Retrospective Analysis Of The Therapeutic Effect Of Bone Transport On Infection Induced Long Bone Defects In The Lower Limbs

(1)Comparison of Antibiotic-loaded Calcium sulphate and Wound irrigation-suction in the Management of Lower Limb Chronic OsteomyelitisBackground:Chronic osteomyelitis of lower limb is not rare but is very hard to treat.Wound irrigation-suction and antibiotic-loaded calcium sulfate following debridement are commonly used in managing chronic osteomyelitis of lower limb,but their efficacies have rarely been compared.We aimed to compare the effectiveness of antibiotic-loaded calcium sulfate with wound irrigation-suction in the treatment of patients with chronic osteomyelitis of lower limb.Methods:Adult patients with lower limb chronic osteomyelitis treated at our hospital by means of segmental bone resection,antibiotic-loaded calcium sulphate implantation or wound irrigation-suction,followed by bone transport with external fixator from January 2011 to July 2015 were retrospectively evaluated.The clinical presentation,laboratory results,complications,docking obstruction,infection recurrence were compared.Results:There were totally 95 patients met the inclusion criteria.Docking obstruction rate and infection recurrence were higher in the irrigation group with significant difference.The success rate of the first operation was 90.00%in the calcium sulphate group compared with 36.00%in the irrigation group.Postoperaton leakage of the incision happened more in the calcium sulphate group,but it wasn’t a risk factor for docking obstruction and infection recurrence.Patients in the calcium sulphate group had shorter hospital stay and systemic antibiotic treatment,also with less external fixator index.Conclusions:The findings of our study suggest that antibiotic-loaded calcium sulphate implantation for lower chronic limb osteomyelitis was a more successful method than wound irrigation-suction,it greatly decreased infection recurrence and docking obstruction.Postoperative leakage after implantation didn’t worsen patient’s outcome.(2)Comparative Study on the Treatment of Posttraumatic Osteomyelitis of the Lower Limbs with Primary and Secondary Bone Transport after DebridementBackground:Treatment of lower limb post-traumatic osteomyelitis used to be a staged process,with radical debridement of bone and soft tissues at first stage,followed by a secondstage limb reconstruction operation to restore the limb integrity.Some studies recently reported that achieving infection eradication and limb reconstruction at single-stage seems to be an effective method for lower limb infection,but a comparative study remains lacking.This study aims to compare the results of radical debridement combined with a first/second-staged osteotomy and bone transport,for the management of lower limb post-traumatic osteomyelitis.Methods:From January 2013 to June 2018,a total of 80 patients with lower limb posttraumatic osteomyelitis met the criteria were included for analysis,in which 50 patients received one-stage debridement,antibiotic-loaded calcium sulfate implantation,metaphysis osteotomy and bone transport were named as one-stage group,while 30 patients with first-stage debridement and antibiotic-loaded calcium sulfate implantation,second-stage osteotomy and bone transport were devised as two-stage group.The outcomes of hospitalization(hospital stay,costs of treatment,surgical time,antibiotic usage)and follow-up(infection-free,treatment failure,infection recurrence,external fixation index(EFI)and docking site union)between the two groups were retrospectively compared.Results:For outcomes of hospitalization,patients in the one-stage group had batter results on hospital stay(17.2 days versus 30.8 days,P<0.05),surgical time(171.8 min versus 266.5 min,P<0.05),cost of treatment(￥106135.2 versus ￥128989.2,P<0.05)and the course of antibiotic usage(10.1 days versus 12.6 days,P<0.05).During the followup,88.0%(44/50)patients in the one-stage group compared to 93.3%(28/30)patients in the two-stage group achieved infection-free(P>0.05)without any additional debridement operation.94.0%(47/50)patients in the one-stage group earned wound healing after the operation,comparing to 93.3%(28/30)patients healed in the twostage group(P>0.05).Uncontrolled infection was observed on 3(6.0%)patients in the onestage group and 1(3.3%)patients in the two-stage group(P>0.05),with a result of three achieved infection free in the one-stage group and one patient suffered from amputation in each group respectively.4(8.2%)patients in the one-stage group and 1(3.4%)patient in the two-stage group encountered with infection recurrence(P>0.05)and were well-managed with re-debridement and antibiotics usage.Significance was not found between two groups on EFI(75.5 days/cm versus 69.3 days/cm,P>0.05)and docking site nonunion rate(14.3%versus17.2%,P>0.05),indicating that bone transport in different stages played a less essential role on bone generation process.The other complications,such as prolonged aseptic drainage[24.0%(12/50)versus 20.0%(6/30)],refracture[6.1%(3/49)versus 3.4%(1/29)],pin-tract infection[22.4%(16/69)versus 17.2%(5/29)],joint stiffness and deformity[26.5%(13/49)versus 31.0%(9/29)],also showed less significance when comparing between two groups(P>0.05),suggesting that different transport stages play little role on complications formation.Conclusion:One-stage radical debridement and bone transport was proven to be a safe and effective method for treating static(or nearly static)lower limb osteomyelitis.Translational potential statement:One-stage debridement and bone transport is sample,effective and time-saving,with similar complications compared to conventional two-stage protocol.This treatment protocol might provide an alternative for the treatment of static(or near static)lower limb osteomyelitis.(3)Comparison of Masquelet technique and Ilizarov bone transport in theManagement of Lower Limb bone defectsBackground:Masquelet technique and Ilizarov bone transport are commonly used in managing chronic osteomyelitis of lower limbs,but their efficacies have rarely been compared.We aimed to compare the effectiveness of Masquelet technique with Ilizarov bone transport in the treatment of patients with chronic osteomyelitis of lower limbs.Methods:From January 2018 to June 2020,adult patients at our institute with chronic osteomyelitis of lower limbs receiving treatment of either Masquelet technique(MT group)or Ilizarov bone transport(IT group)were screened and selected according to the inclusion and exclusion criteria.The clinical symptoms,complications,and the bone outcomes and functional outcomes were compared.Results:A total of 35 patients were included in this study,including 15 in MT group and 20 in IT group.The average external fixation time of MT group was 11.53 months,and the average external fixation time of IT group was 19.25 months.The bone scores and functional results of MT group and IT group were similar.Conclusion:Both treatments have achieved good results in treating bone defects caused by chronic traumatic osteomyelitis of the lower limbs,but the external fixation time of the membrane induction group is shorter.