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在长骨慢性骨髓炎中进行手术切除:是否需要广泛的类似瘤的切除?
Mickhael B Langit1,2, Kae S Tay1, Hussain K Al-Omar1
1Department of Orthopaedics, Hull University Teaching Hospitals NHS Trust, Hull, UK.
Bone & joint open
|August 23, 2023
概括
适当的脱bridement提供了一个可行的替代方案,以广泛切除慢性骨髓炎 (COM). 这项研究显示了使用脱bridement 进行长骨COM的高分辨率,挑战了传统的外科标准.
科学领域:
- 整形外科手术 整形外科手术
- 传染性疾病 传染性疾病
- 骨感染 骨感染
背景情况:
- 慢性骨髓炎 (COM) 的传统手术标准一直是瘤样切除.
- 最近的证据表明,适当的脱可能是管理COM的足够替代方案.
- 这项研究回顾了长骨外科脱bridement技术的演变.
研究的目的:
- 评估适当的脱bridement在管理长骨慢性骨髓炎的结果.
- 在所有COM病例中挑战广泛瘤样切除的必要性.
- 呈现来自第三级骨感染单位的结果.
主要方法:
- 从2014年到2020年,对53名患者 (54个骨头) 进行了回顾性分析,这些患者患有长骨COM.
- 所有患者都按照多学科感染小组 (MDT) 协议进行管理.
- 适当的脱bridement是主要的手术方法;没有进行广泛的切除.
主要成果:
- 解决率高:初始程序后85%,最后一次随访后90.7% (平均29个月).
- 大多数病例 (39/54) 是Cierny-Mader III型.
- 观察到二次手术 (7%) 和并发症 (11%) 的比例较低.
结论:
- 适当的脱bridement,结合MDT规划和局部抗生素的交付,产生与激进的脱bridement可比的结果.
- 这些发现质疑在慢性骨髓炎中广泛的瘤样切除的普遍需要.
- 这种方法为长骨提供了一个不那么激进的手术选择.
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