Application of homemade antibiotic bone cement rod in tibial screw canal osteomyelitis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Xiaofeng , XUE Mingyu , DENG Xinxin , HUANG Zhihu ,  BU Fanyu

Department of Wound Repair, Wuxi Ninth People’s Hospital, Wuxi Jiangsu, 214000, P. R. China;

Corresponding?author：

BU Fanyu, Email: bufanyu1020@163.com

Keywords：

Antibiotic bone cement rod; tibia; screw canal; osteomyelitis; Masquelet technique

DOI：

10.7507/1002-1892.202207133

Video：

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Objective To investigate the effectiveness of homemade antibiotic bone cement rod in the treatment of tibial screw canal osteomyelitis by Masquelet technique. Methods A clinical data of 52 patients with tibial screw canal osteomyelitis met the criteria between October 2019 and September 2020 was retrospectively analyzed. There were 28 males and 24 females, with an average age of 38.6 years (mean, 23-62 years). The tibial fractures were treated with internal fixation in 38 cases and external fixation in 14 cases. The duration of osteomyelitis was 6 months to 20 years with a median of 2.3 years. The bacterial culture of wound secretions showed 47 positive cases, of which 36 cases were infected with single bacteria and 11 cases were infected with mixed bacteria. After thorough debridement and removal of internal and external fixation devices, the locking plate was used to fixed the bone defect. The tibial screw canal was filled with the antibiotic bone cement rod. The sensitive antibiotics were given after operation and the 2nd stage treatment was performed after infection control. The antibiotic cement rod was removed and the bone grafting in the induced membrane was performed. After operation, the clinical manifestations, wound, inflammatory indexes, and X-ray films were monitored dynamically, and the postoperative bone infection control and bone graft healing were evaluated. Results Both patients successfully completed the two stages of treatments. All patients were followed up after the 2nd stage treatment. The follow-up time was 11 to 25 months (mean, 18.3 months). One patient had poor wound healing and the wound healed after enhanced dressing change. X-ray film showed that the bone grafting in the bone defect healed and the healing time was 3-6 months, with an average of 4.5 months. The patient had no recurrence of infection during the follow-up period. Conclusion For the tibial screw canal osteomyelitis, the homemade antibiotic bone cement rod can reduce the recurrence rate of infection and obtain a good effectiveness, and has the advantages of simple operation and less postoperative complications.

Citation： GUO Xiaofeng, XUE Mingyu, DENG Xinxin, HUANG Zhihu, BU Fanyu. Application of homemade antibiotic bone cement rod in tibial screw canal osteomyelitis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(2): 153-156. doi: 10.7507/1002-1892.202207133 Copy

1.	Peng J, Ren Y, He W, et al. Epidemiological, clinical and microbiological characteristics of patients with post-traumatic osteomyelitis of limb fractures in Southwest China: A hospital-based study. J Bone Jt Infect, 2017, 2(3): 149-153.
2.	Walter G, Kemmerer M, Kappler C, et al. Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int, 2012, 109(14): 257-264.
3.	Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis, 2006, 19(4): 349-356.
4.	Blanchette KA, Wenke JC. Current therapies in treatment and prevention of fracture wound biofilms: why a multifaceted approach is essential for resolving persistent infections. J Bone Jt Infect, 2018, 3(2): 50-67.
5.	李振環, 楊柳榭, 滿毅, 等. 骨水泥椎體成形術治療脊柱轉移瘤的效果觀察. 中國腫瘤臨床與康復, 2022, 29(6): 665-668.
6.	Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
7.	Beris AE, Lykissas MG, Korompilias AV, et al. Vascularized fibula transfer for lower limb reconstruction. Microsurgery, 2011, 31(3): 205-211.
8.	魏波. 抗生素骨水泥的研究進展. 中國矯形外科雜志, 2012, 20(5): 439-440.
9.	荊延峰. 抗生素骨水泥被覆鎖定鋼板在膜誘導技術治療脛骨創傷后骨感染中的臨床療效. 中國實用醫藥, 2020, 15(4): 77-79.
10.	佟冰渡, 李楊. 經皮骨穿針針道感染的發生狀況及其影響因素分析. 護理學報, 2015, 22(13): 44-47.
11.	鄭強, 潘志軍, 李杭, 等. 抗生素骨水泥棒治療交鎖釘術后髓內感染. 中華創傷雜志, 2007, 23(4): 265-267.
12.	余鑫, 賈碩, 吳宏日, 等. 抗生素骨水泥被覆鎖定鋼板在膜誘導技術治療脛骨創傷后骨感染中的運用. 中華創傷雜志, 2017, 33(6): 539-543.
13.	王上增. 抗生素骨水泥間置器治療髓內固定術后骨髓炎合并骨不連. 中國修復重建外科雜志, 2011, 25(8): 972-975.
14.	Klein C, Monet M, Barbier V, et al. The Masquelet technique: Current concepts, animal models, and perspectives. J Tissue Eng Regen Med, 2020, 14(9): 1349-1359.
15.	Ueng SW, Wei FC, Shih CH. Management of femoral diaphyseal infected nonunion with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting. J Trauma, 1999, 46(1): 97-103.
16.	袁昊龍, 王志剛, 張鍇. Masquelet技術重建骨缺損研究進展. 中華骨科雜志, 2018, 38(21): 1330-1336.
17.	Ren L, Kang Y, Browne C, et al. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone, 2014, 64: 173-182.
18.	Nau C, Seebach C, Trumm A, et al. Alteration of Masquelet’s induced membrane characteristics by different kinds of antibiotic enriched bone cement in a critical size defect model in the rat’s femur. Injury, 2016, 47(2): 325-334.
19.	Henrich D, Seebach C, Nau C, et al. Establishment and characterization of the Masquelet induced membrane technique in a rat femur critical-sized defect model. J Tissue Eng Regen Med, 2016, 10(10): E382-E396.

