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1.
Rev. inf. cient ; 101(4): e3728, jul.-ago. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1409567

ABSTRACT

RESUMEN Se presentó el caso de una paciente femenina de 9 años con historia de traumatismo a nivel de incisivos centrales superiores, por lo cual recibió tratamiento para apicoformación con hidróxido de calcio durante un periodo prolongado, que luego de realizarle la obturación de los conductos radiculares presentó un cuadro de inflamación aguda en labio superior y vestíbulo bucal. El tratamiento incluyó terapia antimicrobiana, desbridamiento quirúrgico amplio bajo anestesia general, apicectomía de ambos incisivos, obturación a visión directa de los conductos y sellado apical de los dientes con gutapercha. El diagnóstico anatomopatológico fue el de osteomielitis crónica agudizada del maxilar. Año y medio después se observó ausencia clínica de signos inflamatorios y adecuada cicatrización del tejido óseo. Se concluyó que, aunque los reportes de osteomielitis crónica del hueso maxilar son escasos, debe estar presente dentro del diagnóstico diferencial cuando se evalúan pacientes en edad pediátrica con historia de traumatismo dentoalveolar y procesos inflamatorios en la región maxilofacial.


ABSTRACT A nine-year old female patient presented with a history of trauma to the upper central incisors. She received treatment for apicoforming with calcium hydroxide for a prolonged period, who after root canal obturation presented acute inflammation of the upper lip and buccal vestibule. Treatment included antimicrobial therapy, extensive surgical debridement under general anesthesia, apicoectomy of both incisors, and direct visual obturation of the canals and apical sealing of the teeth with gutta-percha. The anatomopathologic diagnosis was acute chronic osteomyelitis of the maxilla. One and a half years later, clinical absence of inflammatory signs and adequate healing of the bone tissue were observed. It was concluded that, although reports concerning chronic osteomyelitis of the maxillary bone are rare events, this type of infection should be always present at the time of the differential diagnosis for evaluating pediatric patients with a history of dentoalveolar trauma and inflammatory processes in the maxillofacial region.


RESUMO Apresentamos o caso de uma paciente feminina de 9 anos de idade com histórico de trauma nos incisivos centrais superiores, para a qual ela recebeu tratamento para apicoformação com hidróxido de cálcio por um período prolongado, que após a obturação do canal radicular apresentou inflamação aguda do lábio superior e vestíbulo vestibular. O tratamento incluiu terapia antimicrobiana, desbridamento cirúrgico extensivo sob anestesia geral, apicoectomia de ambos os incisivos, obturação visual direta dos canais e vedação apical dos dentes com guta-percha. O diagnóstico patológico foi uma osteomielite crônica aguda da maxila. Um ano e meio depois, houve uma ausência clínica de sinais inflamatórios e uma cicatrização adequada do tecido ósseo. Concluiu-se que, embora os relatos de osteomielite crônica do osso maxilar sejam escassos, ela deveria estar presente no diagnóstico diferencial ao avaliar pacientes pediátricos com histórico de trauma dentoalveolar e processos inflamatórios na região maxilofacial.

2.
Article in Chinese | WPRIM | ID: wpr-934168

ABSTRACT

Chronic osteomyelitis is a serious clinical problem with repeated courses and high disability rate, which seriously affects the physical and mental health of patients. Through continuous learning and summary in the process of using traditional therapies, the innovative improvements and changes had made in the treatment of osteomyelitis: Radical debridement of lesions was performed by applying the basic principles of modern bone tumor surgery. The application of microsurgical technique to transfer composite tissue flap can provide guarantee for tissue defect repair and wound closure without tension. Combined with bone grafting, local antibiotics and bone fixation, an one-stage operation has significantly improve the therapeutic effect of chronic complex osteomyelitis.

