Therapeutic effect of multiple techniques in treatment of refractory osteomyelitis

Abstract

Objective \nTo investigate the clinical efficacy of Ilizarov bone transplantation combined with antibiotic bone cement tablets and Masquelet technique in the treatment of chronic osteomyelitis of long bones. \n \n \nMethods \nFrom June 2012 to October 2016, 20 patients with chronic osteomyelitis and infectious nonunion of femur and tibia were treated by combination of focal debridement, Ilizarov technique, antibiotic bone cement filling technique, membrane-induced osteogenesis technique and slow distal retraction technique in the Department of Traumatic Orthopaedics, General Hospital of Xinjiang Military Region. Inclusion criteria: chronic osteomyelitis complicated with nonunion or bone defect; poor routine treatment effect; no complication affecting treatment; complete case data. Exclusion criteria: the patients who do not meet the inclusion criteria of diseases, or with active tuberculosis, cancer and other diseases, poor compliance, can not adjust the external fixator according to doctor’s requirements.Whether the above patients need skin flap transfer operation, time of external fixator, time of full weight bearing and recurrence were recorded. \n \n \nResults \nAll the patients were followed up for(29.2±1.8)months. Good bone healing was achieved in all the patients.All the infected wounds healed at the first stage. The wounds were closed without skin flap transfer or skin grafting. Bone transplantation combined site healed well. The length of bone movement was (7.3±1.8)cm on average. There was no nerve injury in all the patients. Two patients had common peroneal nerve injuries before operation, and different degrees of nerve function recovery occurred during bone transfer after operation. \n \n \nConclusions \nIlizarov’s bone transplantation and bone lengthening technique can effectively treat bone defect or limb shortening after thorough debridement, it can also improve local blood supply, heal wound without skin flap coverage; antibiotic bone cement tablets not only act as space holder, but also membrane induction for osteogenesis. The combination of various methods can effectively improve the cure rate of refractory osteomyelitis, which is a safe and effective treatment method. \n \n \nKey words: \nChronic disease;\xa0Osteomyelitis;\xa0Bone lengthening;\xa0Anti-bacterial agents