Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Dong ¹ ,  ZHANG Yonghong ¹ , HE Guoyu ¹ , ZHANG Xingdong ¹ , QIN Sihe ²

1. Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China;
2. Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;

Corresponding?author：

ZHANG Yonghong, Email: yhzhy@139.com

Keywords：

Tibial transverse transport; chronic infection of foot and ankle; diabetic foot; arteriosclerosis obliterans; thromboangiitis obliterans

DOI：

10.7507/1002-1892.202003098

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Objective To study the effectiveness of tibial transverse transport combined with the antibiotics embedded bone cement in the treatment of chronic infection of foot and ankle with lower extremity ischemic diseases.Methods A retrospective analysis was performed on 28 patients with ischemic diseases of lower extremities associated with chronic foot and ankle infection who were treated with tibial transverse transport combined with antibiotic bone cement between August 2015 and October 2019. There were 22 males and 6 females, with an average age of 65.6 years (range, 41-86 years). There were 25 cases of diabetic foot, 2 cases of arteriosclerosis obliterans, and 1 case of thromboangiitis obliterans. The course of infection ranged from 1 to 27 years, with an average of 14.9 years. The healing condition and time of foot and ankle in all patients were recorded and compared, and the Wagner grading and WIFi (W: lower extremity wound classification; I: ischemic classification; Fi: foot infection classification) grading were compared before and at last follow-up.Results The wound surface of 1 diabetic foot patient improved at 111 days after operation, without purulent secretion, and lost follow-up. The remaining 27 cases were followed up 5 to 21 months (mean, 8.4 months). There was no necrosis in the tibial osteotomy incision and the local flap. After operation, 21 cases showed needle reaction of external fixator, but the needle infection gradually improved after the corresponding treatment. Among the 24 patients with diabetic foot, 1 died of multiple organ failure due to pulmonary infection. Acute lower extremity vascular embolism occurred in 1 case, and the foot was amputated due to acute gangrene. In the remaining 22 cases, the wound healing time of foot and ankle was 2.5-11.0 months (mean, 4.6 months). At last follow-up, Wagner grading and WIFi grading of the patients were significantly improved when compared with those before operation (P<0.05). One patient with thromboangiitis obliterans had foot and ankle healing at 6 months after operation. Two patients with lower extremity arteriosclerosis obliterans had foot and ankle healing at 16 and 18 months after operation, respectively.Conclusion Tibial transverse transport combined with the antibiotics embedded bone cement is effective in treating chronic infection of foot and ankle with lower extremity ischemic diseases.

Citation： WANG Dong, ZHANG Yonghong, HE Guoyu, ZHANG Xingdong, QIN Sihe. Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(8): 979-984. doi: 10.7507/1002-1892.202003098 Copy