3.
Article in English | WPRIM | ID: wpr-929250

ABSTRACT

To explore the effectiveness and safety of a Chinese medicinal decoction Wuwei Xiaodu Drink (WWXDD) in inhibiting chronic osteomyelitis via regulatory T cells signaling. The effective constitutes of WWXDD and osteomyelitis related genes were screened. Target proteins were cross-validated using the Venny database. GO function and KEGG pathway analysis were performed for target proteins, while pharmacological network was constructed. The bone properties were analyzed by HE staining and the concentrations of immune factors were measured by ELISA. The expression of CTLA-4 and Foxp3 mRNA and STAT5, p-STAT5, CTLA-4 and Foxp3 protein were detected using Real-time PCR and Western blot, respectively. FACS was used to analyze the percentages of cells. A total of 117 genes overlapped between 785 target genes of the active compounds of WWXDD and 912 osteomyelitis related genes. Inflammation-related genes, including IL-6, TNFα, IL-1β and IL-2 showed high connection degree in the drug-compound-disease-target network. GO function and KEGG pathway analysis revealed that 117 intersection genes mainly enriched in virus infection related pathways, immune related pathways and chemokine signaling pathway. Furthermore, the development of chronic osteomyelitis was suppressed in model rats after treatment with WWXDD. Meanwhile, the concentrations of IL-2 and CD4+CD25+Foxp3 Treg percentages together with the levels of p-STAT5, CTLA-4 and Foxp3 were also down-regulated. Furthermore, IL-2 and WWXDD drug-containing serum exhibited opposite effects on regulating IL-2, IL-10, TGF-β1, Foxp3, CTLA4 and STAT5. In addition, a STAT5 phosphorylation inhibitor suppressed the expression of Foxp3 and CTLA-4. WWXDD can treat chronic osteomyelitis through suppressing the main regulating factors of Tregs and interfere its immunodepression. Our results bring a new solution for chronic osteomyelitis.


Subject(s)
Animals , Forkhead Transcription Factors/metabolism , Interleukin-2/metabolism , Osteomyelitis/metabolism , Rats , STAT5 Transcription Factor/metabolism , Signal Transduction , T-Lymphocytes, Regulatory
4.
Bol. venez. infectol ; 32(2): 127-135, julio - diciembre 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1363874

ABSTRACT

La osteomielitis es una infección de importancia en la edad pediátrica dado su potencial para ocasionar secuelas que pueden llegar a la incapacidad temporal o permanente e incluso la muerte Objetivo: Describir las características de los pacientes pediátricos con diagnóstico de osteomielitis, hospitalizados entre 2013 y 2018 en el Hospital Universitario de Caracas. Métodos: Se realizó un estudio transversal, retrospectivo, descriptivo, se incluyeron los pacientes con el diagnóstico de osteomielitis que cumplieron los criterios de inclusión, analizados los datos mediante frecuencia, porcentaje, media y desviación estándar. Se compararon las variables en los pacientes con osteomielitis crónica y aguda mediante el cálculo de X2 . Resultados: Se encontró predominio masculino, edad promedio de 5,7 años ± 3,5 desviación estándar. La osteomielitis crónica fue más frecuente (68,5 % de los pacientes). La patología de base con mayor predisposición fue la drepanocitosis. El factor de riesgo más importante fue traumatismos. Las manifestaciones clínicas más comunes fueron la fiebre y el dolor. Los huesos más afectados: tibia (27,8 %) y fémur (20,4 %) de los casos. El microorganismo predominante fue Staphylococcus aureus en 31,5 % de los casos, tanto en la osteomielitis aguda como en la crónica, siendo meticilino resistente en 16,3 % de los aislamientos. El tratamiento antibiótico indicado fue combinado. El 94 % de los pacientes egresaron con buena evolución, no se registraron muertes. Conclusiones: Es importante sospechar tempranamente la osteomielitis, tomando conciencia de las manifestaciones clínicas, para agilizar los estudios diagnósticos que contribuyan a iniciar tratamiento precoz, y mejorar el pronóstico de los pacientes


