-space management, following dead bone resection, is an important element of successful chronic osteomyelitis treatment. This study compared two different biodegradable antibiotic carriers used for dead-space management, and reviewed clinical and radiological outcomes. All cases underwent single-stage surgery and had a minimum one-year follow-up.
Methods: A total of 179 patients received preformed calcium sulphate pellets containing 4% tobramycin (Group OT), and 180 patients had an injectable calcium sulphate/nanocrystalline hydroxyapatite ceramic containing gentamicin (Group CG). Outcome measures were infection recurrence, wound leakage, and subsequent fracture involving the treated segment. Bone-void filling was assessed radiologically at a minimum of six months post-surgery.
Results: The median follow-up was 4.6 years (interquartile range (IQR) 3.2 to 5.4; range 1.3 to 10.5) in Group OT compared to 4.9 years (IQR 2.1 to 6.0; range 1.0 to 8.3) in Group CG. The groups had similar defect sizes following excision (both mean 10.9 cm3 (1 to 30)). Infection recurrence was higher in Group OT (20/179 (11.2%) vs 8/180 (4.4%), p = 0.019) than Group CG, as was early wound leakage (33/179 (18.4%) vs 18/180 (10.0%), p = 0.024) and subsequent fracture (11/179 (6.1%) vs 1.7% (3/180), p = 0.032). Group OT cases had an odds ratio 2.9-times higher of developing any one of these complications, compared to Group CG (95% confidence interval 1.74 to 4.81, p < 0.001). The mean bone-void healing in Group CG was better than in Group OT, in those with ≥ six-month radiological follow-up (73.9% vs 40.0%, p < 0.001).
Conclusion: Local antibiotic carrier choice affects outcome in chronic osteomyelitis surgery. A biphasic injectable carrier with a slower dissolution time was associated with better radiological and clinical outcomes compared to a preformed calcium sulphate pellet carrier.
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