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2.	劉曉毅, 祁光裕, 祿韶英, 等. 靜脈動脈化治療血栓閉塞性脈管炎 31 例. 陜西醫學雜志, 2009, 38(5): 587-589.
3.	中國醫療保健國際交流促進會糖尿病足病分會. 中國糖尿病足診治指南. 中華醫學雜志, 2017, 97(4): 251-258.
4.	Apelqvist J, Bakker K, van Houtum WH, et al. International consensus and practical guidelines on the management and the prevention of the diabetic foot International Working Group on the Diabetic Foot. Diabetes Metab Res Rev, 2000, 16(Suppl 1): S84-92.
5.	Ferguson JY, Sutherland M, Pandit HG, et al. The rate of symptomatic venous thromboembolism in patients undergoing elective Ilizarov surgery and the cost of chemical prophylaxis. Bone Joint J, 2014, 96-B(3): 426-430.
6.	Atef A, El-Tantawy A. Management of open infected comminuted tibial fractures using Ilizarov concept. Eur J Orthop Surg Traumatol, 2014, 24(3): 403-408.
7.	中國糖尿病足細胞與介入治療技術聯盟, 中國介入醫師分會介入醫學與生物工程技術委員會. 糖尿病足介入綜合診治臨床指南 (第五版). 介入放射學雜志, 2019, 28(3): 205-216.
8.	Arokiyaraj S, Vincent S, Saravanan M, et al. Green synthesis of silver nanoparticles using Rheum palmatum root extract and their antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa. Artif Cells Nanomed Biotechnol, 2017, 45(2): 372-379.
9.	Liu Y, Dulchavsky DS, Gao X, et al. Wound repair by bone marrow stromal cells through growth factor production. J Surg Res, 2006, 136(2): 336-341.
10.	Antonopoulos AS, Papanikolaou E, Vogiatzi G, et al. Anti-inflammatory agents in peripheral arterial disease. Curr Opin Pharmacol, 2018, 39: 1-8.
11.	張朝霞. SDF-1/CXCR-4 促進骨髓來源細胞參與脈絡膜新生血管形成. 西安: 第四軍醫大學, 2009.
12.	連浩宇. 干細胞動員在脛骨橫向搬移治療重度糖尿病足機制中的作用研究. 南寧: 廣西醫科大學, 2019.
13.	歐栓機, 許長鵬, 李貴濤, 等. 脛骨橫向骨搬移對血清血管生成相關因子表達的影響. 中國修復重建外科雜志, 2020, 34(1): 98-101.
14.	彭冰, 宋才淵, 金紅婷, 等. 慢性骨髓炎的臨床診斷與治療. 中國骨傷, 2015, 28(9): 870-873.
15.	張永紅, 秦泗河, 王棟, 等. 骨搬運治療脛骨慢性骨髓炎, 是否需要加用抗生素骨水泥?. 中國矯形外科雜志, 2017, 25(4): 331-335.
16.	李軍, 薛寶寶, 徐超, 等. 足踝部慢性骨髓炎的手術治療策略. 現代生物醫學進展, 2019, 19(10): 1894-1897, 1928.
17.	Wiewiorski M, Barg A, Hoerterer H, et al. Risk factors for wound complications in patients after elective orthopedic foot and ankle surgery. Foot Ankle Int, 2015, 36(5): 479-487.
18.	Frommelt L. Antibiotic choice in bone surgery-local therapy using antibiotic-loaded bone cement//Walenkamp G, ed. Local antibiotics in arthroplasty. State of the art from an interdisciplinary view. New York: Thieme Stuttgart, 2007: 59-64.
19.	Wahlig H, Dingeldein E, Buchholz HW, et al. Pharmacokinetic study of gentamicin-loaded cement in total hip replacements. Comparative effects of varying dosage. J Bone Joint Surg (Br), 1984, 66(2): 175-179.
20.	Lorian V, Atkinson B. Effect of serum on gram-positive cocci grown in the presence of penicillin. J Infect Dis, 1978, 138(6): 865-871.
21.	Atkinson BA, Lorian V. Antimicrobial agent susceptibility patterns of bacteria in hospitals from 1971 to 1982. J Clin Microbiol, 1984, 20(4): 791-796.
22.	種濤, 趙斌, 張中華, 等. 骨水泥在骨科手術中的應用及展望. 中國現代醫生, 2018, 56(10): 159-163.
23.	Gouron R, Petit L, Boudot C, et al. Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique. J Tissue Eng Regen Med, 2017, 11(2): 382-389.
24.	Apelqvist J. The foot in perspective. Diabetes Metab Res Rev, 2008, 24(Suppl 1): S110-S115.
25.	陳品英, 付榮, 蘇璇, 等. 血管再通方治療血栓閉塞性脈管炎療效研究. 河北中醫藥學報, 2018, 33(5): 24-26.
26.	李全成, 蘇少飛, 張忠梅. 經皮腔內血管介入治療老年下肢動脈硬化閉塞癥的療效及其影響因素分析. 中華老年心腦血管病雜志, 2019, 21(11): 1207-1208.
27.	王江寧, 高磊. 糖尿病足慢性創面治療的新進展. 中國修復重建外科雜志, 2018, 32(7): 832-837.
28.	鎮普祥. 橫向骨搬移治療重度糖尿病足療效與血管再生現象研究. 南寧: 廣西醫科大學, 2019.

1. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part Ⅱ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989, (239): 263-285.
2. 劉曉毅, 祁光裕, 祿韶英, 等. 靜脈動脈化治療血栓閉塞性脈管炎 31 例. 陜西醫學雜志, 2009, 38(5): 587-589.
3. 中國醫療保健國際交流促進會糖尿病足病分會. 中國糖尿病足診治指南. 中華醫學雜志, 2017, 97(4): 251-258.
4. Apelqvist J, Bakker K, van Houtum WH, et al. International consensus and practical guidelines on the management and the prevention of the diabetic foot International Working Group on the Diabetic Foot. Diabetes Metab Res Rev, 2000, 16(Suppl 1): S84-92.
5. Ferguson JY, Sutherland M, Pandit HG, et al. The rate of symptomatic venous thromboembolism in patients undergoing elective Ilizarov surgery and the cost of chemical prophylaxis. Bone Joint J, 2014, 96-B(3): 426-430.
6. Atef A, El-Tantawy A. Management of open infected comminuted tibial fractures using Ilizarov concept. Eur J Orthop Surg Traumatol, 2014, 24(3): 403-408.
7. 中國糖尿病足細胞與介入治療技術聯盟, 中國介入醫師分會介入醫學與生物工程技術委員會. 糖尿病足介入綜合診治臨床指南 (第五版). 介入放射學雜志, 2019, 28(3): 205-216.
8. Arokiyaraj S, Vincent S, Saravanan M, et al. Green synthesis of silver nanoparticles using Rheum palmatum root extract and their antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa. Artif Cells Nanomed Biotechnol, 2017, 45(2): 372-379.
9. Liu Y, Dulchavsky DS, Gao X, et al. Wound repair by bone marrow stromal cells through growth factor production. J Surg Res, 2006, 136(2): 336-341.
10. Antonopoulos AS, Papanikolaou E, Vogiatzi G, et al. Anti-inflammatory agents in peripheral arterial disease. Curr Opin Pharmacol, 2018, 39: 1-8.
11. 張朝霞. SDF-1/CXCR-4 促進骨髓來源細胞參與脈絡膜新生血管形成. 西安: 第四軍醫大學, 2009.
12. 連浩宇. 干細胞動員在脛骨橫向搬移治療重度糖尿病足機制中的作用研究. 南寧: 廣西醫科大學, 2019.
13. 歐栓機, 許長鵬, 李貴濤, 等. 脛骨橫向骨搬移對血清血管生成相關因子表達的影響. 中國修復重建外科雜志, 2020, 34(1): 98-101.
14. 彭冰, 宋才淵, 金紅婷, 等. 慢性骨髓炎的臨床診斷與治療. 中國骨傷, 2015, 28(9): 870-873.
15. 張永紅, 秦泗河, 王棟, 等. 骨搬運治療脛骨慢性骨髓炎, 是否需要加用抗生素骨水泥?. 中國矯形外科雜志, 2017, 25(4): 331-335.
16. 李軍, 薛寶寶, 徐超, 等. 足踝部慢性骨髓炎的手術治療策略. 現代生物醫學進展, 2019, 19(10): 1894-1897, 1928.
17. Wiewiorski M, Barg A, Hoerterer H, et al. Risk factors for wound complications in patients after elective orthopedic foot and ankle surgery. Foot Ankle Int, 2015, 36(5): 479-487.
18. Frommelt L. Antibiotic choice in bone surgery-local therapy using antibiotic-loaded bone cement//Walenkamp G, ed. Local antibiotics in arthroplasty. State of the art from an interdisciplinary view. New York: Thieme Stuttgart, 2007: 59-64.
19. Wahlig H, Dingeldein E, Buchholz HW, et al. Pharmacokinetic study of gentamicin-loaded cement in total hip replacements. Comparative effects of varying dosage. J Bone Joint Surg (Br), 1984, 66(2): 175-179.
20. Lorian V, Atkinson B. Effect of serum on gram-positive cocci grown in the presence of penicillin. J Infect Dis, 1978, 138(6): 865-871.
21. Atkinson BA, Lorian V. Antimicrobial agent susceptibility patterns of bacteria in hospitals from 1971 to 1982. J Clin Microbiol, 1984, 20(4): 791-796.
22. 種濤, 趙斌, 張中華, 等. 骨水泥在骨科手術中的應用及展望. 中國現代醫生, 2018, 56(10): 159-163.
23. Gouron R, Petit L, Boudot C, et al. Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique. J Tissue Eng Regen Med, 2017, 11(2): 382-389.
24. Apelqvist J. The foot in perspective. Diabetes Metab Res Rev, 2008, 24(Suppl 1): S110-S115.
25. 陳品英, 付榮, 蘇璇, 等. 血管再通方治療血栓閉塞性脈管炎療效研究. 河北中醫藥學報, 2018, 33(5): 24-26.
26. 李全成, 蘇少飛, 張忠梅. 經皮腔內血管介入治療老年下肢動脈硬化閉塞癥的療效及其影響因素分析. 中華老年心腦血管病雜志, 2019, 21(11): 1207-1208.
27. 王江寧, 高磊. 糖尿病足慢性創面治療的新進展. 中國修復重建外科雜志, 2018, 32(7): 832-837.
28. 鎮普祥. 橫向骨搬移治療重度糖尿病足療效與血管再生現象研究. 南寧: 廣西醫科大學, 2019.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement

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