Objective: To describe the characteristics of the pediatric hospitalized patients with diagnosis of osteomyelitis between 2013 and 2018 in the Hospital Universitario de Caracas. Methods: A transversal, retrospective, descriptive study was performed, in which every patient with diagnosis of acute and chronic osteomyelitis who met with all the inclusion criteria, were included. All data was collected in an instrument, designed for that matter, and then was analyzed with frequency, percentages, mean and standard deviation. Variables were compared in acute and chronic osteomyelitis with X2 calculation. Results: Male predominance was found, and average age between 5.7 years ± 3.5 standard deviation. Chronic osteomyelitis was the most frequent (68.5 % of all cases). The most predisposing underlying pathology was sickle cell disease. The most important risk factor was trauma. The most common clinical manifestations were fever and pain in both study groups. The most affected bones: tibia in 27.8 % and femur in 20.4 % of patients. The predominant microorganism was Staphylococcus aureus in 31.5 % of the cases, both in acute and chronic osteomyelitis, being methicillin resistant in 16.3 % of the isolates and in 23.3 % methicilline sensitive. The antibiotic treatment indicated in most cases was combined, followed by surgical treatment. 94 % of the patients were discharged with good outcome, no deaths were registered. Conclusions: The early suspicion of osteomyelitis is important, becoming aware of the clinical manifestations, so as to promptly apply the ideal diagnostic method and contribute to early treatment, in this way improve the patients' prognosis.

5.
Acta ortop. mex ; 35(5): 461-464, sep.-oct. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1393808

ABSTRACT

Resumen: Introducción: La osteomielitis crónica es una enfermedad generalmente de origen infeccioso, la principal causa es postraumática, afecta el tejido óseo y el tejido circundante, el germen causal más frecuente es Staphylococcus aureus. El hueso más afectado es la tibia. Descripción del caso: Masculino de 42 años con diagnóstico de osteomielitis crónica de tibia, con secuelas de intervenciones quirúrgicas previas, múltiples tratamientos antibióticos y clasificación tipo IV B de Cierny-Mader. Material y métodos: Se optó por un manejo quirúrgico en dos tiempos. En el primer tiempo, desbridamiento óseo extenso y de partes blandas, colocación de perlas de cemento medicado con amikacina en cavidad medular y sistema de osteoclisis para irrigación con vancomicina. En el segundo tiempo, colocación de injerto óseo peroné libre, fijación y estabilización con tornillos, colocación de vidrio bioactivo en zonas de interface entre peroné estabilizado y cortical posterior de tibia. Resultados: Ante una osteomielitis crónica multitratada se tiene que individualizar y valorar alternativas de tratamiento; en este caso el manejo quirúrgico en dos tiempos, el uso de perlas de cemento, injerto óseo y el uso de vidrio bioactivo logró una erradicación de la infección y evolución clínica favorable con recuperación funcional de la extremidad afectada.


Abstract: Introduction: Chronic osteomyelitis is a disease usually of infectious origin. The main cause is post-traumatic, it affects the bone tissue and surrounding tissue, the most frequent causative agent is Staphylococcus aureus. The most affected bone is the tibia. Case description: A 42-year-old male with a diagnosis of chronic tibia osteomyelitis, with sequelae of previous surgical interventions, multiple antibiotic treatments, and type IV B classification by Cierny-Mader. Material and methods: Two-stage surgical management was chosen. Firstly, extensive bone and soft tissue debridement, placement of cement beads medicated with amikacin in the medullary cavity and osteoclast system for irrigation with vancomycin. In the second stage, free fibular bone grafting, fixation and stabilization with screws, bioactive glass placement in areas of interface between stabilized fibula and posterior tibial cortex. Results: Before a multitratada chronic osteomyelitis it is necessary to individualize and evaluate treatment alternatives, in this case the surgical management in two time, the use of medication beads, bone graft and the use of bioactive glass, achieved a complete eradication of the infection and favorable clinical evolution with optimal functional recovery of affected limb.