1. Peng J, Ren Y, He W, et al. Epidemiological, clinical and microbiological characteristics of patients with post-traumatic osteomyelitis of limb fractures in Southwest China: A hospital-based study. J Bone Jt Infect, 2017, 2(3): 149-153.
2. Walter G, Kemmerer M, Kappler C, et al. Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int, 2012, 109(14): 257-264.
3. Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis, 2006, 19(4): 349-356.
4. Blanchette KA, Wenke JC. Current therapies in treatment and prevention of fracture wound biofilms: why a multifaceted approach is essential for resolving persistent infections. J Bone Jt Infect, 2018, 3(2): 50-67.
5. 李振環, 楊柳榭, 滿毅, 等. 骨水泥椎體成形術治療脊柱轉移瘤的效果觀察. 中國腫瘤臨床與康復, 2022, 29(6): 665-668.
6. Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
7. Beris AE, Lykissas MG, Korompilias AV, et al. Vascularized fibula transfer for lower limb reconstruction. Microsurgery, 2011, 31(3): 205-211.
8. 魏波. 抗生素骨水泥的研究進展. 中國矯形外科雜志, 2012, 20(5): 439-440.
9. 荊延峰. 抗生素骨水泥被覆鎖定鋼板在膜誘導技術治療脛骨創傷后骨感染中的臨床療效. 中國實用醫藥, 2020, 15(4): 77-79.
10. 佟冰渡, 李楊. 經皮骨穿針針道感染的發生狀況及其影響因素分析. 護理學報, 2015, 22(13): 44-47.
11. 鄭強, 潘志軍, 李杭, 等. 抗生素骨水泥棒治療交鎖釘術后髓內感染. 中華創傷雜志, 2007, 23(4): 265-267.
12. 余鑫, 賈碩, 吳宏日, 等. 抗生素骨水泥被覆鎖定鋼板在膜誘導技術治療脛骨創傷后骨感染中的運用. 中華創傷雜志, 2017, 33(6): 539-543.
13. 王上增. 抗生素骨水泥間置器治療髓內固定術后骨髓炎合并骨不連. 中國修復重建外科雜志, 2011, 25(8): 972-975.
14. Klein C, Monet M, Barbier V, et al. The Masquelet technique: Current concepts, animal models, and perspectives. J Tissue Eng Regen Med, 2020, 14(9): 1349-1359.
15. Ueng SW, Wei FC, Shih CH. Management of femoral diaphyseal infected nonunion with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting. J Trauma, 1999, 46(1): 97-103.
16. 袁昊龍, 王志剛, 張鍇. Masquelet技術重建骨缺損研究進展. 中華骨科雜志, 2018, 38(21): 1330-1336.
17. Ren L, Kang Y, Browne C, et al. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone, 2014, 64: 173-182.
18. Nau C, Seebach C, Trumm A, et al. Alteration of Masquelet’s induced membrane characteristics by different kinds of antibiotic enriched bone cement in a critical size defect model in the rat’s femur. Injury, 2016, 47(2): 325-334.
19. Henrich D, Seebach C, Nau C, et al. Establishment and characterization of the Masquelet induced membrane technique in a rat femur critical-sized defect model. J Tissue Eng Regen Med, 2016, 10(10): E382-E396.

Chinese Journal of Reparative and Reconstructive Surgery

Application of homemade antibiotic bone cement rod in tibial screw canal osteomyelitis

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