Conservative surgery for chronic diabetic foot osteomyelitis: Procedures and recommendations

Osteomyelitis (OM) is the most frequent infection associated with diabetic foot ulcers (DFU) that typically involve the forefoot, the most common location of DFU.Conservative surgical procedures could be attractive alternative that reduces minor and major amputations and avoid future recurrence thus preserving the functionally of the foot. This review aimed to analyze and describe the current evidence on conservative diabetic foot osteomyelitis (DFO) surgical procedures depending on DFU location and indications.A narrative revision of the evidence was carried out by searching Medline through PubMed databases from inception to late July 2020 to identify retrospective, prospective, and randomized controlled trials pertaining to conservative DFO procedures on the forefoot.Seven types of conservative surgical procedures for DFO treatment in the forefoot are described in this review: (1) partial or total distal phalangectomy, (2) arthroplasty of the proximal or distal interphalangeal joint, (3) distal Syme amputation, (4) percutaneous flexor tenotomy, (5) sesamoidectomy, (6) arthroplasty of the metatarsophalangeal joint, and (7) metatarsal head resection.When indicated, conservative surgery for DFUs in patients with chronic forefoot OM is a safe and effective option that increases the chances of healing and reduces the possibility of limb loss and death compared with radical amputation procedures.Since a lack of sufficient evidence supporting this procedure exists, future investigations should be focused on the random clinical trial (RCT) design. The results of prospective trials could help surgeons select the appropriate procedure in each case in order to minimize complications.     

Infecton: a 99mTc–ciprofloxacin radiopharmaceutical for the detection of bone infection

Objective   To evaluate Infecton scintigraphy, with technetium-99m-radiolabeled ciprofloxacin, as a means to detect bone infection, in comparison with other conventional scintigraphic and radiologic methods.
Methods   Forty-five patients with known or suspected bone infection underwent 50 scans with Infecton. Almost all were also subjected to a three-phase ^99mTc-methylene diphosphonate bone scan and most of them to a ^99mTc-human polyclonal immunoglobulin scan as well as to a gallium-67-citrate scan, plus computerized tomography or magnetic resonance imaging or both. Clinical laboratory criteria for the presence of osteomyelitis were based on the definitions of the Centers for Disease Control and Prevention.
Results   Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated pathogens. Based on the CDC clinical laboratory criteria as well as on conventional scan results, Infecton was characterized in 35 studies as 'true positive', in eight as 'true negative', in two as 'false positive', in one as 'false negative', and in four as 'indeterminate'. The sensitivity and specificity of Infecton scintigraphy were found to be 97.2% and 80%, respectively, with positive and negative predictive values of 94.6% and 88.9%.
Conclusions   It is concluded that Infecton is a very sensitive and quite specific marker of bone infection, but care must be taken in cases of excessive new bone formation and primary bone tumors, where false-positive results may be obtained.     

Risk factors for amputation in patients with diabetic foot infection: a prospective study

There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. In this study, we aimed to evaluate the independent risk factors for osteomyelitis, amputation and major amputation in patients with DFI using standard scoring procedures. We prospectively studied 379 patients with DFI. The variables were analysed using logistic analysis. A total of 126 cases (33·2%) underwent amputation. The odds ratios in the amputation model were 3·09 for osteomyelitis (P < 0·001), 4·90 for arterial stenosis (AS) (P < 0·001), 3·67 for the history of DFI (P = 0·001), 2·47 for ulcer duration >60 days (P = 0·001), 3·10 for ulcer depth > 15 mm (P < 0·001) and 10·28 for fungal DFI (P = 0·015). In this study, the unusual result of well‐known literature was fungal DFI as an independent risk factor for amputation in patients with DFI.     

改良双套管脉冲持续冲洗结合VSD在骨髓炎治疗中的应用

目的：比较分析改良双套管脉冲持续冲洗结合VSD在治疗骨折术后继发骨髓炎的临床应用价值。方法：回顾性分析自2014年1月至2017年1月我院收治的25例骨折术后继发骨髓炎患者资料,行常规病灶清除术后,改良组15例采用双套管脉冲冲洗结合VSD持续引流7天,并与传统组10例持续灌洗引流14天比较,随访6个月。疗效评价指标包括血沉和C反应蛋白水平变化,手术时间,住院时间,换药次数,局部炎症消退时间及复发率等。结果：按上述疗效评定标准,两组患者均一期愈合,均无复发病例,但改良组血沉和C反应蛋白水平在术后7天（P=0.001和P=0.002）、14天（P=0.000和P=0.000）较传统组下降明显。同时改良组在住院时间（P=0.001）,术后换药次数（P=0.000）,局部炎症消退时间（P=0.001）等相较传统组有显著性改善。在手术时间（P=0.646）和复发率上两组比较无明显差异。结论：改良双套管脉冲持续冲洗结合VSD法将可调控的脉冲冲洗技术与VSD技术相结合,能迅速控制炎症,有效促进骨髓炎清创术后的恢复,便于术后管理,是一种值得推广的骨髓炎治疗方法。     

Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎的早期临床疗效比较

目的 比较Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎清创后大段骨缺损的早期临床疗效.方法 回顾性分析2011年1月至2015年5月我院收治的45例成人胫骨慢性骨髓炎病人资料,Masquelet技术治疗的27例纳入Masquelet组,男20例,女7例,骨缺损长度为(8.9±2.2)cm;Ilizarov技术治疗的18例纳入Ilizarov组,男12例,女6例,骨缺损长度为(8.3±2.1)cm.收集并比较两组病例的骨愈合时间、完全负重时间、术后并发症情况及末次随访时的Iowa膝关节评分、Iowa踝关节评分、SF-36量表得分.结果 45例病人的随访时间为12～38个月,平均(21.5±6.5)个月.Masquelet组与Ilizarov组的骨愈合时间分别为(20.85±4.31)周、(28.86±6.47)周,完全负重时间分别为(23.17±6.93)周、(32.87±6.79)周,两组间比较,差异均有统计学意义(t=4.944,P<0.0001;t=4.636,P<0.0001);两组末次随访时的Iowa膝、踝关节评分及SF-36量表总得分均较术前明显改善,但两组间比较,差异均无统计学意义(P均>0.05).结论 Masquelet技术与Ilizarov技术均可有效地解决成人胫骨慢性骨髓炎清创后大段骨缺损问题,但Masquelet技术能显著缩短治疗周期,完全负重时间早,是一种简单有效的手术方法.     

糖尿病足的MRI诊断价值

目的:探讨糖尿病足的MRI诊断价值.方法:回顾性分析经临床综合诊断证实的12例糖尿病足患者的MRI表现,对病变部位、软组织病变、骨关节病变进行评估.结果:大部分病变位于前足(9/12,占75.0％)和中足(4/12,占33.3％);12例患者均可见软组织肿胀、窦道形成、骨髓水肿及骨髓炎,部分伴脓肿形成(5/12,占41.7％);2例夏科氏关节伴骨髓炎并可见关节脱位及摇椅足形成.结论:MRI能够清楚地显示糖尿病足的骨关节及软组织病变情况,为临床诊疗提供良好的影像依据.     

鸡急性血源性骨髓炎的药物治疗研究

用鸡急性血源性骨髓炎模型进行4周药物治疗对照研究.105只鸡,分7组,每组15只鸡.有①正常组对照,②实验对照,③青霉素 庆大霉素,④青霉素 庆大霉素 阿斯匹林,⑤邻氯青霉素,⑥短疗程邻氯青霉素(2周),⑦邻氯青霉素延迟48小时治疗.结果发现目前临床常用的青霉素 庆大霉素治疗由耐青霉素金葡菌引起的急性血源性骨髓炎效果并不理想,而邻氯青霉素疗效甚好.实验证明抗菌素必须尽早使用,延迟治疗则疗效下降.邻氯青霉素治疗4周或2周,结果一样满意,支持抗菌素疗程不必过长的新观点.新近观点还认为前列腺素对急性骨髓炎的发生发展起重要作用,但本文实验未能显示阿斯匹林有辅助治疗效用.     

老年骨髓炎患者的围术期护理

目的探讨老年骨髓炎患者围术期护理的体会及经验。方法对32例老年骨髓炎患者围术期护理经验进行分析和总结。结果全组32例患者通过手术治疗及合理护理措施均得到治愈，无褥疮、肺部及泌尿系感染等并发症发生。结论老年骨髓炎患者体质差，合并症多，护理需认真、细致，并且根据术前、术中、术后按不同病情制订个案护理计划，预防并发症，能有效地提高手术成功率。     

Unilateral proptosis secondary to diffuse condensing osteomyelitis

Osteomyelitis of the skull is an uncommon disease in the present days, mainly due to the advent of modern and more effective antibiotics. Hematogenous osteomyelitis is very rare. Osteomyelitis of the skull is usually not associated with sclerosis which is commonly seen in the rest of the skeleton. There are only few occasional case reports of condensing osteomyelitis wherein there was sclerosis of the bone associated with osteomyelitis of the skull and epidural abscess. An unusual case of diffuse condensing osteomyelitis of the skull producing unilateral proptosis is reported. The clinical, radiological features and microbiological aspects are presented. The proptosis was treated by excision of the bone behind the eyeball and thus relieving the proptosis and the impaired vision. The patient was given broad spectrum antibiotics for a period of two months. Further management problems are discussed.