6.
Article | IMSEAR | ID: sea-212618

ABSTRACT

Background: Osteomyelitis is an infection of the bone that can occur from direct or indirect invasion by a pathogens, both of these types can potentially progress to subacute and chronic osteomyelitis that lasts longer than 4 weeks. This disease has important characteristics such as long-term clinical course, long periods of silence, the treatment of the recurrence of serious complications of the disease is difficult financially and it takes a lot of money epidemiology of chronic osteomyelitis in the Afghanistan is largely unknown. The aim of this study was epidemiologic study of chronic osteomyelitis in adult clients of Paktya city regional hospital and Wazir Akbar Khan Hospital in Kabul city of Afghanistan.Methods: This descriptive cross-sectional study was performed in patients' with chronic osteomyelitis who referred in this two hospitals in Paktya city regional hospital and the Wazir Akbar Khan hospital in Kabul During the March 2019 to March 2020, 70 patients were identified with chronic osteomyelitis. The information required for the study, such as general information, underlying diseases of the patients collected from these two medical centers. After encoding, the necessary information was entered into the computer and analyzed.Results: According to the findings of this study the prevalence of chronic bone infections in male were 64% (n=45) in female were 36% (n=25), current findings showed 44.3% of all patient involved with tibial (n=31) chronic osteomyelitis and the most common underlying disease causing chronic osteomyelitis is the direct entry of infection as a result of trauma.Conclusions: Our study showed the chronic osteomyelitis is higher in the male population than in the female population and highest incidence of chronic osteomyelitis site was tibia result of trauma because of humid climate, poor personal and hospital environmental health status and relatively poor medical facilities in Afghanistan may contribute to higher morbidity.

7.
Article | IMSEAR | ID: sea-212429

ABSTRACT

Atraumatic hip pain in growing children is of varied etiology from developmental to infection and tumor. Differential clinical presentation of symptoms and investigation modalities like blood parameters and radiological imaging remains inconclusive at times with differential diagnosis. Biopsy remains the final say in conclusive of establishing final diagnosis unless proved otherwise. Bony lytic lesion of proximal femur in children without systemic illness mimicking benign bone tumor initially (osteiod osteoma) turned out to be chronic osteomyelitis on histopathologically following CT guided biopsy of the lesion which alters the course of management.

8.
Article in Chinese | WPRIM | ID: wpr-856332

ABSTRACT

Objective: To review the progress of clinical diagnosis and treatment of chronic osteomyelitis in adults. Methods: The literature related to chronic osteomyelitis in recent years was extensively reviewed, and the clinical diagnosis and treatment methods were summarized. Results: Clinical characteristics and laboratory examination can help to diagnose chronic osteomyelitis in adults. Pathogenic identification is the basis for choosing antibiotics. Diagnostic imaging is specific. The treatment includes systemic treatment and local treatment, and the local treatment is the key to radical cure. Conclusion: The diagnosis of chronic osteomyelitis in adults should be made as early as possible. According to the anatomical and physiological classification of the patients, the appropriate treatment plan should be made.

9.
Article in Chinese | WPRIM | ID: wpr-856270

ABSTRACT

Objective: To explore the effectiveness of the first-stage debridement and Ilizarov metatarsal bone lengthening in treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head. Methods: Between January 2015 and October 2018, 8 cases (9 feet, 11 sites) of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head were treated by first-stage debridement and Ilizarov metatarsal bone lengthening. There were 3 males (4 feet, 5 sites) and 5 females (5 feet, 6 sites), with an average age of 57.5 years (range, 44-65 years). According to diabetic foot Wagner grade, 6 cases (7 feet) were grade 3 and 2 cases (2 feet) were grade 4. The chronic osteomyelitis located at left foot in 4 cases, right foot in 3 cases, and bilateral feet in 1 case. The duration of chronic osteomyelitis was 1-5 years (mean, 3.1 years). The chronic osteomyelitis site was the 1st metatarsal head in 3 feet, the 3rd metatarsal head in 1 foot, the 4th metatarsal head in 1 foot, and the 5th metatarsal head in 6 feet. Two patients had chronic osteomyelitis at 2 sites on 1 foot. The length of lengthened metatarsal bone, lengthening time, and the time of wearing external fixation frame were recorded, and the external fixation frame index was calculated. The healing conditions of foot ulcer and lengthening bone segment were observed, the healing time was recorded, and the healing index of lengthening bone was calculated. The ankle function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) score criteria. Results: All patients were followed up 9-26 months with an average of 15.0 months. Except pin tract infection during the bone lengthening period, there was no complications such as skin necrosis and vascular or nerve injury occurred during treatment. The length of lengthened metatarsal bone was 12-35 mm with an average of 20.5 mm; the metatarsal bone lengthening time were 21-84 days with an average of 57.8 days. The average time of wearing external fixation frame was 14.6 weeks (range, 10.4-21.1 weeks) and the external fixation frame index was 54.3 days/cm (range, 42.9-59.2 days/cm). The ulcer wound healed with an average healing time of 30.5 days (range, 19-70 days) and no ulcer recurrence was observed during follow-up. Bone healing was obtained in all bone lengthening segments, and the average healing index was 42.5 days/cm (range, 37-51 days/cm). The average AOFAS score was 91.7 (range, 87-95); 5 feet were excellent and 4 feet were good. The excellent and good rate was 100%. Conclusion: The metatarsal bone lengthening under Ilizarov law of tension-stress after debridement can promote diabetic foot ulcers healing and reconstructing the length of metatarsal to retain the function of metatarsal load and avoid amputation. This is an effective method for the treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.

