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Abstract：
BACKGROUND: Adequate debridement of necrotic bone is of paramount importance for eradication of infection in chronic osteomyelitis. Currently, no tools are available to detect the exact amount of necrotic bone in order to optimize surgical resection. The aim of the present study was to evaluate the feasibility of an intraoperative illumination method (VELscope®) and the correlation between intraoperative and pathohistological findings in surgically treated chronic fracture related infection patients.
METHODS: Ten consecutive patients with chronic fracture related infections of the lower extremity were included into this prospectively performed case series. All patients had to be treated surgically for fracture related infections requiring bony debridement. An intraoperative illumination method (VELscope®) was used to intraoperatively differentiate between viable and necrotic bone. Tissue samples from the identified viable and necrotic bone areas were histopathologically examined and compared to intraoperative findings.
RESULTS: In all included patients, the intraoperative illumination was deemed helpful to differentiate between necrotic and viable bone tissues during bony debridement. The histopathological examination of the samples showed good correlation of the intraoperative illumination findings with histopathological signs of necrosis for areas deemed dead and histopathological signs of intact bone for areas deemed vital during illumination.
CONCLUSIONS: The fluorescence-assisted, intraoperative detection of necrotic and viable bone using the VELscope® is an easy-to-use procedure that can help surgeons to optimize intraoperative bone resection in chronic fracture related infections by unmasking viable from necrotic bone tissue. This may help to improve resection techniques and eventually treatment outcome in patients in the future.
METHODS: Ten consecutive patients with chronic fracture related infections of the lower extremity were included into this prospectively performed case series. All patients had to be treated surgically for fracture related infections requiring bony debridement. An intraoperative illumination method (VELscope®) was used to intraoperatively differentiate between viable and necrotic bone. Tissue samples from the identified viable and necrotic bone areas were histopathologically examined and compared to intraoperative findings.
RESULTS: In all included patients, the intraoperative illumination was deemed helpful to differentiate between necrotic and viable bone tissues during bony debridement. The histopathological examination of the samples showed good correlation of the intraoperative illumination findings with histopathological signs of necrosis for areas deemed dead and histopathological signs of intact bone for areas deemed vital during illumination.
CONCLUSIONS: The fluorescence-assisted, intraoperative detection of necrotic and viable bone using the VELscope® is an easy-to-use procedure that can help surgeons to optimize intraoperative bone resection in chronic fracture related infections by unmasking viable from necrotic bone tissue. This may help to improve resection techniques and eventually treatment outcome in patients in the future.
摘要：
背景：坏死骨的充分清创对于根除慢性骨髓炎感染至关重要。目前,没有工具可用于检测坏死骨的确切数量，以优化手术切除。本研究的目的是评估术中照明方法（VELscope®）的可行性以及手术治疗的慢性骨折相关感染患者的术中和病理组织学发现之间的相关性。
方法：将10例连续的下肢慢性骨折相关感染患者纳入本前瞻性病例系列。所有患者都必须通过手术治疗骨折相关感染，需要进行骨清创。术中照明方法（VELscope®）用于在术中区分活骨和坏死骨。对来自所鉴定的活骨和坏死骨区域的组织样品进行组织病理学检查并与术中发现进行比较。
结果：在所有纳入患者中，术中照明被认为有助于在骨清创过程中区分坏死和存活的骨组织。样品的组织病理学检查显示术中照明发现与被认为死亡的区域的坏死的组织病理学征象和在照明期间被认为重要的区域的完整骨的组织病理学征象之间的良好相关性。
结论：荧光辅助，术中使用VELscope®检测坏死和有活力的骨是一种易于使用的方法,可以帮助外科医生在慢性骨折相关感染中通过揭开坏死骨组织的存活,从而优化术中骨切除.这可能有助于改善未来患者的切除技术和最终治疗结果。
方法：将10例连续的下肢慢性骨折相关感染患者纳入本前瞻性病例系列。所有患者都必须通过手术治疗骨折相关感染，需要进行骨清创。术中照明方法（VELscope®）用于在术中区分活骨和坏死骨。对来自所鉴定的活骨和坏死骨区域的组织样品进行组织病理学检查并与术中发现进行比较。
结果：在所有纳入患者中，术中照明被认为有助于在骨清创过程中区分坏死和存活的骨组织。样品的组织病理学检查显示术中照明发现与被认为死亡的区域的坏死的组织病理学征象和在照明期间被认为重要的区域的完整骨的组织病理学征象之间的良好相关性。
结论：荧光辅助，术中使用VELscope®检测坏死和有活力的骨是一种易于使用的方法,可以帮助外科医生在慢性骨折相关感染中通过揭开坏死骨组织的存活,从而优化术中骨切除.这可能有助于改善未来患者的切除技术和最终治疗结果。
