真空辅助蛋壳型骨清除术与抗生素浸渍骨替代物植入术治疗钙骨骨髓炎及随后的夏科氏重建术:病例报告

IF 0.5 4区 医学 Q4 ORTHOPEDICS Journal of the American Podiatric Medical Association Pub Date : 2024-07-01 DOI:10.7547/23-092
Grant Yonemoto, Timothy P Cheung, Steven D Vyce, Michael I Gazes
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引用次数: 0

摘要

夏科氏神经性关节病并发小关节骨髓炎可能很难治疗。各种外科技术都描述了如何处理这些病症。应用抗生素浸渍骨替代物的蛋壳型清创术是一种可行的选择,它能清除受感染的骨骼,并可进行分期重建手术。一名 50 岁的女性患者患有右中足夏科氏神经关节病,在接受切除手术和抗生素治疗失败后,出现了立方体、第四和第五跖骨基底骨髓炎。患者最终出现内收、脓毒性休克以及小方块、舟骨和外侧楔骨的血源性骨髓炎。患者接受了真空辅助蛋壳式清创术,并用抗生素浸渍的硫酸钙和磷酸钙填充了小腿骨缺损处。初次手术八周后,感染缓解,但患者行走困难。她接受了分阶段的沙尔科重建手术,使用动态多平面外固定器进行渐进式畸形矫正,并进行分层厚皮移植以覆盖残留的足底外侧伤口。第二阶段包括从框架上对中足和距下关节进行化脓性融合。术后 12 周,患者实现了放射学结合,外固定器被移除,足部可以跖屈。她被转移到全接触式石膏上,并在可以承受的情况下负重。初次手术后 18 个月,患者伤口愈合,穿上 CROW 靴子可以负重。这种创新的蛋壳型清创技术可以吸出骨髓性松质骨,同时保留皮质骨。对于皮质完整性未被破坏的血源性骨髓炎,或皮质受累极少的情况,这种方法尤其有用。由于保留了主要的负重骨--小腿骨,因此可以进行后续的重建手术规划。18 个月后,骨髓炎没有复发迹象。
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Vacuum-Assisted Eggshell-Type Bone Debridement with Implantation of Antibiotic-Impregnated Bone Substitute for Treatment of Calcaneal Osteomyelitis with Subsequent Charcot's Reconstruction: A Case Report.

Charcot's neuroarthropathy complicated by calcaneal osteomyelitis can be difficult to treat. Various surgical techniques describe how to manage these conditions. Eggshell-type debridement with application of antibiotic-impregnated bone substitute is a viable option that eliminates infected bone and allows staged reconstructive surgery. A 50-year-old woman with right midfoot Charcot's neuroarthropathy presented with osteomyelitis of the cuboid and fourth and fifth metatarsal bases after resection and failed antibiotic therapy. The patient eventually developed adductovarus, septic shock, and hematogenous osteomyelitis of the calcaneus, navicular, and lateral cuneiform. Vacuum-assisted eggshell-type debridement was performed, and the calcaneal defect was filled with antibiotic-impregnated calcium sulfate and calcium phosphate. Eight weeks after the initial surgery, the infection resolved; however, the patient had trouble walking. She underwent staged Charcot's reconstructive surgery with application of a dynamic multiplanar external fixator with gradual deformity and split-thickness skin graft to cover the residual plantar lateral foot wound. The second stage included septic fusion of the midfoot and subtalar joint from the frame. Twelve weeks postoperatively, radiographic union was achieved, the external fixator was removed, and the patient demonstrated a plantigrade foot. She was transitioned to a total-contact cast and allowed to bear weight as tolerated. Eighteen months after the initial procedure, the patient is wound-free and weightbearing in a CROW boot. This innovative eggshell-type debridement technique aspirates osteomyelitic cancellous bone while preserving cortical bone. It can be particularly useful in hematogenous osteomyelitis, where cortical integrity is not breached, or in situations where there is minimal cortical involvement. Specifically preserving the calcaneus, a major weightbearing bone, permits subsequent reconstructive surgical planning. At 18 months, there were no signs of osteomyelitis recurrence.

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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
128
审稿时长
6-12 weeks
期刊介绍: The Journal of the American Podiatric Medical Association, the official journal of the Association, is the oldest and most frequently cited peer-reviewed journal in the profession of foot and ankle medicine. Founded in 1907 and appearing 6 times per year, it publishes research studies, case reports, literature reviews, special communications, clinical correspondence, letters to the editor, book reviews, and various other types of submissions. The Journal is included in major indexing and abstracting services for biomedical literature.
期刊最新文献
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