10.
Article in Chinese | WPRIM | ID: wpr-856797

ABSTRACT

Objective: To investigate the appropriate concentration of methicillin-resistant Staphylococcus aureus (MRSA) in establishing chronic femoral osteomyelitis model in rabbits.

11.
Article in Chinese | WPRIM | ID: wpr-856734

ABSTRACT

Objective: To evaluate the bone repair efficacy of the new nano-hydroxyapatite (n-HA)/polyurethane (PU) composite scaffold in the treatment of chronic osteomyelitis in tibia. Methods: A novel levofloxacin@mesoporous silica microspheres (Lev@MSNs)/n-HA/PU was successfully synthesized. Its surface structure was observed by scanning electron microscopy (SEM). Fifty adult female New Zealand rabbits were randomly selected, and osteomyelitis was induced in the right tibia of the rabbit by injecting bacterial suspension ( Staphylococcus aureus; 3×10 7 CFU/mL), which of the method was described by Norden. A total of 45 animals with the evidence of osteomyelitis were randomly divided into 4 groups, and the right medullary cavity of each animal was exposed. Animals in the blank control group (group A, n=9) were treated with exhaustive debridement only. The remaining animals were first treated by exhaustive debridement, and received implantations of 5 mg Lev@PMMA (group B, n=12), 1 mg Lev@MSNs/n-HA/PU (group C, n=12), and 5 mg Lev@MSNs/n-HA/PU (group D, n=12), respectively. At 12 weeks postoperatively, the right tibia of rabbits were observed by X-ray film, and then gross observation, methylene blue/acid fuchsin staining, and SEM observation of implant-bone interface, as well as biomechanical test (measuring the maximal compression force) were performed. Results: X-ray films showed that the infection were severer than those of preoperation in group A, while the control of inflammation and bone healing of rabbits in group D were obviously better than those at preoperation. The gross observation showed extensive bone destruction in group A, a significant gap between bone tissue and the material in groups B and C, and close combination between bone tissue and the material in group D. The histology of the resected specimens showed that there was no obvious new bone formation around the materials in groups B and C, and there was abundant new bone formation around the periphery and along the voids of the materials and active bone remodeling in group D. The SEM observation of the bone-implant interface demonstrated that no new bone formation was observed at the bone-implant interface in groups B and C. However, bony connections and blurred boundaries were observed between the material and host bone tissue in group D. The biomechanical test showed the maximal compression force of groups B and D were significantly higher than that of groups A and C ( P0.05). Conclusion: The novel synthetic composite Lev@MSNs/n-HA/PU exhibit good antibacterial activities, osteoconductivity, and biomechanical properties, and show great potential in the treatment of chronic osteomyelitis of rabbits.

12.
Article in Chinese | WPRIM | ID: wpr-687990

ABSTRACT

Gardner syndrome is a rare autosomal dominant disease. Its symptoms include multiple intestinal polyps, soft tissue tumors, dental disorders, osteoma, and congenital hypertrophy of the retinal pigment epithelium. Here, we present a patient with Gardner syndrome and chronic osteomyelitis of the jaw to highlight the serious damage that can be caused by Gardner syndrome.

13.
Int. j. odontostomatol. (Print) ; 11(3): 261-265, set. 2017. graf
Article in English | LILACS | ID: biblio-893260

ABSTRACT

ABSTRACT: Osteomyelitis is an infection that affects bone and bone marrow, it occurs due to inoculation of microorganisms either directly or by continuous accumulation through a hematogenous way. Female patient, 64 years old, presenting an increase of volume of the parotid masseteric region and right submandibular region, with approximately two weeks of evolution, which had a slightly fluctuating, hyperemic and hyperthermic indurated consistency; the patient complained of severe pain. CT scan and biopsy was indicated. It is imperative to identify the causative agent; the use of antibiotics must be complemented by surgical treatment to eliminate the possibility of a remaining infection.


