One-stage surgical treatment for Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis: Single-centre experience of 63 cases
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摘要:
目的 慢性跟骨骨髓炎致病因素多，分型复杂，治疗具有挑战性。本研究回顾性分析Cierny-Mader Ⅱ型及Ⅲ型慢性跟骨骨髓炎的临床特点，并探究采用一期手术的临床疗效和影响肢体功能的相关因素。 方法 回顾性分析东部战区总医院2005年1月—2018年12月收治的63例Cierny-Mader Ⅱ型及Ⅲ型慢性跟骨骨髓炎患者，其中男性55例，女性8例; 年龄6~68岁，中位年龄为39(23，57)岁。Cierny-Mader分型：Ⅱ型32例，Ⅲ型31例。32例Ⅱ型患者单纯采取一期病灶清除，18例Ⅲ型患者采取病灶清除后植入自体骨，13例Ⅲ型患者采取病灶清除后抗生素骨水泥填塞。采用AOFAS-AH评分量表对患肢术后功能评估。 结果 63例患者均获随访，随访时间12~68个月。8例患者复发，其中32例Ⅱ型患者中5例复发; 采自体髂骨植入的18例Ⅲ型患者中2例复发; 采取抗生素骨水泥填塞的13例Ⅲ型患者中1例复发。63例患者术前AOFAS评分为(63.4±7.6)分，术后AOFAS评分为(84.8±7.4)分。统计分析后发现术前肢体功能与Cierny-Mader分型(P < 0.001)及跟骨骨髓炎的病因(P=0.005)有关，术后AOFAS评分与患者年龄(P=0.018)及病因(P=0.035)相关。 结论 一期手术治疗周期短，疗效良好，是治疗Cierny-Mader Ⅱ型及Ⅲ型慢性跟骨骨髓炎的有效手段。 Abstract:Objective Chronic calcaneal osteomyelitis has many pathogenic factors and complex classification, and it is challenging to treat. This study retrospectively analysed the clinical characteristics of Cierny-Mader type Ⅱ and Ⅲ chronic calcaneal osteomyelitis and explored the clinical efficacy of one-stage surgery and related factors of limb function. Methods A retrospective case series study was conducted to analyse the clinical data of 63 patients with Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis admitted at the Eastern Theater General Hospital from January 2005 to December 2018. A total of 55 patients were males, and 8 were females. The ages ranged from 6 to 68 years, with the median age of 39 (23, 57) years. According to the Cierny-Mader classification, 32 cases had type Ⅱ disease, and 31 had type Ⅲ disease. Thirty-two patients with type Ⅱ disease were treated with debridement, and 18 patients with type Ⅲ disease were treated with autologous bone implantation after debridement. The remaining 13 patients with type Ⅲ disease were treated with antibiotic bone cement after debridement. The American Orthopaedic Foot and Ankle Society's hind foot (AOFAS-AH) score was used to assess the postoperative limb function. Results All patients were followed up for 12-68 months. A total of 8 cases recurred, of which 5 with type Ⅱ disease recurred. Two of the 18 patients with type Ⅲ disease recurred, and 1 case in 13 patients with type Ⅲ disease who were treated with antibiotic bone cement after debridement recurred. The AOFAS-AH score improved from preoperative (63.4±7.6) points to postoperative (84.8±7.4) points. After statistical analysis, the preoperative limb function was found to be related to the Cierny-Mader classification (P < 0.001) and the aetiology of calcaneal osteomyelitis (P=0.005), and the postoperative AOFAS score was related to the patient's age (P=0.018) and aetiology (P=0.035). Conclusion One-stage surgery is an effective method for Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis with short treatment cycle and good curative effect. -
Key words:
- Calcaneus /
- Chronic osteomyelitis /
- Surgery
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图 1 1例Cierny-Mader Ⅲ型慢性跟骨骨髓炎的一期手术治疗
注：患者, 男，52岁，坠落伤致左足跟骨骨折，行左足跟骨骨折内固定术后2个月外侧切口不愈合，流脓。A为CT可见骨质破坏，死骨形成，符合Cierny-Mader Ⅲ型慢性骨髓炎。B为行1期手术清创治疗，术中给予抗生素骨水泥置入。C为术后3个月复查X线片骨水泥充填良好。D为术后1年复查左足伤口愈合良好，肢体功能良好。
图 2 1例Cierny-Mader Ⅱ型慢性跟骨骨髓炎的一期手术治疗
注：患者，男，60岁，足底铁钉扎伤2个月。A为术前X线片可见骨皮质破坏，符合Cierny-Mader Ⅱ型。B为行1期手术清创治疗，磨除病变骨组织后缝合VSD负压引流。
表 1 63例Cierny-Mader Ⅱ型及Ⅲ型跟骨骨髓炎患者一般资料、复发及术前术后AOFAS评分比较
项目 类别 例数 复发(例) 术前AOFAS评分(x±s，分) 统计量 P值 术后AOFAS评分(x±s，分) 统计量 P值 年龄 ＜60岁 48 6 64.3±8.6 1.478b 0.145 86.1±7.0 2.442b 0.018 ≥60岁 15 2 60.6±8.3 80.7±8.7 分型 Ⅱ型 32 5 69.3±7.4 6.338b < 0.001 85.3±8.1 0.517b 0.607 Ⅲ型 31 3 57.3±7.6 84.3±7.7 病因 跟骨骨折 42 6 60.7±7.7 -2.958b 0.005 81.4±8.2 -2.165b 0.035 足底刺伤 16 2 67.8±9.3 86.4±7.4 病原学 阴性 23 4 63.9±5.9 0.449b 0.655 82.3±8.3 -1.771b 0.082 阳性 40 4 63.1±7.7 86.3±8.6 手术类型 刮除 32 5 69.3±8.4 18.354c < 0.001 85.3±6.9 0.243c 0.785 植自体骨 18 2 57.2±7.1a 84.9±9.7 填骨水泥 13 1 57.6±7.5a 83.5±8.5 注：因血源性感染较少，仅有5例，故仅比较骨折与足底刺伤数据。与刮除比较，aP < 0.05。b为t值，c为F值。 
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