RESUMEN: La osteomielitis es un proceso infeccioso que afecta al hueso y medula ósea y que se produce debido a la inoculación de microorganismos ya sea de manera directa, por continuidad o bien por medio de la vía hematógena. Paciente femenino de 64 años de edad que presentaba aumento de volumen en región submandibular derecha refiriendo dolor intenso con evolución de 2 semanas aproximadamente, el cual era de consistencia indurada ligeramente fluctuante, hiperémico e hipertérmico; la paciente se quejaba de dolor intenso, se indicó TC y biopsia. En estos casos para tener éxito en el tratamiento el uso de antibióticos debe complementarse con desbridamiento quirúrgico, aunado a un seguimiento estrecho para descartar la posibilidad de una infección remanente.


Subject(s)
Humans , Female , Middle Aged , Osteomyelitis/diagnosis , Mandibular Diseases/diagnosis , Osteomyelitis/surgery , Osteomyelitis/drug therapy , Osteonecrosis/diagnosis , Periapical Abscess/diagnosis , Suppuration , Radiography, Panoramic , Mandibular Diseases/surgery , Mandibular Diseases/drug therapy , Tomography, X-Ray Computed , Chronic Disease , Dental Fistula/diagnosis , Debridement , Controlled Before-After Studies , Anti-Bacterial Agents/therapeutic use
14.
Article in Chinese | WPRIM | ID: wpr-856872

ABSTRACT

Objective: To evaluate the limbs shortening and re-lengthening in the treatment of tibial infectious bone defect and chronic osteomyelitis.

15.
Article | IMSEAR | ID: sea-186714

ABSTRACT

Introduction: For bridging gap in bone defects created by tumor excision, trauma or as sequelae to infection, various treatment modalities are described including iliac crest graft, cortical tibial graft, allograft, bone transport using the principles of Ilizarov, fibula as an intercalary bone graft and vascularized fibula. Various implants used for fixation are wires, screws, plates, and ring or monorail fixator. Free non vascularized fibula is a popular substitute for this method because of its easy accessibility and minimal donor site morbidity. It has the advantage of being a much simpler procedure and avoids the use of costly implants making it a more feasible and practical solution for bone defects in developing countries. The present study was aimed at finding the results of it in bone gap created after debridement of radius/ulna following chronic osteomyelitis in pediatric population. Material and methods: 12 children of age 4-13 years with diagnosis of chronic osteomyelitis of forearm bones were included in the study. In first stage adequate bone and soft tissue debridement was done. In radial chronic osteomyelitis, to maintain radial length and DRUJ, distractor application was done. Distractor was removed after about 3 weeks and then, “press fit” free non vascularized fibular graft was applied and fixed with intramedullary K wire. The limb was immobilized in plaster till union of fibula at both ends. Results: The average per operative gap at time of grafting was 7 cm (range 4-8 cm). Union was achieved at both ends in all cases in 12-18 weeks with no major complication. One ulnar osteomyelitis Siddharth Goel, Sansar Chand Sharma, Harnam Singh Madan. Intercalary Non Vascularized Fibular Graft in Pediatric Forearm Bone Defects - Post Chronic Osteomyelitis. IAIM, 2017; 4(11): 187-192. Page 188 case had delayed union at one site which gradually healed. At about 1 year children had good forearm range of motion. Conclusion: Non-vascularized fibular grafting is a good option for bone defects in paediatric population provided adequate debridement, fixation and immobilization has been done.

16.
Journal of Clinical Surgery ; (12): 222-225, 2017.
Article in Chinese | WPRIM | ID: wpr-511263

ABSTRACT

Objective To analyze the effects of vascularized fibular flap combined with vacuum sealing drainage (VSD) in the repair of tibia defect.Methods Clinical data of 24 patients with chronic osteomyelitis of the tibia who accepted the operation of vascularized fibular flap combined with VSD were collected in the study.In the first operation, the lesions were completely debrided and the dead bone was removed, then the vascularized fibular was replaced from the other limb to repair the tibia defect.Later, vacuum-assisted closure was applied to cover the wound.Results All patients enrolled in the study were followed up for 13 to 50 months, with an average of 32.3 months.The sinus of 22 cases healed in 4 weeks and the healing rate was 91.7%.The other two patients received additional debridement for the sinus and they also healed soon after that.All flaps survived and the survival rate was 100%.The X-ray showed that the transplanted fibula was healed in all cases, with a healing rate of 100%.The healing time ranged from 4 to 7 months, with an average of 4.9 months.Based on the Enneking scoring system, the patients achieved an average score of 26 points out of 30 points, and the recovery rate of limb function was evaluated as 86.7%.Conclusion For patients with chronic osteomyelitis of the tibia, vascularized fibular flap combined with VSD can not only effectively repair bone defect, but also restore the continuity of limbs.The application of VSD can effectively control infection, shorten treatment course, and restore limb function.

17.
Article in Chinese | WPRIM | ID: wpr-259841

ABSTRACT

<p><b>OBJECTIVE</b>To study the clinical effects of negative pressure closed drainage combined with vancomycin loaded calcium sulfate and autogenous bone in the treatment of chronic osteomyelitis.</p><p><b>METHODS</b>From June 2013 to December 2016, there were 35 cases of chronic osteomyelitis patients in our department, including 23 males and 12 females, ranging in age from 11 to 65 years old, with an average of 34 years old. The course of disease ranged from 8 to 46 months, with an average of 26 months. All patients were chronic osteomyelitis caused by open wounds. The lesions had recurrent redness and swelling and purulent skin perforation. Thirty-two patients had positive results in bacterial culture of sinus secretions, and 3 patients had negative results. Imaging examination showed the lesions of bone destruction, bone defects, surrounded by bone hyperplasia sclerosis. At the first stage, complete debridement was performed to remove necrotic tissues and inflammatory tissues; and the dressing of negative pressure closed drainage was used to completely cover the wound so as to promote the repair of the wound. At the second stage, the vancomycin loaded, calcium sulfate and autogenous iliac cancellous bone were mixed into the bone graft complex to evenly fill the lesions. The healing of the wound was observed and X-ray examination of the lesion was carried out to observe the absorption of calcium sulfate and the growth of new bone.</p><p><b>RESULTS</b>Twenty-six patients underwent debridement and negative pressure closed drainage on time, 6 patients 2 times, and 3 patients 3 times. Thirty-two patients had incisions healed with grade A; 2 patients had incisions healed with grade B, and got completely healing after anti-infection, and wound dressing treatment; 1 patient had an incision healed with grade C, and got normal healing after re-debridement at the 4th week after operation. All patients did not have skin redness and ulceration again. X-ray imaging showed that the implanted calcium sulphate was absorbed gradually around 4 weeks, new bone was formed at 8 weeks, and bone defects in the lesions area were healed completely at 6 months to 2 years.</p><p><b>CONCLUSIONS</b>Negative pressure closed drainage combined with vancomycin loaded calcium sulfate and autogenous bone in the treatment of chronic osteomyelitis is a good and reliable method, worthy of clinical promotion.</p>

18.
Article in Chinese | WPRIM | ID: wpr-613942

ABSTRACT

Objective To evaluate the the effect of vancomycin artificial bone on the treatment of elderly patients with chronic osteomyelitis and the influence to TNF-α.MethodsIn Yongkang orthopaedic hospital, 48 cases of elderly patients with chronic osteomyelitis were selected as the object of study, and were randomly divided into the control group and the experimental group, 24 cases in each group.This is a retrospective study.Three days before operation, the control group were given cloxacillin 2g/d by 4 times intravenous drip.The experimental group were given Norvancomycin Hydrochloride 0.8g/d by two times intravenous drip.In the process of operation, the control group were given bone graft substitutes 5-10g and the experimental group were given Norvancomycin Hydrochloride 1g that is added to the water to form a paste.After operation, the control group were given cloxacillin 2g/d by 4 times intravenous dripand the experimental group were given Norvancomycin Hydrochloride 0.8g/d by 2 times intravenous drip.The two groups were treated continuously for two weeks.The effect,CRP, ESR, TNF-α, NF-κB and adverse drug reactions were compared between the two groups.ResultsThe effect in the experiment group was 95.45%,is significant higher than that in the control group 81.82%(P<0.05).The serum level of CRP、ESR、TNF-α and NF-κB decreased post-treatment in the experiment group much lower than that in the control group (P<0.05).The adverse drug reactions was not statistically different between the two groups.ConclusionVancomycin artificial bone on the treatment of elderly patients with chronic osteomyelitis was effective with high safety and it can decrease the level of TNF-α.

19.
Article in Korean | WPRIM | ID: wpr-654011

ABSTRACT

PURPOSE: We aimed to report the clinical results of diaphyseal osteoplasty and primary soft tissue closure in recalcitrant poor skin lesion with superficial or localized bone infection on the anterior shin after chronic osteomyelitis. MATERIALS AND METHODS: We retrospectively reviewed 7 patients with poor shin skin lesion complicated by superficial and localized bone infection after chronic osteomyelitis. The average duration of chronic osteomyelitis was 39 years. After excision of the poor skin lesion, diaphyseal osteoplasty of the tibia was performed for the resection of infected bone and primary closure of the soft tissue defect. Postoperative results were evaluated with recovery of skin lesion, the amount of bone resection by osteoplasty and complications including recurrence of osteomyelitis. RESULTS: Mean size of excised skin lesion during surgery was 3.0×14.1 cm and successful primary closures of the defect were possible in all cases. All shin skin lesions were recovered and the amount of resected bone was mean of 18.7% of the anteroposterior diameter of the tibia. There was no recurrence of skin lesion, osteomyelitis or stress fracture. CONCLUSION: After treatment of a previous intramedullary infection in chronic osteomyelitis of the tibia, recalcitrant poor shin skin lesion complicated with superficial or localized bone infection was effectively recovered by diaphyseal osteoplasty and primary soft tissue closure. This procedure is relatively simple compared to other surgeries and effective in recovery of healthy shin skin without recurrence of osteomyelitis.


Subject(s)
Fractures, Stress , Humans , Osteomyelitis , Recurrence , Retrospective Studies , Skin , Tibia
20.
Chinese Journal of Microsurgery ; (6): 248-253, 2015.
Article in Chinese | WPRIM | ID: wpr-469327

ABSTRACT

Objective To investigate the efficacy of the combination of improved intramedullary VSD drainage and contained antibiotics bone graft to treat chronic tubular bones osteomyelitis.Methods From March,2011 to December,2013,our department have total of 40 patients with chronic tubular bones osteomyelitis.Twenty cases (group A) treat with one-stage osteomyelitis debridement cortical bone slotted,contained antibiotic bone and autologous bone implants and wound repair.Twenty cases (group B) treat with improved intramedullary VSD drainage 3-5 days temporarily after osteomyelitis debridement cortical bone slotted,then contained antibiotic bone and autologous bone implants and wound repair.A retrospective comparison of two groups of an average residence time of wound drainage postoperative,bone bed bacterial culture positive rate,average healing time,the average time of hospital stay,the average bone healing time,and recurrence rate of osteomyelitis.Statistical analysis with T test was used for above independent parametric.Results The two groups were followed-up for 6-24 months,independent samples t-test was used for two groups in the wound healing time,bone healing time,the drainage tube removal time and the length of hospital stay,in group A bone bed bacteria culture positive rate was 40%,group B was 5%,group A infection relapse has 2 cases,1 case was debridement cured,1 case was amputation,and the recurrence rate of 10%.Group B without infection recurrence,and the recurrence rate of 0% ; The healing time and hospital stay of intramedullary drainage surgery patients (18.05 ± 2.74 d and 22.65 ± 2.80 d,respectively,in group B) was significantly less than one-stage surgery patients (24.10 ± 8.20 d and 28.10 ± 9.35 d,respectively,in group A),but the bone healing time and the drainage tube removal tine of two groups.There was no significant difference (P > 0.05).Conclusion Contained antibiotic bone and autologous bone implants with wound healing therapy after osteomyelitis debridement cortical bone slotted with improvement VSD intramedullary drainage to treat patient with tubular bones osteomyelitis was more effective,it worthy of clinical spread.

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